[B]23.06.2013 [/B] [B][CENTER][SIZE="5"]History and archives[/SIZE]
Archives are not only important for the training of historians but also for practitioners in various disciplines of the social sciences
By Tahir Kamran[/CENTER][/B]

History offers a raison d’être for state and society: therefore history is vital for humans as social beings. The sensibility emanating from history not only helps in determining the future, but also has the capacity to provide an ambience of social camaraderie whereby diverse groups come together and form a polity. Thus, history is far too important to be left in a state that it is in, at present.

In Pakistan’s socio-cultural plurality, history becomes even more important. Hence, Ayesha Jalal’s concern, which she articulated quite succinctly at F.C. College, Lahore, a few months back, regarding the dismal state of history as a discipline in Pakistan’s educational institutions, makes absolute sense. Academic rigour, a trait of any historian of international repute like Ayesha herself, is a fundamental need which regrettably is starkly missing among Pakistani historians.

It was reported that she also alluded, during her exhortation to the young scholars, to the importance of archives in particular for nurturing and encouraging new generations of historians. Making access to archives easier, in the face of strenuous and arbitrary rules, was brought sharply into focus. Historians are trained only through archives, a fact that needs to be emphasised to the people at the helm.

As things stand, the making of history is becoming an occupation only for the affluent, who can afford to go abroad and consult archives at Kew Garden, London or the British Library. This is the reason that the most credible histories are being written outside Pakistan. Archives must be put in order, properly catalogued, perhaps digitised, and made more easily available to a wide public, says Dr. Kevin Greenbank, a historian and archivist at the Centre of South Asian Studies, University of Cambridge. The Punjab Archives, in particular, could attract many international scholars if the rules of access and use were rationalised.

Some regulations, such as the requirement for visiting scholars to have a research visa (a category that does not even exist in many of Pakistani embassies around the world) or asking them to seek permission from the Home Ministry, are bizarre. Such regulations discourage scholars from travelling to Pakistan, and as a consequence the country is becoming academically isolated. Furthermore, such rules give leverage to the concerned official to use his personal discretion.

A scarcity of trained archivists in Pakistan is also a big hazard. Essential conservation and preservation of documents requires trained staff. Similarly, as Dr Greenbank revealed, the maintenance of environmental conditions in an archive is important to safeguard the longevity of archived documents. To regulate the temperature and other environmental factors in an archive store is very expensive, warned Dr. Greenbank, but is very essential for fostering scholarship. It, therefore, requires the government to invest substantial amount of funds for the purpose of preserving the archives. Equally important is to equip the people working at various archives with proper training.

Another aspect that has drawn the attention of scholars is the de-classification of state documents after a stipulated time (either 30 or 50 years). Ironically, that exercise is conducted without any input from any serious academic, but is presided over by a joint secretary-level official, contrary to usual practice anywhere else (like the United Kingdom for instance).

Archives, in fact, should be made independent from any state’s interference. A separate service structure has to be devised for archivists and their attendant staff. Leaving archives at the mercy of disgruntled civil servants is counterproductive. Generally, an officer, who incurs the displeasure of his boss, is deputed to look after the archives. Besides being housed in the premises of the Punjab Secretariat, it serves as an obstruction to ready access for scholars. Therefore, the Punjab government should provide a separate place where archives are kept and preserved.

The way these documents of immense value are currently shelved and the overall environment of the archives are not at all conducive for the long-term safety of the records. Hence, they are rotting in dilapidated structures built 150 years ago.

Archives are not only important for the training of historians but also for practitioners in various disciplines of the social sciences. The structures conjured into existence by the British scholars, whether political, economic or social, still have a profound bearing on our lives. In order to make any sense of those structures, perusal of the records at the archives is imperative. Even if we want to jettison those structures put in place by the colonial power, acquainting ourselves with the system of governance etc. is absolutely essential.

Thus, archives are important in order to have an indigenous perspective of various social sciences. The government, therefore, is urged to draw some concrete plans to preserve the extremely important repository of knowledge that are our provincial archives. One is consoled by the fact that the archives at Sindh and Khyber-Pakhtunkhwa are relatively better managed. However, much needs to be done to bring them into compliance with international standards.

[B]23.06.2013[/B] [B][CENTER][SIZE="5"]Who help themselves[/SIZE]
All the chambers of commerce and industry in the country can emulate Sialkot in resolving the problems and issues besetting the trade and industry
By Alauddin Masood[/CENTER][/B]

To protect export industries from the ill-effects of prolonged loadshedding and further losses, Sialkot Chamber of Commerce and Industry (SCCI) has announced to establish its own power generation and distribution company — Sialkot Electric Power Company (SEPCO), on self-help basis, for meeting Sialkot city’s electricity needs.

Exporters from Sialkot would invest in this SCCI supervised project, announced SCCI President Sheikh Abdul Majid while talking to the media in Sialkot in mid-May, this year. Earlier, this city’s exporters had successfully completed a number of mega projects, setting unique examples of self-help for their counterparts elsewhere to emulate for resolving problems facing trade and industry and spurring economic growth. Amongst others, these projects include: Sialkot Dry Port Trust, Sialkot Export Processing Zone (EPZ), Seerat Study Center Sialkot Cantonment, construction of all the main inter-city roads under Sialkot City Development Package, Sialkot Business and Commerce Centre for display of products under one roof, Sialkot Public School, Sports Industry Development Centre, Sialkot Tanneries Zone for treatment of the effluent besides establishing Rs2.6 billion Sialkot International Airport — the first international airport in the private sector in the whole of South and West Asia. It is handling both passenger and cargo services for the golden triangle of Sialkot, Gujrat and Gujranwala.

The establishment of a private dry port in Sambrial was also a trend-setting step undertaken by the SCCI. One of the busiest dry ports in Pakistan, the Sialkot Dry Port is handling about 55,000 tons of cargo valuing over Rs45 billion. This dry port has its own fleet of bonded vehicles. In order to keep pace with the technological advancements, this solitary privately running dry port in the country also provides Online Tracking Facility to its customers. With regional offices in Lahore and Islamabad and terminal office in Karachi, the Sialkot Dry Port provides in-house facilities free of cost to Customs, clearing and forwarding agents, government agencies, banks and the National Logistics Cell. The dry port has proved to be a source of employment for thousands of people directly or indirectly, while having 300 regular employees.

