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| June 15, 2006 | Thursday | Jumadi-ul-Awwal 18, 1427 |
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Regulating private health care
Power blues in Karachi
A tale of two polls
Bush’s visit to Iraq
THE gloom that has been hanging over the nation for the past five years is showing some signs of being dispelled. Amid the debate about the legal niceties of providing the current military regime with an opportunity to continue in office for another extended period, it is good to see that some changes in the direction of national life are beginning to capture the national consciousness.
THE Shanghai Cooperation Organisation, as the Shanghai Six is formally termed, is holding its fifth summit on June 15. This will be more than a routine get together for its members, Russia, China, Kazakhstan, Tajikistan, Kyrghyzstan and Uzbekistan. It reaffirms the success of these members in joining hands to form a regional grouping that has already begun to make an impact on global politics. Moreover, the SCO has begun to expand not just its activities but also its membership - Pakistan, Iran, India and Mongolia enjoy observer status while a contact group liaises with Afghanistan. This has brought more than half the world’s population under the SCO’s umbrella. Established in June 2001 as a “regional anti-terrorism entity”, the SCO has swiftly forged ahead and has moved from its political goals to playing a significant economic, cultural and commercial role.
What has made the SCO so significant at a time when regional groupings are the norm and more or less every area has one. The SCO counts more than the others because it carries weight —two major powers are its members (Russia and China) and a third is an observer (India) — and it has begun to directly challenge the United States politically and economically. Thus, the SCO has an effective mechanism for fighting terrorism in Central Asia and this appears to have paid dividends in that some members such as Uzbekistan have been able to ward off the challenge from the extremists. With greater cooperation among the members it has been possible to fend off the terrorists while keeping an expansionist America at bay. In the last summit in 2005 the SCO demanded a deadline from the Americans for the withdrawal of their troops from the region. Although the US presence continues with the acquiescence of the smaller Central Asian states, the SCO can collectively project itself as a countervailing force to the United States. Joint military exercises are due next year, which will demonstrate the will of the Shanghai Six not to bend before the Americans politically or militarily.
In the coming months the SCO’s weight will count in the on-going energy diplomacy that seeks to tie up the region in a network of oil and gas pipelines. An oil pipeline linking China with Kazakhstan has been completed. In the south, Iran and Pakistan are planning a gas pipeline which might be extended to India as well. Afghanistan will be linked with Pakistan to supply gas from Turkmenistan. That explains the SCO’s interest in forging links with Iran, Pakistan, India and Afghanistan. So far Russia and China have managed to stall America’s attempts to impose sanctions on Iran, compelling Washington to offer a dialogue with Tehran if Iran gives up uranium enrichment. A renewed US effort on Tuesday to punish Iran failed to get through at the IAEA in Vienna in the face of opposition from Russia and China. It is unlikely that Moscow and Beijing would close ranks with the other officially recognised nuclear powers to bring pressure on Iran, with whom they have entered into multi-million dollar agreements on oil exploration. This would also explain Pakistan’s keenness to be accepted as a full member of SCO. Recognising the key position of oil and gas in regional diplomacy, President Musharraf has offered an “energy corridor” to China linking it with Central Asia and the Middle East. If Pakistan obtains membership of the SCO, the pressure it faces from the US is likely to ease.
THE health authorities in Sindh are once again talking about enacting a law to regulate private health facilities in the province. A draft ordinance has been prepared for the establishment of the Sindh Private Hospitals and Clinics Regulatory Authority. On promulgation of the ordinance, all private health centres will have to register themselves with the authority which will regulate and monitor the institutions, and take action against errant units that are found guilty of violating the rules. When the authority starts functioning, it will be a welcome departure from the past when private health facilities operated freely without any kind of checks or restrictions. This resulted in medical malpractices and a high fee structure, leaving many people with no option but to turn to quacks, with the services offered by public sector hospitals proving to be grossly inadequate and deficient in quality. The draft ordinance proposes to do away with such irregularities and will empower the authority to bring down the fee charged at hospitals and clinics to acceptable levels.
