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| September 24, 2006 | Sunday | Sha'aban 30, 1427 |
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Rationalising drug prices
Population planning strategies
Military rule: then and now
Crying Wolfowitz
THERE is a great deal of clamour that General Musharraf should remove his uniform. He had made an ill-considered promise to do so, but realising this mistake he has sensibly gone back on it. The implication, of course, is that he should lose control over the army. Field Marshal Ayub made this mistake and Yahya Khan took over. What are Generals Tanvir and Moinuddin Haider thinking: are they hoping for another Yahya Khan?
STREET crime in Karachi has reached an unprecedented and frightening level. For that reason, the sense of insecurity among its 10 million plus citizens has never been more acute. Even a cursory look at the happenings of the last few days in the nation’s biggest city and commercial and industrial hub is enough to send shivers down the spine. On Thursday, robbers shot dead two persons, one of them a lady doctor, who attempted to resist criminals trying to rob her in Gulistan-i-Jauhar, an area that till midnight bustles with shoppers. The other one was murdered in Landhi by bandits who were after his cash as he came out of a bank. A day earlier, four women legislators of the Sindh Assembly were robbed in the Tin Hatti area, and the same day a journalist went missing. On Monday, a policeman and an alleged informer were shot dead in Malir, while the same day bandits killed two men in the Site area when they resisted the snatching of their cell phones. The real dimensions of the crime scene are apparent from two reports in Dawn. One said that criminals deprived people of 750 vehicles and 4,000 cell phones in 20 days (Sept 1-20), while the other report says there were seven robberies every hour in July and August.
Are the high-ups, moving around in bullet-proof cars and protected by armed escorts in a dozen security vans, aware of this nightmarish crime situation? Of course, they will point out that urban crime is a worldwide phenomenon. It may even be claimed that the situation in some cities — Rio de Janeiro is often mentioned — is worse than that in Karachi. But there are certain factors peculiar to the Pakistani situation. Somehow there is an impression among the people that all the security agencies, armed with the latest techniques of crime detection and the most modern gadgetry, are there — not for the protection of the people but for fighting the war on terror and against perceived anti-state elements. Every now and then, TV shots show huge caches of arms seized in Balochistan or the tribal areas, but will there ever be the satisfaction of seeing such scenes about Karachi, given the fact that arms are as freely available here as in the tribal belt and Dera Bugti? Why can’t the free flow of arms to Karachi and the sale of guns in the city be stopped? Buying a gun here is like buying a packet of cigarettes.
The security agencies ought to know all about how the powerful mafia runs the lucrative gun trade. In fact, certain localities — Sohrab Goth, for one — are known to be a haven for the gun mafia and it seems to enjoy an inexplicable immunity. This has given rise to apprehensions in some quarters that sections of the law enforcement agencies are hand in glove with criminal elements and that a successful war on crime will not be possible without an overhaul of the existing police set-up. We also hear a lot about the official claim that poverty is going down. Yet, regrettably, going by the rising rate of crime in Karachi, the claim seems hardly convincing. All this notwithstanding, the rulers should know that the first responsibility of any government is the protection of the life, liberty and property of its citizens. From this point of view, this government has hardly any achievement to claim.
A MATTER of pressing concern was highlighted in Karachi on Friday when a leading physician stressed the need to “end the human greed” that is pushing the cost of life-saving medicines beyond the reach of ordinary citizens. Dr Adibul Hasan Rizvi, the highly respected director of the Sindh Institute of Urology and Transplantation (SIUT), strongly criticised pharmaceutical companies for raising prices without “any rationale”, a practice that is adding to human misery and making disease control difficult. Many essential drugs, he said, cost at least twice as much here than in neighbouring countries. Recognising the need for urgent action, he announced that SIUT would shortly launch a campaign, involving end-users, the pharmaceutical industry, the government and the media, to address this crucial issue. Other health-care institutions would do well to follow SIUT’s lead.