With the highest per capita exports, Sialkot is often called “Pakistan’s export capital”. Sialkot city’s industry holds many lessons for achieving accelerated economic development. Three industries — surgical goods, sports goods and leather goods — dominate exports from this city.

Sialkot produces over 2,000 different types of surgical instruments, mostly from stainless steel, for worldwide export. The city’s surgical goods industry accounts for 75 per cent of Pakistan’s engineering goods exports. With a 20 per cent share of the total world surgical goods exports, surgical instruments made in Sialkot are used by surgeons, dentists and veterinarians throughout the world, and these are considered second in quality only to Germany.

Sialkot is a well-known name in the world of sports goods. Numerous famous brands of the world, like Nike, Adidas, Puma, Umbro, Grays, etc have set up their supply chains in this city.

Sialkot was selected to supply footballs for the 1994 and 1998 Football World Cup tournaments. The 1994 Football World Cup in the US culminated in a year of frenetic activity when the city’s industry turned over 20 million footballs to cater to the excitement created by publicity surrounding the mega event. In addition to top brands, like Adidas, Nike and Puma, major sports clubs around the world sourced footballs from Sialkot. One of the popular burger chains reportedly took a planeload of footballs to be distributed as souvenirs during the tournament.

Recorded history of Sialkot sports industry goes back to the year 1895 when the city started becoming famous for its tennis racquets. By 1903, cricket bats were being crafted from imported English willow and gradually exported to different parts of the South Asia Subcontinent and beyond. Over the years, the industry grew to include a variety of wood and leather based sporting equipment, and diversified into related industries, such as sports apparel and riding equipment and even Scottish bagpipes. The city’s sports goods industry is primarily cottage based, employing around 20,000 workers.

Over 10,000 registered firms are working in the city. In addition to sports goods and surgical products, these firms mostly deal in leather products, musical instruments, cutlery, knives, martial arts products, rice and cotton rags. Sialkot earns over one billion dollar annually through export of goods and services.

Located 130 kilometres northwest of Punjab’s provincial capital of Lahore, Sialkot represents an economy and a class of entrepreneurs different from that nurtured by the State apparatus over the years.

With a population of about 0.75 million, Sialkot’s culture of enterprise and contribution to the national economy and improving the quality of life of the society is unmatched by any other city in the country.

In many ways, Sialkot is a unique city in Pakistan. It epitomises the industrial bourgeoisie of Pakistan, a class that has created “pockets of efficiency and opulence” in the national economy. A strong export and entrepreneurial culture, combined with widespread availability of sub-contracting arrangements, has resulted in low barriers to entry and a proliferation of small and medium scale ventures, mostly financed from family savings. These undertakings compete by remaining lean, with low and shared overheads. They thrive through a network of sub-contracting, which allow each enterprise to specialise in only a part of the overall chain.

These companies are also deeply embedded in the socio-economic context in which they exist. The trickle down effect in terms of information, skills, and wealth are innumerable in sharp contrast to the relatively insular circuits of power and wealth promoted by the vertically integrated organisations, which have developed elsewhere in Pakistan.

When ventures work in international market, they face multiple issues and challenges, mostly related to compliance, infrastructure and new technology or skills. Generally, firms use the Chamber of Commerce and Industry for tackling those challenges with collective wisdom and efforts to fulfill the requirements of customers and get better results.

Child labour, changing technology and customers’ preferences, investment and management issues remain Sialkot’s prime concerns. As an institution, the SCCI identifies emerging problems and comes up with pragmatic solutions to solve the social and industrial issues.

Taking a cue from the folk-saying that you only find a helping hand at the end of your own arm, if all the chambers of commerce and industry in the country emulate the SCCI and start resolving the problems and issues besetting the trade and industry in their respective regions, on self-help basis, an economic revolution can usher in Pakistan within foreseeable future.

The infrastructure development projects undertaken by the chambers of commerce and industry would not only cater to the trade and industrial needs of their respective regions, they would also accelerate the pace of economic growth while providing gainful employment to the people near their home towns.

As a result of the cumulative efforts by both the government and the chambers for the rapid development of infrastructure and the national economy, the day would not be far when Pakistan would appear on the global economic map as a fast emerging economy.
[I]
The writer is a freelance columnist based at Islamabad. [/I]alauddinmasood@gmail.com

[B]23.06.2013[/B] [B][CENTER][SIZE="5"]Lessons from neighbours[/SIZE]
Pakistan can follow China and India to reform its energy sector
By Dr Vaqar Ahmed[/CENTER][/B]

China represents 21 per cent of global energy demand and its energy consumption is growing four times faster than rest of the world. The country is due to become the world’s energy production hub by 2020. More importantly, the country is trying to position itself as a regional provider of greener energy in the future.

While the transition from fossil fuels to green energy may take decades, however, the state-owned enterprises in China have already started to shift from dirty coal to liquefied natural gas, and also benefiting from imported gas from US where shale gas revolution is being witnessed.

India is the 4th largest consumer of energy in the world. After the blackouts of July 2012, which affected nearly 680 million population of northern India, the country is now simultaneously improving its portfolio in all its energy sub-sectors. This includes planning and investment in over 8 dozen coal-fired plants, expansion of solar power systems, hydroelectric dams and various renewable energy resources.

Currently three per cent of India’s energy needs are being met through renewable sources (this excludes water). However, the country plans to increase the share of renewables in the energy mix to around 17 per cent by 2030. This will largely involve increasing the share of wind and solar energy. There is also a plan to amend the building codes in a manner that prevents energy wastages. This is intended to save USD 42 billion in the energy sector annually.

There are four key messages for Pakistan from the energy development in China and India. First, both countries (China and India) stand ready to inject or modify reforms that can enable private sector participation in energy sector. This is not just confined to the local private sector and there is aggressive pursuit of foreign direct investment in this sector. Second, both the countries are trading heavily with their neighbours and beyond in energy and energy products. In fact, India has also offered Pakistan electricity through transmission lines across Wagah-Attari border. Third, both the countries are continuously trying to lower prices of energy for all consumer types. While for a domestic consumer, this may imply lower inflation however for the external account of a country this will imply greater competitiveness. Finally, both the countries are trying through demand-side and price reforms to drive energy mix away from i) expensive sources (e.g. fossil fuels) and ii) polluting sources (e.g. coal).