All this sounds too good to be true, but, if translated into reality, it should have a positive impact on the health sector. But does the government have the political will to see the ordinance through and to implement its provisions once it is promulgated? After all, this is not the first time that it has talked about regulating the private health sector. Moreover, when even in the public health sector there is resistance by doctors to certain rules, how successful will its attempts be to regulate private institutions, many of which have become commercial ventures and will defy any rule that is not perceived to be in their interest? This makes it all the more important for the health authorities to have a well-planned strategy in place that would not evoke any resistance from private institutions, while ensuring that as many patients as possible benefit from their services. Outside the framework of the proposed ordinance, too, the provincial authorities must improve government hospitals as this would impel private medical centres to improve their services and to bring down their charges to more affordable levels.
IT IS frustrating that despite repeated public protests over several weeks of frequent power failures affecting Karachi, there seems to be no respite in sight. This is frustrating as last week’s move to close market places by 8pm was meant to ease the situation by substantially reducing the load on the power system. Although it was a small step considering the extent of power shortage in Karachi, one had still hoped that there would be some immediate benefit to show for it. Instead, riots broke out in Liaquatabad on Tuesday as angry residents took to the streets to protest against frequent power failures. Such is the frustration of consumers whose lives have been made miserable by repeated power outages. It is also understood that the new management of the KESC has inherited a host of problems from its predecessors in terms of sizable line losses, neglect of repair and replacement of vital equipment and installations, leaking distribution lines and so on. All this will naturally take time to put right.
Meanwhile, one step the new power system management must take is to launch a campaign in the media, telling the public about the importance of austerity in the use of electricity at home and in workplaces. The purpose should be to secure the cooperation of the people in reducing the impact of the present power crisis. Until the people are made to realise that they too have an important role to play in conserving energy — by reducing the use of lights, fans and airconditoners, for example — the crisis is likely to even worsen. Such a campaign will not, however, detract the power system management from doing its best to remove problems and deficiencies at the root of the present power crisis.
The dominant national discourse remains focused on elections. With the government’s intention of holding elections in 2007 and the acceptance of this challenge, in the form of a charter of democracy, by the opposition, the final battle lines seem to have been drawn. But before the games begin, a level playing field has to be prepared and a neutral umpire needs to be chosen. The advantage of incumbency, particularly when it is reinforced with the donning of the uniform of the most powerful institution in the country, needs to be offset by assigning the administrative responsibility of holding the elections to an independent, neutral and consensual body.
Merely the appointment of an election commissioner and an interim caretaker government will not ensure the political atmosphere necessary for holding free and fair polls.
In this context, the election of the president by the existing electoral college would be patently mala fide, even if it can be held legally tenable by some convoluted interpretation of the Constitution, which has been deliberately disfigured by the present regime for the sole purpose of extending its tenure. In fact, what would be necessary under the circumstances is the appointment of a caretaker president rather than a caretaker cabinet to run the government before the election.
The current president can run for the presidency, after elections to the federal and provincial legislatures have taken place. Given that the president and his political supporters have often claimed a popularity rating of over 90 per cent, his election as president should presumably be a cakewalk. The small matter of his wearing or discarding his uniform, as well as the legal bar on contesting a public office before two years have lapsed, should be overcome by the overwhelming mandate he expects to receive.
The current regime has shown no inclination to create conditions for a peaceful transition to a democratic polity and seems bent to perpetuate its rule, without caring for the rules of fair play. It seems to be in a strident mood and solely focused on reinstalling itself after the end of its artificially-derived tenure, unconcerned about the larger consequences for the nation’s polity, economy and integrity.
Although it is under pressure from the US and other western countries to give the electoral process a semblance of fairness, it is unlikely that it will ever agree to make more than cosmetic concessions on this score or refrain from manipulating the administrative machinery and state power in favour of its candidates. If the government remains as negative and intransigent as it has been so far about entering into a meaningful dialogue with the opposition parties and making significant concessions, it risks facing a mass uprising such as the one that occurred in Nepal recently.
Indeed, the government’s reluctance to accept these pre-conditions negate its tall claims about its legitimacy, popularity and the economic prosperity which is visible only in the contrived statistics in official documents that are unabashedly pedalled by its spokesmen.
The basis for a less spectacular but more effective solution can be found in the Bangladesh example. When military dictator General Hussain Mohammad Ershad was forced to resign in 1990, following massive protests, state power was handed over to a respected Supreme Court judge, Shahabuddin Ahmed, who headed a caretaker government with the help of technocrats and civil society representatives, with a view to creating conducive conditions for holding elections and for establishing benchmarks for the country’s political and economic governance.