The free rein currently enjoyed by pharmaceutical companies is unacceptable. It is widely known that life-saving drugs are exorbitantly priced in Pakistan not because of higher costs of production but rampant greed on the part of pharmaceutical companies. Given their failure to curb profiteering, it can be assumed that the health authorities are either indifferent or complicit in this practice. This kind of playing with human lives is not restricted to fleecing patients in their times of distress, nor are pharmaceutical firms the only party to these crimes. Inconsistent quality is also a factor of major concern, as is the sale of expired medicines by unscrupulous pharmacists. The health authorities may lack the resources to monitor retail sale in every corner of the country, but there is no reason why their drug inspectors cannot do a proper job of monitoring in cities and towns. At the very least, the health authorities should be able to ensure quality control at the factory level. In the overall context, it is important that an autonomous drug administration authority is established on the lines of the US FDA, as is currently being done in India. Physicians too are not beyond reproach. In return for gifts that can include laptops, cars and overseas trips, many doctors are all too willing to prescribe whatever the pharmaceutical companies tell them to, irrespective of whether or not the patient needs the drug in question. This unholy nexus must come to an end.
THE federal secretary of population welfare’s remarks that two new cities the size of Sargodha and Sialkot were needed to absorb the three million people being added to the population every year were hardly surprising. Pakistan has made little progress in reducing its high population growth rate which today stands at two per cent a year. Of the total population, 53 per cent is said to be of reproductive age. However, how many of these people — especially women — know about family planning is hard to tell. It is obvious that unless contained, Pakistan’s high growth rate will continue to create a host of socio-economic problems which the country simply cannot cope with. This is why it is important to devise comprehensive population planning strategies. Despite good intentions, like trying to rope in the ulema in spreading the message of family planning, the issue is still seen as a controversial one. As a result, campaigns in the media are not as forceful as they could be. Access to contraceptives also remains difficult in far-flung areas where they are needed the most.
In countries where the ulema have played a vital role in educating the people on family planning — like Indonesia — the growth rate has seen a remarkable drop. Bangladesh and Iran too have made headway in reducing their growth rate without being held back by the religious orthodoxy. It is widely accepted that Islam does not forbid family planning but a section of ulema here sees population control programmes as a western design aimed at reducing the number of Muslims in the world. Pakistan will have to engage the more enlightened leaders in preaching the virtues of having smaller families. Its awareness campaigns must focus on ways of family planning along with steps to ensure easy availability of contraceptives.
General Zia didn’t make this mistake, but his rule was nevertheless terminated when he was blown out of the sky. The then vice-chief of the army staff decided that he was not in a position to take over and we had four successive civilian governments: BB-NS-BB-NS. Those governments brought to power through elections managed by the “agencies” are now being called democratic. They were barely democratic, they were, in fact, dictatorial, corrupt and incompetent.
We are responsible for bringing military rule upon us. It started right in the beginning. The problem was a simple one: how could the “Western Wing” establishment dominate East Bengal where the majority of the population happened to reside? It could to be done through any democratic process.
After the assassination of Liaquat Ali Khan, Ghulam Mohammad was elevated to governor-general and Khwaja Nazimuddin stepped down to become prime minister. Ghulam Mohammad had got his chance to work something out with the Chief Justice of Pakistan. According to Qudratullah Shahab who worked in the governor-general’s office,the Chief Justice regularly met the governor-general. The defining step was taken with the collaboration of General Ayub Khan, the Commander-in-Chief of the Pakistan Army, and the Nazimuddin government was dismissed. The action was supported by the Chief Justice Mohammed Munir, Justice S.A. Rahman, Justice Mohammed Sharif and Justice S.A.M. Akram. Justice A.R. Cornelius dissented. It also resulted in a cooperative relationship between the executive and the Federal Court, which resulted in the Federal Court being subordinated to the executive.
The process of army rule had been initiated, although a democratic facade was maintained and the politicians were allowed to cobble together a constitution by 1956. When the clamour for elections became a little too loud, there was no choice but for the army to take over — first under General Iskander Mirza, but within three weeks the real ruler, General Ayub Khan, became president and chief martial law administrator on October 28, 1958.
The only chance we have had to get rid of army rule and become a democracy was after the military surrender in Dhaka on December 16, 1971. Z.A. Bhutto had successfully encouraged the army into a no-win situation in dealing with the East Pakistan situation. It was a high-risk gamble, but he won. It seems that after the Dhaka surrender the Pakistan army had also decided to surrender to civilian rule.
General Gul Hasan was the most vociferous supporter that the government be handed over to Bhutto. He was right. Bhutto was easily the ablest politician that Pakistan has produced to date. Besides he had won the majority of seats in parliament from West Pakistan. The general, however, did not realize that the same Zulfikar Ali Bhutto would sack him, practically at gunpoint, after three months. This was inevitable.