The key question now is how to enable the institutions dealing with energy governance in Pakistan to undertake the sort of initiatives that our neighbourhood has already adopted. With a fragmented energy sector governance comprising 29 departments in total and with lack of coordination between these bodies, it seems unlikely that any integrated energy planning could take place. In fact, some well-intentioned energy reforms under the Integrated Energy Framework developed under the previous government died before they could even be placed in an implementation matrix.

The moral then is to bring all departments related to energy under either one federal ministry or authority so that issues such as fragmented decision-making, rent-seeking and lack of accountability can be done away with. The new government has already tipped three things they aim to do in the short to medium term i.e. managing circular debt, reduction in loadshedding by around 30 per cent and in the longer run privatising several components in energy supply chain, for example distribution companies (DISCOS). However, energy experts are expecting a more comprehensive plan which is reforms-based and can ensure that Pakistan comes out of darkness in the longer term. What are these reforms?

First, apart from the consolidation of energy decision-making bodies into one authority, it is also essential to build the regulator’s capacity. Both Nepra and Ogra have been termed toothless on several occasions. Their lack of capacity to regulate has even invited the Supreme Court of Pakistan to intervene on certain occasions. Furthermore, necessary legislative changes should be undertaken so that the government in power should not intervene in regulatory matters. This includes postings and transfers at the regulatory bodies.

Second, the government is expected to devise policies and programmes which exhibit a longer term vision. However, executing such plans requires technical capacity which is missing at both ministries dealing with energy at the federal level. It is surprising to see that despite the availability of computation infrastructure, the transmission optimisation is conducted through manual methods. It has also been difficult for both ministries to attract and retain professionals from a technical background. However, the lack of career planning in federal administrative structure prevents such professional from joining these ministries.

Third, there is a strong desire from all stakeholders that pricing structure in the energy sector should be deregulated. This will not only correct the incentives structure in this sector but also improve position of receivables. This reform will also require phasing out of cross and hidden subsidies which are nothing but cost of inefficiency. Subsidies should be targeted and only for the poorest of the poor. Untargeted subsidies must be laid to rest. The provincial government, after the 18th Amendment, should also be held accountable for administrative losses (including power and gas theft). These governments can be facilitated through smart metering system; a proposal towards such a system was developed by the Planning Commission and is still pending with the Ministry of Water and Power for over 12 months now.

Fourth, one of the key successes that Pakistan can learn from India has been the role of private sector at the distribution level. This has brought greater certainty in the supply side of the power sector in India (particularly at the state level). For this to happen in Pakistan, the new government must initiate privatisation of DISCOs which will not only reduce the burden of future circular debt but also drastically bring down the administrative losses.

Finally, we also need to challenge our existing power generation entities. Gas allocations should strictly be on the basis of efficiency exhibited by generation units. This will imply that if a generation entity continuously indicates relatively lower efficiency levels, its gas allocation should be cut down until the time there is some proven improvement.

Similarly, price paid for oil to generation units should vary with the quality of oil provided to the generation entities. Currently, same price is paid even for the lower quality oil supplied to power generation sector. There is also a need to look into the potential of coal water slurry which is being advocated by experts as a more cleaner and cheaper substitute of oil.

The above mentioned reforms are certainly not untested. Most of them have already been in vogue in our neighbourhood. We have enough evidence and documented practices to learn from. It is now for the new government to show its will to act on its own manifesto which puts energy sector reform on top of its priority list.

[I]The author is at Sustainable Development Policy Institute (SDPI). [/I]vaqar@sdpi.org

[B]23.06.2013[/B] [B][CENTER][SIZE="5"]Flood of negligence[/SIZE]
Are the governments and flood-control authorities prepared to deal with
looming threat?
By Altaf Hussain[/CENTER][/B]

Before the current spell of rains started, it was being speculated by the international humanitarian agencies that this time around Pakistan may witness greater glacier meltdown and unprecedented monsoon rains which will ultimately affect the entire regions of Pakistan from the mountainous areas of Gilgit-Baltistan to the plains and sea shores of Sindh.

The recent rains in the upper parts of the country have caused rise in the flows of Kabul River which has resulted in inundation of many areas of the province and compelled the populations to flee and settle in camps and other high terrain areas. The glacier meltdown has also started which has caused flooding of many parts of the Karakorum Highway.

Rising water in River Swat is also an indication of another possible flood during this monsoon season. This situation has caused concerns among the people across the spectrum in Sindh that any possible flood will have devastating impact over Sindh that is still battling the effects of past floods.

The United Nations Office for Coordination and Humanitarian Affairs (UNOCHA) Operations Director John Ging this month warned the government of possible disaster this year and expressed his concerns over the lack of funding for the emergency preparedness. “We may be called upon in a couple of weeks to support the Pakistani authorities in responding to flooding,” he said. “That has been the pattern over the last number of years so we need to be prepared. And yet, the emergency stocks are not there.”

The case of Sindh is of particular attention because of the fact that it was the most affected province in the 2010 floods; the entire right bank of the river Indus was devastated by floodwaters that displaced more than 7 million people — hundreds lost their lives, millions of acres of standing crops were destroyed and thousands of livestock perished.

Floods in 2010 left deep imprints on the socio-economic dynamics of the province. Is the government ready for another flood? The embankments of canals and barrages, including FP and Suprio embankments, haven’t been plugged yet. Though the government has initiated stone-pitching of dykes, the pace of work remains slow. “Plugging and stone-pitching of the Tori dyke is not satisfactory,” says Parial Marri, President ISWA. Also other embankments of canals in Shikarpur, Larkana and Sukkur have not been fully plugged yet. This year again, 45 places have been identified as weak if water level rises in Indus.

It is noteworthy that the four-member Inquiry Commission formed by the Supreme Court of Pakistan had also pointed out brazen negligence of irrigation officials in the breaches in the River Indus. According to the Commission’s report the Chief Engineer, Guddu, and his team were directly responsible for consequential losses in Sindh and Balochistan. The Supreme Court, in the light of findings of the Commission, ordered the government of Sindh to suspend these officials. The Sindh government did suspend these officials, but reinstated them after some time owing to their political influence.

