| 05 December 2004 | Sunday | 22 Shawwal 1425 |
Change through elections
How Africa subsidizes US health care
Rise of Rice
Our commentators have often observed that America is fickle as a friend. It has taken Pakistan as an ally to serve its objectives in our region and then abandoned it when these were either achieved or given up. Its interest in Pakistan declined in the 1970s as the cold war thawed, revived when it needed Pakistan's assistance with the Afghan drive to roll back the Soviet occupation of their country, slumped again after the Soviet withdrawal, and took an even deeper plunge as the cold war ended and the Soviet Union disintegrated.
The alliance resurfaced after the events of 9/11 as America needed Pakistan's help with its invasion of the Taliban regime and its Al Qaeda allies in Afghanistan. There is concern that Pakistan's current alliance with America will also prove to be transient.
Before we go further, certain notions about Pakistan's position should be examined. Mr Shaukat Aziz spoke the other day (November 29) of its "unique" strategic situation in that it is the "gateway" to South Asia, Central Asia, and the Middle East. This is an exaggeration. All of the countries in these regions can be reached from places other than Pakistan. Only Indian persons and goods destined for Afghanistan by land must pass through its territory. It is strategically important only to those outside powers who want to use land forces to invade Afghanistan.
The prospect of a long-term cooperative relationship between the United States and Pakistan is evidently contingent upon an identity of vital interests between them. Let us then see what America's objectives in our region are. During the years of its heightened concern with communist expansionism, its primary objective was to recruit partners in its campaign of containing the Soviet Union.
Pakistan enlisted and was adopted in spite of the fact that it perceived no communist threat to its integrity either from within or from any of the communist powers. Yet, the alliance continued until Pakistan went to war with India in 1965 without America's prior consent, and thus shattered the illusion of mutuality of interests.
Pakistan lamented the Soviet occupation of Afghanistan. But, left to itself, it could not, and would not, have done anything significant to help the emerging Afghan resistance. When the United States asked Pakistan to serve as a disbursing agent for its aid to the insurgents, the latter made it clear that it would do so only in return for appropriate compensation.
It may then be said that while some mutuality of interests did exist, the American-Pakistani relationship at this time resembled that between an entrepreneur and a building contractor (who happened to like the structure to be built).
What are the current American objectives? The foremost of these is the eradication of terrorism. This is an objective that the government of Pakistan shares. The American war on terror is directed against the Al Qaeda and Taliban whose members have not only been harassing the "coalition" forces in Afghanistan, they are also bombing people and installations, assassinating important public figures, and spreading chaos in Pakistan. There is thus a mutuality of interests in the campaign against terrorism.
The United States has an interest in the maintenance of peace in South Asia. It deplored the wars of 1965 and 1971 between Pakistan and India, but note that these wars did not hurt any of its own vital interests. The current situation is radically different in that both Pakistan and India have stockpiles of nuclear weapons and their resort to them in case of another war cannot be excluded.
That being the case, the United States, perhaps the whole world, has an interest in the continuation of peace between these nations. There can be no doubt that Pakistan, on its part, also wants peace. Here then is another case of an important shared interest.
From the American standpoint, it would be nice if amity came with peace between the two South Asian neighbours. Each of them also wants amity, but on its own terms. Pakistan says it will not come, and even durable peace is not assured, unless the Kashmir dispute is settled to its satisfaction. The United States can live with the absence of amity between India and Pakistan, and it is even less concerned with the terms on which it is attained. It would welcome an end to the Kashmir dispute, but it is neutral as to the ways and means (other than war) of settling it.
Nuclear non-proliferation is a high priority object of American policy. It has never approved of Pakistan's acquisition of nuclear weapons and the requisite delivery systems. It instituted wide-ranging sanctions against Pakistan when it tested its nuclear "devices" in May 1998. At this point in time, while Pakistan's assistance is urgently needed, the United States is willing to overlook Pakistan's nuclear arsenal.
Ideally, it would like to see Pakistan roll back or freeze its nuclear programme. Pakistan, on the other hand, is immensely gratified with its new status as a nuclear power. There is thus no mutuality of interests between the two countries in this critical area of policy. The potential discord is compounded by the fact that the United States does not object to India's nuclear weapons and missiles quite as much.
The United States would like to see democratic institutions take root and function effectively in Pakistan. It imposed additional sanctions against Pakistan following General Musharraf's coup in October 1999. But this is a peripheral interest, and it comes into play only when Pakistan's assistance with an important American undertaking is not needed.
