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| November 20, 2006 | Monday | Shawwal 27, 1427 |
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Tackling doctors’ negligence
An invitation to graft
Management of economy under military rule
Getting sued
ONE of the strange coincidences of military rule is that whenever this happens there is heightened interest in Pakistan by the US. In the beginning, the US was probably hoping that India would cooperate, but it decided to become non-aligned.
THE UN World Food Programme’s warning that millions of Afghans will face hunger in the coming winter months is something to be taken seriously if a human tragedy is to be averted. The WFP has complained of non-availability of funds — $30 million in this case — to buy food for the 3.5 million Afghans who rely on the agency for food. Another 4.9 million Afghans will also suffer on account of food shortages and drought. The WFP has been able to mobilise only 34 per cent of the funds it had asked for its work in Afghanistan. Financial constraint has affected its projects in that war-ravaged country. It appears that donor fatigue has set in and it is becoming increasingly difficult for various humanitarian aid agencies to generate the needed funds for their work. This is not surprising because Afghanistan still presents a grim picture and it is difficult to see the light at the end of the tunnel.
As the Nobel laureate Amartya Sen observes, famines occur not only from lack of food but from inequalities built into the mechanisms for distributing food. Afghanistan’s tragedy is not simply that of shortage of it. Political factors, especially conflicts, also promote famine since they hinder food production and distribution. The country, which has been in the grip of turmoil for nearly three decades, has experienced destruction of the worst kind. Its civic infrastructure is a shambles, the agriculture and communication network are hardly functional and political stability is elusive. Over and above this, the country continues to be the victim of a Taliban insurgency partly aided by expanding poppy cultivation. Not surprisingly, these factors have prevented the government from stabilising and pacifying the country. In this situation, a tragedy of human dimensions would simply compound the Afghan crisis making a solution even more difficult.
The fact is that the Karzai government, which has been sustained in office with American assistance, has yet to consolidate its power base and extend its writ to the entire country. With large areas beyond its control and its dependence on the American military forces for maintaining a semblance of security, the Kabul government has not been able to touch Afghan society in a big way, eliminate poverty, bring economic stability to the country and launch a reconstruction programme of any significance. With the resurgence of the Taliban — there were 600 militant attacks last month and 3,700 people have died this year — the pressure on the Karzai government has mounted, making it difficult for it to address all the fundamental concerns that should be its first priority in policymaking. As a result, there is a lot of social unrest in the country that feeds the Taliban uprising which in turn hampers the government’s working. Thus the vicious cycle goes on. The Americans, who are basically responsible for creating this situation, have not managed to alleviate the Afghans’ hardship. Although they have poured $10.3 billion into the country, they have nothing much to show by way of reconstruction or security. This has also created a dilemma for Washington. If American troops withdrew from Afghanistan, the government in Kabul would be left fighting for its survival. But if the Americans stay on, their military presence will continue to provide a focal point for the Taliban resistance.
THOUGH negligence by healthcare professionals is widespread in Pakistan, debate on this critical issue tends to be infrequent and short-lived. Public and media interest is stirred when a fatal case comes to light — only to fizzle out shortly thereafter. Even fewer are the occasions when the health authorities break their silence on the problem. Doctors’ negligence is now back in the news following the allegedly preventable death of a journalist in a leading government hospital in Islamabad. Tragic as it was, the incident may have never become public had the patient not been connected to a newspaper. This too is distressing as there is no knowing how many people die across the country because of negligence or improper care at both government and private hospitals. Complications on account of inattention or carelessness are routine, while fatalities are not uncommon either. In March 2006, a woman died in Hyderabad after forceps were left in her abdomen during an operation. The Supreme Court is currently considering a case in which doctors are blamed for the deaths of three children in Chakwal. Earlier this month, a woman in Jhang died during childbirth at the district headquarters hospital, reportedly because no lady doctor was present to attend to her.
Again, these were cases where the families of the patients insisted on pursuing the matter. How many among the poor and uneducated, especially those who come to city hospitals from remote areas, can even begin to understand the medical reason for the death of a loved one? Even getting to a hospital in a city is an arduous journey for them. Most assume that the doctor, elevated to the status of a minor deity, knows what is best and will do what is right. If a family member dies, they attribute it to divine will and take the body home. There is no doubt that hospitals are short on staff and that the available doctors, nurses and paramedics are often overworked and underpaid. Doctors and hospital administrators can, arguably, justify their lapses on this count. The health authorities, however, cannot hide behind such excuses. Accountability in government as well as private hospitals is long overdue and it is the duty of the government to take remedial action.