The government of Sindh and the Forest Department have been unable to remove the encroachments along these rivers. The issue of encroachments in River Indus and other water channels was raised during a recent meeting, but the CM Sindh, instead of taking stern measures, said the issue of encroachment would be resolved in consultations with local MPAs and MNAs.

Irrigation expert Idrees Rajput says it is the responsibility of Irrigation Department Sindh to be fully prepared and vigilant to cope with any flood because control of the mighty Indus rests with the Irrigation Department. Provincial Disaster Management Authority’s role starts if any emergency erupts.

The other question which is also equally important is the case of Internally Displaced Persons (IDPs) who are still living in camps in different parts of the country, particularly in Sindh. According to UNOCHA, “About 1.5 million people in southern Pakistan are still highly vulnerable and require livelihood assistance as they try and recover from the impact of floods.” In addition to that, cash support initiative of Watan and Pakistan Cards has been lost in the wilderness.

Month of July may witness wide-spread monsoon rains and rise in the flow of Indus River. The government must publicly announce the measures it will be taking to avoid the possibility of floods. The Irrigation Department, the PDMA and DDMAs must come up with tangible contingency plans and avoid repeating the past mistakes.

[B]23.06.2013 [/B][B][CENTER][SIZE="5"]Going English in Fata[/SIZE]
The government has decided to convert a number of schools to
English medium to improve the standard of education and restore the trust of the people in public sector institutions in the tribal areas
By Javed Aziz Khan
[/CENTER][/B]
The Federally Administered Tribal Areas (Fata) has one of the lowest literacy rates for lack of attention by the respective governments, headed by the President of Pakistan through the Governor of the Khyber Pakhtunkhwa province. The entire tribal area, comprising seven tribal agencies and six Frontier regions, is one of the least developed parts of the country. Fata is troubled for the last many years with a number of militant groups operating in the area, from South Waziristan to the Bajaur Agency.

Besides killing of a large number of people in suicide attacks, bombings, rocket barrages and ambushes, the people of the area suffered badly for having their schools bombed during the last over seven years. With the bombing of a large number of schools, hundreds of other institutions had to be closed for security reasons, directly affecting the already neglected education sector in the Fata.

Presently, 1880 boys and 617 girls’ schools in tribal areas are functioning without boundary walls, 2303 boys and 1246 girls schools do not have the facility of drinking water, 2126 boys and 1024 girls schools are without electricity while 2585 boys and 1095 girls schools have no proper toilet facility.

The overall literacy rate in Fata is 24.05 per cent, out of which the male literacy rate is 36.66 per cent and female literacy rate only 10.5 per cent. There is no university, no medical college in the entire Fata.

“The President of Pakistan has recently approved the charter of the first Fata University which is to be built in the Frontier Region Kohat this year. The Fata Medical College has been approved in Bajaur Agency while IT University is to be established in the Parachinar town of the Kurram Agency,” Abid Majeed, Principal Secretary to the Governor Khyber Pakhtunkhwa told The News on Sunday.

The official continued that the Cadet College Razmak, Wana and Spinkai, are providing top of the line education to students from Fata and rest of the country. Land for cadet colleges in Bajaur and Mohmand has just been acquired and these institutions will start functioning during the coming financial year. Property in Kurram and Khyber is also about to be finalised. Several steps are being taken to improve the standard education in the remote and neglected tribal areas.

According to the statistics of the Education Directorate of Fata, there are a total of 5,625 government-run educational institutes in Fata out of which 4,442 are functional (including 2614 boys and 1828 girls) while 1064 are non-functional (578 boys + 486 girls) and 119 are closed. However, institutions which have either been destroyed or located in troubled areas, their students and teachers have been shifted to nearby buildings, hujras or tents. The 1064 non-functional schools are mostly located in turbulent areas from where people have migrated to safer places as internally displaced persons.

“Out of the 4442 functional educational institutes, 2963 are government primary schools, 136 are mosque schools, 607 are community primary schools, 39 are IHC Schools, 391 (252 male + 139 female) middle schools, 255 (212 male + 43 female) high schools, 14 (10 male + 4 female) higher secondary schools, 33 (22 male + 11 female) degree colleges and 4 (3 male + 1 female) elementary colleges. In addition to those, 3 cadet colleges are working in Fata with an intake of around 150 students per year from class 8 to 12,” Hashim Khan Afridi, Additional Director Education Fata, told The News on Sunday.

Among the 1064 non-functional institutes, there are 927 (482 male + 445 female) primary, 98 (67 male + 63 female) middle, 33 (26 male + 7 female) high, 2 (1 male + 1 female) higher secondary schools and 4 (2 male + 2 female) degree colleges. Students of all the colleges have been adjusted in colleges within the agency or, in case of Mehsud area of South Waziristan, in evening shifts in colleges of Dera Ismail Khan and Tank districts.

The authorities have decided to convert a number of schools to English medium to improve the standard of education and restore the trust of the people in public sector institutions in the tribal areas. “A total of 69 schools in Fata have been converted into English medium, 52 of them this year. The conversion has been from class 6 where mathematics, social studies and general science is taught in English. We are currently in the process of finalising ten schools in each agency and four in each Frontier Region with equal number of girls and boys’ schools, for conversion into English medium from primary level. That only requires teachers’ conversion training for which the summer vacations is the best time after which 94 primary schools would be converted into English medium,” Abid Majeed maintained.

The statistics show that the overall enrollment in government institutes is 589,083, with 407,008 students (69 per cent) enrolled in primary, 65,929 (11 per cent) in middle, 89,877 (15 per cent) in high, 7,816 (1.3 per cent) in higher secondary schools while 18,453 (3 per cent) are enrolled in colleges. The primary to middle schools ratio should ideally be 3:1 but it is in fact 8:1, indicating unplanned investment in primary schools. Similarly, the middle to high school ratio should have been 2:1 but is actually 4:1.

One of the reasons for dropouts from schools is simply that there are not enough higher level schools. Overall dropout rate from nursery to class-5 in primary schools over a period of six years is 61 per cent in which 62 per cent is of boys and 58 per cent girls. The dropout rate from class-6 to Class-10 in schools over a cycle of five years is 72 per cent in which 68 per cent is of boys and 78 per cent is of girls.

