| December 29, 2003 | Monday | Ziqa’ad 5, 1424 |
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NIC extension
Issues of governance
THE director of the Jinnah Post-Graduate Medical Centre in Karachi stated the other day that the federal government had given a special grant of Rs40 million to the hospital to enable it to upgrade its facilities and services. This is a positive step, especially if it is indicative of the government’s new-found emphasis on public health care, which has been one of the most neglected sectors in Pakistan. One hopes that the JPMC will be able to make good use of the funds it has received and the improvement which is effected will show in what the hospital has to offer. One also hopes that this will prompt the federal and provincial governments to take a hard look at their health policies which badly need to be spruced up if the health status of the people is to be upgraded and brought to the same level as in many other Third World countries. According to the government’s own admission, we lag behind other South and Southeast Asian countries in the health-related key indicators. Thus, our infant mortality rate (83.3 per 1,000) and mortality rate of children under-5 (110 per 1,000) are woefully higher than our neighbours’.
This is not surprising when one notes the state of public hospitals, the shortage of health facilities, the high cost of medicines and diagnostic technologies, and the inaccessibility of the mushrooming high-cost private hospitals for a large segment of the population. The fact is that the government has gradually disengaged itself from the health sector. It has not stepped up its financial allocations to this area of national life as is warranted by the growing population, increasing poverty and lack of basic civic amenities which affect people’s health and lead to diseases. The health budget in Pakistan has declined from 0.8 per cent of GNP in 1995-96 to 0.7 per cent today. In absolute terms, the amount has grown but the increase is nominal. The financial stringency has affected the government’s facilities in several ways. First of all, the emphasis on primary health care and preventive medicine which is essential to keep the people healthy has been declining. As a result, the incidence of disease remains pretty high, if it is not actually on the rise, and this only adds to the burden of hospitals which find it difficult to cope with the massive increase in patients.
There is also the shocking state of public sector hospitals, which have been left to decay because they are not given enough funds. Some institutions have tried to maintain their standards by mobilizing donations from philanthropists. Others have raised their users’ charges to balance their budget. Yet others have resorted to other means to keep going but it has not been easy for government hospitals to remain functional as well as efficient. If the government does not wish to abandon this sector altogether, it will have to first of all increase its health spending and secondly draw up a strategy to make health care accessible to all people. But any strategy to be successfully implemented will require funding. Hence for a few years at least the government should be prepared to heavily subsidize the health sector, whatever the aid giving agencies might have to say.
THE announcement by the interior minister on Friday that old identity cards will be valid for another month, till January 31, 2004, should provide welcome respite for the millions of Pakistanis who have yet to obtain the new computerized ID cards. However, the extension is unlikely to reduce the massive rush that has been seen in recent weeks at the National Database and Registration Authority’s (Nadra) registration centres. Several issues need to be looked into by the authority to make life easier for those who apply for the new cards. For a start, it should be publicized clearly that the cut-off date applies only to the old ID cards. Many people, even in the cities, seem to be under the impression that they will not be able to apply for the new computerized cards after the cut-off date.
The crowding at the centres means that long delays are inevitable. One view of this is that Nadra simply does not have the resources to deal with the gigantic task at hand and should either establish more centres or increase the human and technical resources currently available at the existing registration centres. The other view takes into the account the fact that many people, human as they are, tend to leave matters to the last minute. Realizing that the time is now approaching where they will not be able to open a bank account or obtain a phone or utility connection unless they have a new card, they are now descending on the registration centres in the thousands — hence the long delays. Given the nature of the exercise and the huge number of applicants, some mistakes are to be expected. In fact, for the 30 million or so cards issued so far, there have been, according to Nadra’s own figures, around 400,000 with mistakes which means a significant number of dissatisfied applicants. What the authority can do is to make life easier for those who have to go back to the centres to rectify the mistakes. This can be done by routing them on a track that is separate from that for first-time applicants.
IT comes as no surprise that a survey conducted by the National Reconstruction Bureau in collaboration with another organization reveals that an overwhelming majority of Pakistanis is not satisfied with the state of public services provided by the government. The baseline survey covered a representative sample of 57,000 households in all the 97 districts of the country. The survey results, which were released on Wednesday, show that most of the respondents expressed their dissatisfaction over the provision of such essentials as health services, primary education, water supply, transportation, garbage disposal and sewage services, and power supply as well as over delays in the dispensation of justice. The reason for holding such a survey, say its organizers, is to provide policy makers with feedback and information on the ground realities as they exist in the country.
The survey can be a good starting point for the government in its efforts to improve the standard of public services and the quality of governance available to the common man. It goes without saying that such an exercise should not be restricted to the larger cities. It should take into account the quality of services being provided in towns as well as in rural areas, as these are usually ignored in favour of the big cities and provincial capitals in the country. The provision of efficient public services is the basic responsibility of the government. However, it has been suggested in some quarters that such services should be privatized so that those who can afford to pay are able to have access to better facilities. This approach is a cold-blooded one that leaves out millions of underprivileged people from the social services net. The government should not shy away from what is essentially its responsibility. The improvement of these public services must be done as part of a larger plan in a time frame that is realistic and acceptable. It will be possible to achieve these goals only if the government checks inefficiency, bureaucratic delays as well as corruption in the system. These are some of the factors that have hindered access to improved public services in the past. But, basically, the government has to make up its mind as to where its priorities lie — with those in real need or with those who are already in a position to pay for what they want.