WEDNESDAY’s legislative frenzy in the Sindh Assembly saw the passage of no less than 13 government-sponsored bills. Most of them were adopted in the absence of the opposition, which chose to boycott much of the proceedings in protest against “legislation in haste”. One bill is indeed a shocker, resembling an open invitation to graft. The Sindh Disposal of Urban Land (Repeal) Bill 2005 empowers the provincial authorities to allot government land at any rate of its own choosing and without calling for an auction. The bill repeals the Sindh Disposal of Urban Land Ordinance 2002, promulgated by the governor, which made it mandatory that government land be sold at market rates through a bidding process.
The government line is that the bill is designed to “accelerate housing and industrial activities in the better interest of the province”. The 2002 ordinance, it argues, was hindering foreign investment and industrial growth because no one was willing to buy government land at market rates. This begs the question: why should commercial projects be eligible for concessionary land rates? Investment can be encouraged through incentives such as limited tax holidays, but allowing land to be allotted at throwaway prices is a recipe for corruption. And if low-cost housing schemes are truly a priority for the government, surely the law could have been amended in a way that exempted such projects from the restrictions imposed by the 2002 ordinance. Allotment of amenity plots — subject to a permanent bar on conversion — could have also benefited from a similar relaxation in rules. Instead, the government has declared open season on whatever open spaces are still available in urban Sindh. The new legislation is open to abuse and the motives behind its passage are highly suspect. The people of Sindh and the spirit of transparency have not been well served.
Since Pakistan, although much smaller, also happened to be a little more strategically situated, Cento and Seato were created as instruments of US policy and Pakistan became a member of these organisations. The Ayub Khan government thrived on substantial US support. In Yahya’s time, China became important.
General Zia’s rule coincided with the Russian invasion of Afghanistan. However, by the 1990s, with the collapse of the USSR, the US lost interest in Pakistan. General Musharraf had a difficult three years 1999 — 2001 and then 9/11 occurred.
All three military governments followed somewhat different economic policies depending on internal and external conditions and the technocrat assigned to the job. During army rule the growth rate has usually been six per cent-plus. During civilian rule it has generally hovered around three and four per cent. The most important difference is that military rulers leave economic management to technocrats. The civilians employ technocrats but as a facade: to stay on they have to be pliable and acquiescent no matter what the prime minister wishes to perpetrate.
As far as current economic management is concerned, General Musharraf seems to have been fed the wrong paradigm: “liberalisation, de-regulation and privatisation.” This is the Wall Street mantra meant for the benefit of large multinational institutions generally supported by the IMF and the World Bank. There is nothing wrong with it per se, but it is not at the heart of the development process.
For countries like Pakistan, it is still “savings, investment and exports.” Liberalisation and deregulation have to be compatible with this process, otherwise it leads to trouble. It often starts with excessive import liberalisation on the assumption that it will automatically stimulate exports. It doesn’t.
The other problem which arises is that import substitution as an important element in the development process is ignored. The paradigm import — import substitution-export does not always hold in the short run, but unless excessive protection is offered and continued for too long, it is likely to work in the longer term, and, in any case, a transfer and development of skills does take place.
For the last few years we have followed an excessively relaxed monetary policy supplemented by liberalised imports. Base interest rates were brought down to around two per cent. In theory, low interest rates are supposed to encourage investment and also reduce the debt service on government borrowing. It probably did to some extent. However, the spillover from too much money sloshing around the financial sector found its way into consumer financing. Because of a desire to achieve a spectacular rate of growth, no attempt was made to contain this.
The result was rising inflation which is now being curbed by rising interest rates through reducing bank liquidity. This roller coaster management of interest rates is not good economic policy, but is the inevitable result of excessive lowering of the rates in the first place.
One result of the earlier policy of low interest rates was the pressure on the availability and prices of automobiles. As a result, a speculative secondary market developed which, by some accounts, was larger than the primary market. Up to 15 per cent premium was demanded for early delivery.
This excess demand could be contained through market-oriented fiscal measures — that is, a tax on interest for consumption loans or alternatively an increase in sales tax, particularly on the import component in local assembly. In order to protect domestic industry, an equivalent amount could be levied on import of the finished products.