One reason why dropout ratio in Fata schools is higher than the others is the absence of teachers. “Strict disciplinary action is being taken on absence with deduction of pay. Since April 2013, 1251 teachers have had their pay deducted for one day or more of absence. However, it has also been realised that female teachers face transportation problems. A donor assisted project already in field is being strengthened to make arrangements across Fata for transport of female teachers from their hostels to the educational institutions,” said the principal secretary to the KP Governor.

There are a total of 22361 teachers in Fata (15033 males + 7328 females) out of which 11509 (6709 male + 4800 female) are in primary, 4495 (3076 male + 1419 female) are in middle, 4932 (4238 male + 694 female) are in high, 490 (368 male + 122 female) are in higher secondary schools while 935 (642 male + 293 female) are in colleges.

The average number of students in a primary school is 85 while at secondary level schools the number is 206. Teacher student ratio is 1:37 in primary and 1:18 in secondary schools while teacher, classroom ratio is 1:42 at primary and 1:26 in secondary schools.

Instead of concentrating on new primary schools, the focus has been shifted to strengthening and rehabilitation of the existing facilities. “Based on the data of Education Management Information System, schools where the students surpass the standard number are being provided with additional classrooms. In order to make these schools attractive to children of impressionable age, small playgrounds with swings and classrooms with charts etc are being introduced. The educational pyramid has to be set right by bringing the ratio of primary, middle and high schools upto the standard 6:2:1,” said Abid Majeed.

To encourage the girl students, an exclusive stipend scheme has been introduced under which a girl will be paid Rs 200 per month for having attendance of at least 20 days a month. “We are also working on a proposal to have radio programmes on PBC run radio and Fata radio stations concentrating on primary education where the elders could also listen to these educational programmes.”

The government is also concentrating on religious schools in Fata where over 50000 students are presently enrolled. The government is focusing on a partnership with registered seminaries in Fata where they could be provided support in infrastructure, scholarships for introducing science subjects, languages and computer classes.

Recently, 156265 students of Fata have been provided scholarships, from class 8 till post graduate level, amounting to Rs 717 million in the last 5 years. With further increase in the scholarship a student of post graduate level will now get Rs 6000/ per annum, the student of degree and inter level will get Rs 5,000 while trainees will get Rs 3000 per annum. Free laptops will also be provided to those getting first three positions in any agency at high, inter and degree level.

[I]The writer can be contacted at [email]javedaziz1@gmail.com[/email] and followed on Twitter at JavedAzizKhan[/I]

[B]23.06.2013 [/B][B][CENTER][SIZE="5"]Changing strategies[/SIZE]
Civil-military coordination is essential to win the anti-militants war in tribal areas
By Dr Syed Hussain Shaheed Soherwordi
[/CENTER][/B]
Pakistan is writing a classic military history of the blow-by-blow fighting against insurgents. Military law enforcement operations in Waziristans, Swat, Dir, and recently in Tirah valley make an irrefutable case for where the laurels lay for the victories and where the blame lies for the retreats. Lack of civil-military coordination and gap of communication or information sharing is hurting the cause of the military. Pakistan Army deserves civilian support. However, that is possible once common man knows what’s happening on the front.

In most of law enforcement operations in Pakistan’s tribal belt, army is asked for a solo flight. This breaks the civilian relationship between the tribal and settled areas. To keep both wings balanced and to have a successful ‘National Counter-Insurgency Strategy’, there should be ‘military operations and civilian provincial development support’ going side by side. This strategy will keep law enforcement operations reinforced and simultaneously maintain a link between civilians of both areas.

With the inception of the 18th Amendment, the provincial government will feel more responsible in assisting the federal government for any development support that it can extend for the uplift of tribal areas. It will be a joint civilian and military effort that will enlist provincial, federal bureaucracy, political acumen, and military officers to build hospitals, schools, roads, and other infrastructure to win over the hearts and minds of not only tribal but also settled areas’ people. Any grand strategy which entails deployment of army with its solo flight in tribal areas will be a strategic failure as it has proved in South Waziristan.

No strategy is possible without the involvement of local tribal leaders. Hence, working closely with the tribal chieftains, the army needs to make overtures to the tribal leaders in the newly established Taliban-free areas. Their support and consent will further strengthen steel curtain against the insurgents.

History is a witness that the people from the areas like Tirah have proved to be very good soldiers and officers. Hence, there is a dire need for the construction of Cadet Colleges in these areas so that this may not only prove a hub of army recruitment, but may also contribute to the direct establishment of the writ of the government. More students from the region in such colleges will not only uplift this area, but would also bring obedience and order into the lives of the people around such establishments.

At the moment, consolidation of the army bases and bridging the gap between the local people and the army must be the main thrust of the strategy. This may require a troop-intensive strategy. But in the long run, this may be committed to shrinking it.

We need to take personal interest in tribal areas as these are the centerpiece of our border strategy. For that matter, as I normally write that Pakistan needs a Deforeign policy (a blend of defense and foreign policies) that will keep the Foreign Office and the GHQ on the same page. Both will hold responsibility for military strategy and foreign policy, the combination of which will bring some changes at the policies execution level. Saying it enough just might make it so, especially if it caught on the Prime Minister’s House which is now occupied by Nawaz Sharif — one of the guarantors by the TTP for negotiation process.

When an insurgent realises that he cannot defeat regular army in the battlefield, he turns up to an urban terrorism campaign. This involves, bombing civilian and military targets (attacks on election rallies, bazaars, Mehran airbase, GHQ, Kamra etc), kidnapping of renowned and rich people of a locality, gaining ransoms to fund their organisation and resultantly acquiring weapons, and having imprisoned important governmental functionaries (kidnapping of VC of Islamic College University Peshawar, Ajmal Khan) exchanged for hostages. In the circumstances, tracing down the hatchery of the insurgents is the best military strategy. This would be followed by “isolate, weaken, fight”.

In case of insurgents in tribal areas of Pakistan, it’s a well known fact that they have been supported by a few foreign agencies. Hence, first, any such life-line that is supplying them money, material and weapons must be cut-off. Similarly, the other life-lines of the insurgents must be trimmed before going for an all-out operation.