Since 9/11 both nuclear-related and democracy-related sanctions have been lifted. At the present time, President Bush is not losing any sleep over General Musharraf's undue enhancement of his own powers at the expense of the parliament, the prime minister, and his cabinet, or over his retention of an army post at the same time that he is president.
The United States wants Pakistan to become economically developed, politically stable, internally coherent and united, peaceful and orderly. It would like to see the Pakistani people become educated, enlightened, moderate, tolerant of diversity, and have access to the amenities of life. From time to time, as is currently the case, the United States has aided Pakistan's endeavours in all of these areas.
But its progress towards these goals is not a major American interest. It is probably no greater than its interest in any number of other developing countries. America's aid stops when Pakistan's policies and pursuits become irrelevant, or run counter, to its own important goals and preferences.
It may be fair to say in conclusion that official American relations with Pakistan are likely to be close and cordial when America needs the latter's assistance in a big way. During such times, the vagaries of Pakistan's domestic policy and the measures it takes to safeguard its security are not allowed to stand in the way of their cooperation.
Otherwise, America is likely to be indifferent or even disapproving of Pakistan's domestic politics and its security policy. These shifts of attitude should be apparent from the sanctions it has periodically imposed on Pakistan.
America's war on terror, its engagement in Afghanistan, and its need for Pakistan's cooperation will continue for the foreseeable future. Relations between them are, therefore, likely to remain satisfactory during President Bush's second term and possibly even beyond 2008. But it should be noted also that there is no "natural" or enduring basis for their closeness. Normally, America feels closer to India than to Pakistan.
In this connection, one may recall President Bill Clinton's five-day visit to India in March 2000 during which he spoke of a "natural partnership of shared endeavours" and a "natural alliance" between the United States and India. Recall also, for contrast, his stopover of a few hours in Pakistan, on his way back home, which he utilized to scold the Pakistani people in a sermon broadcast by the Pakistan television.
The observations above relate to the interaction between the two governments. A word should also be said about perceptions and attitudes of the people. It is safe to say that the vast majority of the American people are indifferent towards Pakistan, and many of them may not have even heard of it. There is greater awareness of its existence and affairs among American politicians, academics, journalists, other professionals, and corporate executives. Awareness is not necessarily accompanied by benevolent attitudes.
Some of those who do pay attention to Pakistani affairs have an adverse view of the rationale of the country's founding, the role of religion and that of the military in its politics, its treatment of the minorities, its rivalry with India, and the prevalent levels of corruption and incompetence in the management of its affairs, among other things. During the years preceding 9/11, many American commentators had begun to refer to Pakistan as a "failed" or "failing" state.
In Pakistan, the admiration, or envy, of America's wealth, accomplishments in the advancement of knowledge, technology, and military capability were always tempered with disapproval of its arrogance of power, its self-appointed role as the guardian and enforcer of a "world order," and denunciation of certain aspects of its culture.
Since 9/11 Pakistani attitudes and perceptions have become much harsher. All classes of Pakistanis - from the taxi driver to the esoteric philosopher, from the secular-minded to the religiously devout, housewives, shopkeepers, bankers, civil and military bureaucrats, professionals of all kinds - regard not only some of the key persons in the present American government but many of the American elite groups across the board as intensely anti-Islam and anti-Muslim. An American expert in foreign affairs, testifying before a US Senate committee, recently characterized Pakistan as the most anti-American country in the world.
Given these popular perceptions and attitudes on both sides, cooperation between their two governments cannot be but expediential and transitory. It should be understood also that while nations can be allies to defend or advance their common interests, they do not become "friends."
The writer is professor emeritus of political science at the University of Massachusetts at Amherst, USA. E-mail: anwarsyed@cox. net
Change through elections
The MMA religious alliance launched its protest movement last Sunday. Another alliance, chiefly of the PPP and Muslim League, is poised to launch its own next Tuesday. The purpose of both alliances is hazy, and what is even hazier is how they will achieve their agenda through street power.
The MMA made it possible for General Pervez Musharraf, to become the president of Pakistan for five years through a constitutional writ. Now they propose to lay siege to Islamabad for his retracting from an oral promise.
The parties in the other alliance have thought of shifting their confrontation with the government from parliament to the streets only after Musharraf was seen to loosen his iron grip and seek rapprochement. Both alliances seem to have determined, at the same time but separately, that the moment had arrived for them to achieve their respective objectives by exerting pressure, or by using force, rather than through collaboration - as the MMA did in the past - or cooperation - as Benazir Bhutto has been hinting.