Despite his ability, Bhutto had a strong juvenile streak and carried far too many chips on his shoulder. As a result, he was a little too sensitive to imagined slights and always found time for ‘fixing’ people. For instance, I had been awarded the Eisenhower Fellowship for 1972. However, I was so taken in that we at last had a democratically elected prime minister that I gave up the fellowship and preferred to stay back instead of going off on a jaunt to the United States. It was one of my silly mistakes. In about six months I was out for “arrogance, irreverence and impertinence”. I didn’t particularly mind. Despise an addiction to public service it was not possible to work in this environment as one could already feel a mist of fear slowly enveloping the administrative machinery.
Mr Bhutto had begun taking the first steps towards absolute power. He brought the judiciary to the heel, changed the rules for senior government servants to make them easily dispensable. He also convinced himself that the armed forces were at his beck and call. The parliament was under his thumb. Though a combination of charm and persuasion by other means, he had managed enough support to amend the Constitution whenever it got in his way. He did it seven times and thoroughly mismanaged the economy.
My own, rather intuitive, view was that in spite of all multifarious shortcomings, Pakistani society still had the resilience to oppose absolute rule. The crisis was most likely to occur at the time of the next election. When I expressed this opinion my friends were convinced that I had lost my mind. They were sure that Mr. Bhutto would be around for the next twentyfive years. We all know what happened.
The problem that we have inherited is that every single prime minister has had the ambition to emulate Zulfikar Ali Bhutto and secure absolute power. Our Parliament is simply regarded as an adjunct to executive authority. The only hurdle in people’s perception is the role of the military. For instance, Mr Nawaz Sharif had taken all the preliminary steps to acquire absolute power. He had successfully attacked the Supreme Court and the rest of the higher judiciary had buckled under. They had never before sunk so low. His confidence further increased when he easily managed to dismiss General Jahangir Keramat. This encouraged him to make plans for seizing control of the armed services. Fortunately, lightning struck at the critical moment.
If we want democracy, certain prerequisites have to be fulfilled. The first is freedom of expression and freedom of association. This is the first government which has not stood in the way of freedom of expression or and as far as one is aware, freedom of association too unless the association is of a violent nature. The judiciary also seems to have been given the nod to appear more independent. This will probably continue. The issue which has still not been tackled is freedom of information. It is essential in good governance.
General Parvez Musharraf has made a few faux pas such as pronouncing in advance that the captain who was supposed to have raped Dr Shazia in Sui was innocent before an inquiry could be held. The most celebrated was his reaction to Mukhtaran Mai. He proudly announced on a foreign visit that he had put her on the Exit Control List so that she would not tarnish Pakistan’s image abroad. He subsequently got into a spat with a lady in the US on the same subject. The whole thing was counter-productive, and quite unnecessarily presented him as a male chauvinist..
A democratic facade had to be created to appease western opinion. The current ‘politicians’ are probably the same as they have been in the past, except that no ministerial positions probably don’t matter, and that the ‘cabinet’ should be restricted to not more than ten or twelve members, if it is supposed to be a forum for serious discussion on policy. If it isn’t, size is irrelevant.
So far the government has moved a little too slowly on promises of ‘moderate Islam’ — whatever that means. The simplest meaning is being able to revert tot the pre-Zia period. Probably there are fears of political obstacles since such apprehensions are usually subjective; it is difficult to persuade people that they can move much faster, without massive political turmoil.
The question of restoring democracy is a red herring. The problem is about creating a democratic environment which could lead to free and air elections. Some things will improve but the forthcoming elections will probably follow the pattern of those held from 1985 onwards, except that this time there will be a repeat performance in favour of the PML (Q). Devolution was probably designed to help in the process.
WHEN President Bush appointed former Deputy Defence Secretary Paul D. Wolfowitz as head of the World Bank 18 months ago, it was as if John Ashcroft had been tapped to run the American Civil Liberties Union.
Not since an architect of another war, Robert McNamara, led the bank has there been such mistrust within the development community, which typically ranges from left-leaning to socialist on the political scale.
The clash of perspectives is part of the reason for the recent tiff over Wolfowitz’s drive to root out corruption in poor countries. In advance of last week’s meeting of finance ministers in Singapore, Britain had threatened to withhold a $94-million contribution to the bank, while debate over Wolfowitz’s policies has been roiling the bank’s executive board for months.
Critics are irked by Wolfowitz’s tendency to cut off money to governments accused of corruption. Last year, he suspended $800 million in loans to a suspect programme for maternal and children’s health in India, and he suspended debt relief to the Republic of Congo.
—Los Angeles Times