Take the example of Tirah valley. In Tirah valley, the most important link that supports and keeps the insurgents breathing is their life-line back into Afghanistan. All bridges that link Afghanistan with Tirah valley must be guarded and filtered that the army believes eased al-Qaeda and the TTP mobility. Later troops move into one village after another. Such move will enable Pak Army to make a steel curtain in the valley which will keep the insurgents away from settled areas like Peshawar. This will isolate them. Then, it’s important that the public opinion in the region must be molded. This is possible by pamphlets and different other means in which writ of the government must be explained in the light of Quran and Sunnah.

This will not only help in winning hearts and minds of the people, but would also weaken the insurgents’ grounds. Now as the insurgents will be internationally isolated and locally weakened, a minor strike of ‘fight’ will bring the entire edifice down. In the meanwhile, troops must concentrate inside Tirah. To make fortification faster, troops must bring disposable and quick-fit equipment and materials necessary to austere operating base.

If the insurgents agree to negotiate, negotiate along with political parties’ representation. This will make it multilateral talks which will give a serious look to the public. However, negotiation must be followed by rebuilding tribal areas. Using backwardness as a reason of their backwardness is enough. There must be a change in tribal areas. Construction of roads, schools colleges and offices related to the governance of tribal areas must be established in the vicinity. This would mean “negotiate, rebuild and educate”.

There is a strong correlation between public opinion in war time and the effects of casualties on the part of Pak Army. Human loss is acceptable to the public if it thought the Pak Army could and should win. Such sentiment is possible only and only if the gap between military operations and public awareness is shrunk. For that matter, establishment of a strategic planning cell for civil-military understanding (that would take a long-term look at security issues for both’s understanding) is a prerequisite.

Moreover, functions like the recently held Yom-e-Shuhada are extremely necessary. Likewise, there is a need to establish a ‘counter-insurgency academy’, to share civilian approach with the commanders. This will also contribute in bridging the gap between the civilian and military opinions. The idea is to inform people what had gone wrong till now and provide clear benchmarks for the public to measure progress, like the growth of insurgents, their supporting groups and countries which assist them to carry out their subversive activities in Pakistan. The public would be shown that Pakistan’s law enforcing agencies are making headway; deflating the pressure from Afghan border. The goal would remain the same: a united, resilient and democratic Pakistan. The Pak Army does not need to come up with a new strategy, but would do a better job by describing the strategy already in place.

In a country where military takeover has been a routine, this might be considered a step towards militarisation of democracy. However, we need to grow up to differentiate between a peacetime military takeover and a wartime civil-military relationship. Military is not a national institution to be scared of. It’s the custodian of a country’s borders and during counter-insurgency, it deserves our full and unconditional support.

If the Pak Army is in the midst of this war, the people of Pakistan must be given this realisation. Soldiers cannot win a war on the front which is not known to their supporting countrymen.

[I]The author teaches at the Department of International Relations, University of Peshawar, [email]syedshaheed@hotmail.co.uk[/email][/I]

[B]30.06.2013[/B] [B][CENTER][SIZE="5"]Negotiating for peace[/SIZE]
Talks are not about surrendering to the militants. They are about taking the lead in developing a strategy to resolve the problems
By Helal Pasha
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In his speech at the National Defense University on May 23, this year, President Obama touched on many issues. From drones to his commitment to help other nations “modernise economies, upgrade education, and encourage entrepreneurship,” and “connect with people’s hopes, and not simply their fears” everything he said, had implications for Pakistan. Pakistan needs to modernise its economy, upgrade education, encourage entrepreneurship, and find a way to deal with drones. The newly elected government should focus on these tasks.

Pakistan, for the last three decades, has tied itself up in knots so comprehensively that these modest aspirations appear unattainable ideals. The two dilemmas that Pakistan state needs to come to grips with –– the power supply and terrorism –– should never be the priority of any government. Pakistan needed to put systems in place that managed these issues on a permanent basis rather than slapping Band-Aids around as needed. While the power supply issue takes up time, the issue of terrorism is the one that will make or break the government and perhaps the nation with it too.

Dwelling on how Pakistan got into this quagmire has no significance now, finding a way out should be the primary focus. Terrorism and the militant groups affect the common folks the most; it is the middle classes and the elite that control the debate. The Muslim League government has promoted dialogue as the primary means. The chattering groups vehemently disapprove of and exert enormous pressure on the new government against dialogue.

Many public intellectuals have spoken out against the dialogue. The principal arguments are; the offer to talks would place the country in a vulnerable position, and all dialogues should be from a position of strength. Chattering classes consider dialogue identical to surrender to the militant groups. Positions of strength or weakness are merely tactical side of any strategy. In the absence of any cohesive strategy, to combat terrorism, debating tactics is akin to putting the probabilistic cart before the horse, amounting to skirting the issue.

Pakistan faces multifaceted problem involving many countries including the US that have prime interest in any position Pakistan takes vis-à-vis the militants. The problem is not about some business deal or a loan from international banks where strength and weakness matter; it is about the economic future and the survival of the State.

Pakistan estimated a loss of nearly $90-100 billion in the last several years; it did not deal with the issue proactively. The economic bleeding and the loss of human lives must stop before the US forces leave the area. The opponents of dialogue do not identify any alternate to dialogue explicitly. Between the lines, they favour a military solution to force the militants in a weaker position.

The support of a military solution first glosses over the history of the problem. Taliban showed up on the radar in 1994. They were in charge of Afghanistan before the people of Afghanistan even knew who they were. Similarly, the Pakistani Taliban, an alliance of several groups, sprung up while a military general ruled Pakistan. Had the army been capable of dealing with the issue, it would have done that a long time ago. Instead, the US, Afghanistan, India, and many other countries believed that the Pakistan Army had close ties with these groups. The US, for years, pursued many diplomatic and financial initiatives to encourage the army to resolve the issue; none succeeded.