The objectives of the two alliances, as far as it can be made out from their public statements, differ widely. The religious parties want the president to relinquish his army command, or take off his uniform as they prefer to say, and continue merrily as so will they and their government in the NWFP, up to the year 2007. The PPP and its allies, on the other hand, want elections within four months - with Asif Zardari stretching the deadline to one year.
With objectives seen not only to be different but also to clash the government has been given ample room to strike a deal or sow the seeds of discord. Both alliances are equally vulnerable. The PPP and Muslim League both have elements in the government or those who get along with it. If there is confrontation, it is more likely that more of their supporters will cross over than defectors return to the party fold.
The ministerial bait will be there always for freewheeling members to bite. The Sindh chief minister has already announced his intention to expand the cabinet though some ministers and advisers even in the present lot of 30 have no portfolio or work.
The religious alliance has split once already (Maulana Samiul Haq walked out) and should be ready to brave a similar incident if it keeps to its current hard line stance. The JUI, which is the senior partner in the alliance, has its government in the NWFP to protect. Its chief, Maulana Fazlur Rahman, is also the leader of the opposition in the National Assembly. The stakes of the JUI in retaining the status quo or opting for conciliation, thus, are high. The hard-liner Jamaat-e-Islami has none and may even gain ground in a showdown with the government.
The parties joining hands to force the president to take off his uniform or to hold early elections themselves stand in danger of being factionalized further. If the MMA's inaugural rally in Karachi is an indication to go by, they would. Even if it was not a damp squib of 10,000 as reported to the Sindh chief minister but a 100,000 as claimed by the sponsors the crowd lacked not just in numbers but in fervour which can be sensed when a revolt is in the making. If Musharraf is there, it does not seem to matter to the people whether he is a serving or a retired general. Compelling him to doff his uniform may give a sense of achievement to the clerics and other political activists but not to the people at large.
In this atmosphere of divisive and self-centred politics, Asif Zardari has taken it upon himself to bring all parties on one platform. How would he do it and what for he has not explained. The popular acclaim for his steadfastness during his long prison years notwithstanding, the task is beyond him. All parties have their own agendas. Over the past five years they have not been able to agree even on the lowest common denominator for collective opposition to the government.
To the contrary, the middle-of-the-road elements, to whatever party they might belong, have always viewed the MMA as a Trojan horse in their midst. Their apprehension would remain that one day it might strike a deal on the "uniform" issue, as it did on the LFO, and thus rescue the government from the pressure of holding early elections which to them is the real issue.
Asif Zardari would do well to use his time and new-found stature to put his own party together. If the founders of the past and defectors of the present can be persuaded to return to its fold, the PPP can once again become a formidable force in politics. The founding fathers of the party like Mustafa Khar and Mubashir Hasan, Mumtaz Bhutto and Mustafa Jatoi and Hafiz Pirzada and Mairaj Mohammad Khan still owe allegiance to the party.
They, and many others, left because they were either neglected or persecuted. The latter-day defectors who left in search of power would return to it once the party itself is in sight of power. This is a fact of politics. All parties everywhere have a mix of loyalists and opportunists which keeps changing with the times.
The point worth making is that the old parties of like-minded people and common outlook on life should come together again and organize themselves to contest the next elections. Parties inherently antagonistic to each other but forging temporary alliances can neither topple a government, howsoever unrepresentative of public opinion it might be nor can it stay united to win the elections and govern.
Under the current circumstances, it looks well-nigh impossible for any one party or even a combination of any number of parties to overthrow the government by force. The people, too, are indifferent and wary of violent change. In the present dispensation, if not democracy at least the economy is on the right track. To arouse the common man's interest in their campaign the speakers at the MMA meeting had to appeal to religious sentiments, and the organizers of the PPP convention had to promise plots and jobs for all.
Even if by combining forces and holding out hopes a mass agitation can be built up, the point to ponder is whether the outcome this time round would be any different what it was in 1969 when Ayub Khan was driven out of office, or the wheel-jam of 1977 which sent Zulfikar Ali Bhutto to prison and later to the gallows, and foisted General Ziaul Haq on the country for 11 years, or the series of sordid events which enabled Musharraf to seize power five years ago.
It is most unlikely. On all these occasions the politicians lost the battle on the streets and the argument in the courts; extra-constitutional intervention was held to be justified in terms of state necessity and revolutionary legality, and the military rulers were empowered to make laws and amend the Constitution; the liberal and democratic forces retreated and parochial parties came to the fore.