This solution can only come about if the military junta realises, as our former ambassador to the US, General Jehangir Karamat, does, that it would be in the military’s as well as the country’s best interest to stage a retreat from the political arena. While it is idle to speculate on debates within the military, if any, on the subject, it is unlikely that it would be prepared to easily wean itself away from the perks, privilege and power which an extended period of supremacy over civilian governments has bestowed on it.
While there is considerable uncertainty about the timing and the modalities of the next national elections, it is strange that next month’s elections in Azad Kashmir are hardly a subject of debate, although there really seems to be no justification for holding them, while the major problem of the state — the rehabilitation of refugees and the reconstruction of houses — remains largely unattended to. Elections are no substitute for a concerted, people-centred effort for rehabilitation of displaced persons and reconstruction in the devastated land.
There is no guarantee that in the current disturbed conditions of Kashmir, free and fair elections would ensure the participation of the earthquake-affected people who are openly showing their disgust at the prospect while dead bodies continue to be retrieved from the rubble. It is like inviting a bereaved family to a grand feast. The government abruptly ended its relief programme at the end of March in order to force the internally displaced population to return to their home to cast their votes.
If the government was really keen to ensure the participation of the earthquake-affected people in the reconstruction of their homes and rebuilding of their societies, it would have adopted a more grassroots approach. The one at present is very bureaucratised and centred on the influential sections of the population. The latter seem to have benefited most from the government’s ill-conceived compensation schemes. Much of the funding received from generous donors at home and abroad is being deployed for non-earthquake reconstruction activities and the army is being paid for services which should be a normal part of its duties.
The only rationale for the Azad Kashmir elections seems to be to provide the regime some dubious political advantage in its ongoing negotiations with India over Kashmir. By holding these elections, which are overseen by the GHQ in Rawalpindi, the regime is not doing much better than India during elections in the part of Kashmir it controls. The international support for Pakistan on Kashmir is also evaporating in the wake of the war against terror and India’s recent strategic compact with the United States. Even China is less unequivocal in its support on the issue, in view of regional political realities.
The best way to solve the Kashmir issue is to broaden the scope of our relationship with India on the basis of a long-term friendship treaty. As far as the future of the people of Kashmir is concerned it would depend on the way the two countries develop their respective parts in the next decade or so. In the last six decades, Pakistan has done little to develop its part of Kashmir, which is evidenced by the high rate of migration from these areas. The earthquake reconstruction effort, if imaginatively conceived and executed, can provide the basis for building a fair, equitable and prosperous society.
Elections in Kashmir will hardly help in realising this opportunity and will be tantamount to wasting valuable human and financial resources. It would be much better to postpone these elections for a year during which all efforts should be centred on reconstruction efforts, involving a bottom-up approach.
sm_naseem@hotmail.comss
PRESIDENT Bush delivered an important demonstration of American support for Iraq’s new democratic government in his visit to Baghdad on Tuesday. Prime Minister Nouri al-Maliki represents the best and maybe last hope that a national government can stem sectarian bloodshed, defeat Islamic terrorist organizations and die-hard defenders of Saddam Hussein, and make economic recovery possible.
He has formed a unity cabinet, appointed a well-qualified defence minister and spelled out the right agenda, including an imminent campaign to pacify Baghdad with tens of thousands of Iraq’s newly trained troops. But Mr Maliki desperately needs international help to turn the tide of violence and chaos. Mr Bush’s appearance, and his assurance that America “will keep its word,” should reassure Iraqis who have feared that the United States would precipitously withdraw rather than defend the country’s first truly democratic government.
US support, of course, cannot be unqualified, and it certainly cannot ensure success: Mr Bush rightly told Mr Maliki that “the future of your country is in your hands.” The president spoke of the decisions the Iraqi cabinet must make, which include how to neutralise the militias maintained by several of the coalition’s parties and whether and how to revise the constitution so as to share oil revenue fairly and prevent Iraq’s breakup into sectarian ministates. If those decisions are wrong, or don’t get made in the coming months, there will be little the Bush administration can do to rescue the country or the US mission.
But what Mr Bush can do is give the government some precious time by continuing to provide American troops and aid to it.
—The Washington Post