Talks and negotiations are not about surrendering to the militants. They are about taking the lead in developing a strategy to resolve the problems to find a comprehensive solution. The Taliban and the other terrorists in Fata are not separated conundrum. It involves many layers of interrelated complications. The relations with Afghanistan, the US, India, and Iran are part of the whole enchilada. The local and international groups that operate from Fata are of foremost concern for Central Asian countries as well as Russia and China. The drones are part of this problem. Pakistan never gained any traction against the drones in the world, including with China and Russia, as all see the drones a result of Pakistan failure to be proactive to handle the militants in Fata.

Except for Pakistan, civilians lead every country involved in the larger issue of terrorism. The US civilian administration calls the shot on Fata and Afghanistan, not the US military. The White House has come down hard on any transgression. The civilian government in Pakistan should have the lead role. In a broader context of terrorism, it is largely a political and diplomatic issue.

As we have seen in the past, the Army is unable to find a large-scale military solution to the problem. The resolution of regional issue should rest with the civilians and the army should only support the civilians and follow their lead. The army approaches the issue as a security issue. The issue is about national interests of Pakistan. Security interests are one aspect of national interests and should not dominate the economic and business side of national interests of the country. Terrorists in Pakistan are not one entity; there are several groups involved in terrorism. Talks and negotiations symbolise exploring other options that include isolating the militants gradually to render them ineffective.

The US administration is looking towards the civilian government in Pakistan to take the lead. It knows that without a broader public support in Pakistan, terrorism and militancy will continue to bleed the region and the US would not be able to reduce its military involvement.

Pakistan’s primary interest is promoting business, industry, and investments in the country. Without peace in the region, Pakistan will not succeed in promoting its interests.

[B]30.06.2013 [/B][B][CENTER][SIZE="5"]Another deadline expires [/SIZE]
Afghan refugees’ stay in Pakistan beyond June 30, 2013, will be illegal unless the government frames a new policy
By Alauddin Masood
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The legal right to stay in Pakistan of the registered Afghan refugees, under the Afghan Management and Repatriation Strategy 2010-2012 (AMRS), expires on June 30, 2013. Well before the expiry date, the government should have revisited the AMRS to formulate a new policy for the management and repatriation of the Afghan refugees beyond the deadline that has expired today. However, for some reasons, the outgoing government could not do so. Now, the PML-N government needs to chalk out a policy framework for regulating the stay of Afghan refugees beyond June 30, 2013, and also fix a target, in consultation with the government of Afghanistan, for the voluntary repatriation of Afghan refugees in 2013 and beyond.

Despite return of over 3.8 million Afghan refugees to their homeland since 2002, there are still over 1.6 million registered Afghan refugees in Pakistan. In addition to the registered refugees, there are about 300,000 Afghans whose registration needs validation, while over one million unregistered Afghan refugees are also residing in the country.

Over 85 per cent of the registered Afghan refugees are Pashtuns, while the rest consist of Tajiks, Uzbeks and other ethnic groups. The Khyber Pakhtunkhwa (KP) province hosts over 62 per cent of the Afghan refugees, followed by over 20 per cent in Balochistan, some 202,832 in Punjab and about 50,000 in Sindh. The registered Afghan refugees comprise 283,337 families. Some 52.6 per cent of them are males and 47.4 per cent females.

With a refugee population exceeding 1.7 million (mostly of the Afghan origin), Pakistan continues to host more refugees than any other nation in the world. It may be recalled that more than one-third of the total population of Afghanistan was forced by the circumstances and domestic unrest, following the Soviet intervention in 1979, to migrate to the neighbouring countries of Pakistan and Iran. At one time, the number of Afghan refugees in Pakistan had reportedly swelled to around seven million.

AMRS is a tripartite agreement between Pakistan, Afghanistan and the United Nations High Commissioner for Refugees (UNHCR) governing the repatriation of Afghan citizens living in Pakistan. Signed on May 7, 2010, AMRS aimed at voluntary repatriation of Afghan refugees, temporary management of refugees residing in Pakistan, border management and development of host communities.

The deadline for the return of the Afghan refugees has been extended many times and the latest one expires on June 30, 2013. Earlier, the government of Pakistan and the UNHCR had signed an agreement in March 2003, according to which the repatriation of all refugees had to be completed by the end of March, 2006.

In a report to Pakistan government in June 2005, the UNHCR informed that of the total refugees, 1,565,095 were repatriated in the year 2002, some 343,074 in 2003 and 338,598 in 2004, while 108,134 were repatriated in 2005. For the repatriation of the remaining refugees, when the Population Census Organisation of Pakistan conducted a census in 2004, it reported that the previously estimated number of 1.1 million refugees had increased to 3.04 million.

Acknowledging the need to reinvigorate efforts to seek solutions for Afghan refugees, a quadripartite consultative process began in May 2011 between the governments of Pakistan, Afghanistan and Iran and the UNHCR to develop a multi-year strategy with a focus on voluntary repatriation, sustainable reintegration, and support to host communities. Pending repatriation of the Afghan refugees, the Solutions Strategy underscored the need to complement the AMRS by innovative assistance and empowerment projects designed to facilitate voluntary repatriation of the refugees and capacity enhancement of the concerned institutions in dealing with issues associated with the refugees’ management.

The strategy recognised that numerous challenges continue to hamper its implementation, including the need for increasing coordinated efforts between Pakistan and Afghanistan for creating demand and pull factors for the Afghan refugee so as to facilitate their voluntary repatriation.

The Solutions Strategy agreed upon by Pakistan, Afghanistan and Iran also recognised the need for provision of social services to both the refugees and the host communities. It underscored the need to invest in the human capital development in both the communities (the refugees and host communities) with focus on such livelihood opportunities in Afghanistan that facilitate the Afghan refugees return. It also recognised “the need to enhance the development and reintegration potential of high return communities in Afghanistan, particularly in the sectors of livelihood..., in order to create communities that are viable in the long-term, which will help returnees remain in Afghanistan and support the increased return of refugees from the host communities.”

To facilitate the work, the ILO and the UNHCR designed various project components, including two baseline research studies in Quetta and Peshawar, and holding a series of consultation meetings with the parliamentarians, employers, workers and the media. The studies carried out in Peshawar and Quetta noted poor social and economic indicators for both the Afghan refugees and host communities.