The best hope for the people lies in early and fair elections and in just actions by the elected government. Both elements have eluded them so far. Hopefully our chief election commissioner, now in India, will return convinced that it is possible to hold fair and free elections here too, and political leaders returning from exile also convinced that democracy means the rule of law and not of a person even though elected.
How Africa subsidizes US health care
Last Wednesday was World AIDS Day: It was marked by concerts and candlelit vigils from Armenia to Zambia. The speeches and statistics had a horrific familiarity: Two decades after the first diagnoses, AIDS shows no signs of letting up. And yet the debate about AIDS is changing subtly.
In Africa, the epicentre of the crisis, the shortage of cash and affordable medicines is no longer the prime issue. Attention is turning to the shortage of health workers, and hence to a dark aspect of globalization.
It isn't a surprise that Africa is short of doctors and nurses: The continent has 1.4 health workers per 1,000 people, compared with 9.9 per 1,000 in North America. What's shocking is that this shortage is partly created by rich countries. Poor nations such as Malawi and Zambia are paying to train medics who emigrate to staff the hospitals of the United States and Europe. We should be helping Africa. Instead, Africa is subsidizing us.
Not just slightly, either. Ghana trains 150 doctors annually; five years after graduation, 80 percent have left, according to Ghanaian data reported by the World Bank. For pharmacists, the proportion is about 40 percent; for nurses and midwives, it's about 75 percent - which is why half the nursing posts in Ghana are vacant. Meanwhile, South African doctors emigrate at a rate of about 1,000 annually. In 2001, Zimbabwe graduated 737 nurses; 437 left for one country, Britain.
Medical migration is not a new phenomenon. Sabina Alkire and Lincoln Chen of Harvard cite the (non-African) example of the Philippines: In 1970 more Filipino nurses were registered in the United States and Canada than in their home country. But the migration is accelerating. In 2001, the number of emigrating Filipino nurses was three times higher than in 1996. Likewise, the number of non-European Union nurses and midwives in Britain has jumped more than tenfold in a decade.
This isn't a scandal; it's more complex than that. Development economists have traditionally celebrated migration as a route out of poverty: If a cab driver moves from Lima, Peru, to Los Angeles, his income whizzes up even though his skills remain the same. Moreover, the immigrant cab driver may send money home to relatives; such remittances to poor countries are twice the size of official development assistance. Harvard's Dani Rodrik calculates that further liberalization of visa rules could benefit the citizens of poor countries more than liberalized access to the rich world's outrageously protected markets for farm goods.
That's the upside of the global labour market. But the downside is equally powerful, and it deserves special consideration given the evolution in our understanding of what it takes for poor countries to grow. The central finding of development economics in the past decade is that institutions matter: You need efficient, uncorrupt government departments and public services to create a foundation for private-sector growth. But how do you create competent institutions if global price signals are sucking your best people out of the country? The medical brain drain is just one example of this problem, which is the central challenge of development in a globalized world.
It's a particularly vivid one, however. After a century of the most spectacular health advances in human history, life expectancy in many poor countries is actually falling. Donors have battled this reversal by making money and medicines available: In Botswana, for example, the pharmaceutical giant Merck has teamed up with the Bill and Melinda Gates Foundation to bring overwhelming resources to bear in the battle against AIDS. But Botswana has made only gradual progress, and a main obstacle has been the shortage of competent administrators and health workers.
It's hard to weigh the issues here: the right of individuals to seek a better life by emigrating and the poverty trap that they entrench by doing so. But it's clear that, in the absence of some kind of intervention, this poverty trap may deepen. The citizens of the rich world are aging; their willingness to care for infirm relatives is waning; medical breakthroughs constantly expand the demand for medical personnel. All these factors reinforce the rich world's temptation to poach the poor world's health workers.
There is no one-shot fix for this problem, but several policies could help. Rich countries should compensate poor ones for the cost of training medics who emigrate; that money, supplemented by other aid flows, should be used to boost medical salaries in the poor world. Poaching countries should issue fewer permanent visas and more temporary ones. Temporary visas spread the opportunity to migrate more broadly, and returnees go home with experience and savings that fuel development.
And then there is another reform that applies specifically to one country. The United States must end its nutty overpayment for health care, which not only wastes billions but also sends price signals that depopulate hospitals in the poor world. Elliott Fisher of Dartmouth Medical School has demonstrated that regions of the United States with a high concentration of medics spend extra on health care without becoming healthier: This country actually has too many health workers.