Since we appear to be ideologically committed to the Washington Consensus on liberalisation etc., we acted by facilitating the import of used cars. This did bring down premiums on quick delivery, but put pressure on foreign exchange reserves, and also added to traffic congestion, pollution and a rising energy bill for the country. The costs of this are not negligible: some will be immediate, others may take longer to emerge. The foreign exchange spent on this would have been much better used in providing efficient urban transport in major cities. Since such activity, if carried out properly, is insufficiently profitable, it would have to be in the public sector. But that is anathema.
Another example of a similar problem is in private sector power generation. In the previous round sponsored by the World Bank the IPPs were given very generous terms. This was further enhanced by heavily over-invoiced projects being approved by the government. There was so much extra cash floating around that the sponsors could generously bribe the decision-makers. The end result was high cost of electricity.
This time around circumstances had changed and lower prices for electricity were offered. There was not much enthusiasm for this in the private sector. Wapda was debarred from putting up more generating capacity under some sort of understanding with the World Bank.
Since the Bank had not covered itself with glory in the previous round, why was this taken so seriously? It has only resulted in a shortage of generating capacity.
When one considers how the public sector has operated in Pakistan, the reluctance of the present government to entrust anything to a state-owned enterprise is understandable. This also coincides with its commitment to privatisation. Public sector enterprises have been treated by all governments as happy hunting grounds for favourites either from the military or civilian life.
The result was a combination of corruption and incompetence. These enterprises suffered from the usual problems of over-staffing, under-investment, political interference and corruption.
Nevertheless, in developing countries some things have to be done through the public sector. Making it effective is not impossible. Alternatively, public/private partnership can be considered, except that finding a suitable private partner is a major problem. What is needed is the proper selection of a suitable chief executive on the basis of competence, with adequate emoluments, a reasonable length of tenure, and assured autonomy of management. Under a political government the last is the most difficult.
This is based on my personal experience. On my rejoining the government, I was parked in the NDFC, a small unknown investment institution for financing public sector enterprises. I was supposed to be there for three months but was struck there for seven years because my peers did not want me around in Islamabad. This view was shared by the chief of staff to the president.
The options were either to feel sorry for myself and sulk and complain, or to get on with doing something useful. Under the martial law government, we had almost complete autonomy of management. As a result, the net income rose from Rs30 million to almost Rs270 million by the time I left. Some of it was the result of inflation but the bulk was real growth.
However, as soon as we got an elected prime minister in Mohammed Khan Junejo he made a couple of demands which were not possible to meet. He was naturally miffed and I was transferred to the ministry of production — which was fine. After all, it controlled the largest conglomerate in the country.
Whenever visiting the secretary, ministry of production, I was always intrigued by the fact that he was surrounded by files. How that helped in running a business was a mystery. On finding myself in that position, I discovered that the ministry was not organised as the headquarters of the conglomerate.
To make this plausible they had the support of something called the expert advisory cell which was supposed to provide them with the necessary input for assessing performance: it was where the Management Information System (MIS) was closed. On investigation, it appeared that the MIS was not very good; besides, the data was two months old by the time it was available on the computer. It wasn’t much use as a management tool. But who cared?
IT is not unusual in this era of reality TV shows for people to be filmed saying or doing something they’ll later regret. Less common is for them to turn their embarrassment into a lawsuit. Yet that is what two “cast members” in the movie Borat did last week.
Calling them “cast members” may be a stretch. Like all the other “average Americans” who appear in Borat, the two fraternity brothers from the University of South Carolina who filed a lawsuit against 20th Century Fox signed consent forms after allowing themselves to be filmed making racist, sexist (and often downright bizarre) remarks.
But they say the filmmakers misled them, plying them with alcohol and telling them the movie would never be shown in the United States. Because of these deceptions, the lawsuit claims, the students “engaged in behaviour that they otherwise would not have engaged in.” The result, they say, has been humiliation and mental anguish.
If they can show that the filmmakers’ deceptions led them to sign the release forms, the pair may have a case. But it’s hard to come up with much of an ethical, moral or even logical defence of their actions.
Did they think that, in a YouTube world, the filmmakers would have been able to keep their movie out of the United States even if they had wanted to? What are we to make of someone who feels free to act like a bigot when he thinks no one is looking? Furthermore, why would these three students subject themselves to further exposure and mockery by filing a lawsuit?
Maybe these enterprising young men simply smell an opportunity for a cash settlement. Litigiousness, oddly enough, is one aspect of American culture that Borat does not lampoon. Clearly it doesn’t need to, as the fallout from the lawsuit provides not only free publicity but an extension of the film’s central gag.
As Borat himself might say: “High five — lawsuit can make benefit even if cultural learnings do not.”
— The Los Angeles Times