Meanwhile in Africa a single nurse can be responsible for 50 patients. Because of America's dysfunctional system, the global labour market is siphoning doctors from places where they are needed into places where they accomplish nothing measurable at all.-Dawn/Washington Post Service
Rise of Rice
MS Condoleezza Rice may be the apple of President George W. Bush's eye, but her nomination as secretary of state is being met with disappointment and dismay in Europe and across Asia.
The long-anticipated resignations of the respected state secretary, Colin Powell, and his tough deputy, Richard Armitage, leaves US foreign policy in the hands of the fire-breathing vice president, Dick Cheney, and his Greater Israel allies at the Pentagon. The new national security adviser, Stephen Hadely, is a bland functionary well known for being under Cheney's thumb.
Powell, an honourable soldier and gentleman, was humiliated, ignored, and cynically used to sell the Iraq war. Tragically, he made a fool of himself before the world when his UN Philippic about Iraq's supposed arsenal of death turned out to be a total fabrication. Of course, no more a fool than the other senior members of the cabinet who rushed the US into a disastrous, totally unnecessary war that is now costing $5.8 billion a month.
Rice, an academic Soviet expert, has been the worst national security adviser since the Reagan administration's bumbling William Clark, whose only foreign affairs experience, wits said, came from eating at the International House of Pancakes.
But Rice, however shallow and waspish, and uninformed about Pakistan and South Asia, is totally loyal to Bush, a consummate yes-woman in an administration prizing subservience and the party line. She would be right at home these days in Islamabad. At least she will speak abroad with full presidential authority.
Prior to 9/11, Rice advocated cutting anti-terrorism spending and concentrating on anti-missile defence. She played a key role in misleading Americans into believing Iraq had weapons of mass destruction and that Saddam Hussein posed a dire threat to mankind. She urged Bush to invade Iraq and plunge deeper into Afghanistan. Her ludicrous claims about Iraqi "mushroom clouds" panicked Americans to war. For this alone she should have been dismissed. Instead, she has been promoted.
The most important function of national security adviser - and I can say this having myself been interviewed at the White House for a position on the National Security Council - is to coordinate all national security policy. But under Rice, the defence department, state department and the CIA were constantly at each other's throats. She allowed the president to humiliate himself over Iraq's non-existent weapons, including his comical claims about Saddam's imaginary uranium and "drones of death."
After the European powers refused to join the trumped-up Iraq war, Rice famously advised Bush to "punish France, ignore Germany, and forgive Russia." Bush followed this amateurish, vindictive bad advice, seriously damaging US-Europe relations and helping advance dictatorship in Russia.
Bush's second term foreign policy may grow even more aggressive, unilateralist, and driven by rightwing ideology and anti-Islamic religious zealotry. Powell's departure means the last shreds of civilized diplomacy could give way to populist, anti-intellectual foreign policy based on bizarre religious beliefs of Protestant cultists and Dick Cheney's dark fantasies that often owe more to "The Lord of the Rings" than "realpolitik."
Fortunately, Bush's declared intention to pursue his ideological crusading will be curtailed by the fact that he has run out of soldiers and money for new military adventures beyond bombing "axis of evil" nations like Iran or Syria. Iraq and Afghanistan have already bled the US military and treasury dry.
Educated Americans must yearn for foreign policy greats George Marshall, Dean Acheson, Paul Nitze, George Kennan, and Zbigniew Brzezinski whose brilliant strategic minds ably guided the US through the cold war.
Instead, we have Ms Condoleezza, who knows little about the outside world, but a lot about Bush, with whom she likes to belt out gospel hymns. At the Pentagon, Donald Rumsfeld, that latter-day Robert McNamara of the Vietnam War infamy, is stuck in a lost war in Iraq engineered by the pro-Israel neocons.
CIA's new chief, Porter Goss, another Bush yes-man, whose agency is in revolt, just ordered - in best Soviet tradition - all CIA officers to obey Bush's party line or else. Such bureaucratic boot-licking is how CIA got everything wrong about Iraq. It's also why Pakistan's ISI has lost its former superb reputation and sharp cutting edge.
Attorney General John Aschroft, the scourge of North America's terrified Muslims, blessedly took his leave. But further dashing hopes Bush would soften and upgrade his cabinet, Ashcroft is to be replaced by an unknown lawyer, Alberto Gonzalez. - Copyright Eric S. Margolis 2004