In addition to high illiteracy rate, both communities were earning less than the minimum wage and were also experiencing child labour and decent work deficits. Amongst the decent work deficits, the most notable ones included: freedom to form association, negotiate wages and terms of employment, fair treatment, equal opportunities for promotion and social security benefits to workers and their families.

Given a weak bargaining position to negotiate the terms of their employment, a vast majority of Afghan refugees — around 90 percent — had no formal or written employment contracts and also appeared to be unaware of the present minimum wage level.

The areas affected by the prolonged stay of Afghan refugees as well as those who continue to host the Afghan refugees in Pakistan are typically those with poor infrastructure, acute shortage of basic services and lack of economic opportunities, thus providing a case for investing in social assets, like education, health, skills enhancement, etcetera for their empowerment and development.

[I]The writer is a freelance columnist based at Islamabad.
[/I]
[email]alauddinmasood@gmail.com[/email]

[B]30.06.2013[/B] [B][CENTER][SIZE="5"]Water bodies[/SIZE]
Farmer organisations can manage water resources well if empowered and purged of political influences
By Shahzada Irfan Ahmed
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Agriculture is the mainstay of Pakistan as it caters to the economic and dietary needs of its population as well as feeds it overwhelmingly agro-based industry. The success of the textile sector which contributes major share to the country’s exports is also dependent on bumper and high-quality yield of cotton crop.

The largest share of agricultural produce comes from Punjab province which fortunately has one of the largest contiguous irrigation systems in the world. The distribution of surface water among farmers is managed through a huge network of main canals, branch canals, distributaries and so on.

With the passage of time and increase in population, the demand for irrigation water has increased tremendously. Besides, the cultivation patterns have changed drastically. Today, the landholders are putting their lands to maximum use through multi-cropping strategies and are least willing to leave them unused or underused during any time of the year. In terminology used by agriculture and irrigation experts, the pressure of food and fibre is too much to sustain.

This situation has led to aggravation of water shortage issue and calls for proper management of water resources and maintenance of the existing water distribution infrastructure. The need to check non-judicious use of water, its theft and non-payment of provincial taxes such as abiyana (water cess) becomes more important with the resource becoming dearer.

These were some of the points which the government wanted to solve with the help of institutional reform process it initiated in 1997 and the legislation it did to form the Punjab Irrigation and Drainage Authority (PIDA) Act. There were suggestions from several international donors to bring all stakeholders, especially the farmers, on board to manage water resources properly.

The PIDA — a body formed under the Act — introduced several reforms in the irrigation sector but the one about management of water distribution systems through Farmer Organisations (FOs) was the hallmark of its achievements. In 1997, there were a few FOs formed under a pilot project. It was in 2005 when the FOs initiative was expanded, under a comprehensive irrigation sector institutional reforms programme.

The roles assigned to FOs, which manage distributaries, include equitable distribution of canal water among farmers, checking of water theft, recovery of water cess, dispute resolution, maintenance of infrastructure falling within their jurisdiction. The FO office-bearers are elected by farmers for a three-year term and the organisation should ideally be free of any political influence. The FOs are imparted relevant training and taught courses on different technical, revenue and administrative issues pertaining to the irrigation sector.

Over the years, the FOs have performed well and many of them have succeeded in achieving above 90 per cent cess recovery levels. They have confronted influential farmers habitual of water theft and solved disputes related to water and farms issues.

However, a review of the whole programme highlights certain issues that need to be tackled on an urgent basis. Ignoring them will lead to undoing of the benefits of this reformed water management initiative. The said issues are:

First, the government should direct the local police to cooperate fully with FOs regarding running of their affairs. What happens is that police are reluctant to register criminal cases against water thieves. This encourages them to operate with immunity and make mockery of the belittled FOs.

Second, the FOs should be given back up support to proceed against the defaulters who do not pay water cess or any other irrigation related dues. Currently, they cannot get hold of culprits, and have to rely on the communication skills of social mobilisers.

Third, the taking over of FOs’ role by administrators comprising Irrigation Department officers during transition periods inflicts the maximum harm. Instead of transferring power from one FO after completion of its 3-year term to the newly elected ones, administrators are appointed who remain there for a year or years on different grounds. When the new FO takes over, a lot of damage has already been done.

Four, the rate of abiyana should be increased rationally. Currently, it is only Rs85 per acre per year for Kharif season and Rs55 per acre per year for Rabi. If added, the amount comes to Rs140 per acre per year. This amount is not enough to even buy one and a half litres of diesel. It is unfortunate that farmers are ready to buy diesel worth thousands to run their tubewells but not willing to pay meager cess amount.

Five, so far the FOs have been formed in only five of the 17 circles and Area Water Boards (AWBs) of the country. They should be introduced all over the province as early as possible. Some say the government is short of funds, and some hold the powerful agricultural elite responsible for keeping the FOs away from intruding into their domains and encroaching upon their powers.

Six, a large number of PIDA officials have not been regularised. They are trained by international bodies including JICA and know the details of the irrigation reforms project. How can they deliver and coordinate with FOs if they are not sure about their very future? They should be regularised to make the programme more productive and sustainable.

[B]30.06.2013[/B][B][CENTER][SIZE="5"] Poor on the cards [/SIZE]
What exactly will the proposed ‘healthcare cards’ do if there is no availability or access to
medical care to start with?
By Syed Mansoor Hussain
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Recently the government of Punjab floated the idea of a ‘healthcare card’ that would allow ordinary people to receive ‘free’ or at least subsidised healthcare. The problem is that at the present time, most patients are already supposed to receive free or subsidised medical care in the public sector hospitals and health centres in rural areas. What would a card do is debatable.

The problems facing poor patients especially in rural areas that seek medical care are at three levels. We might refer to these as the three ‘As’. First is availability, then accessibility and finally the ability to pay. All three of these are serious problems but before any attention is directed towards the ability to pay, the Punjab government must first take care of the problem of the availability of healthcare starting from the Basic Health Units all the way up to the larger health centres and hospitals.

At the present time, a majority of rural patients do not have appropriate healthcare available and most of them out of necessity resort to ‘non-formal’ medical practitioners or else ‘quacks’ without any medical training that pose as doctors. This leads to multiple serious problems. First, many sick people get worse without appropriate treatment and end up in the public healthcare system with advanced medical problems overburdening an already fragile medical environment. A problem that might have required minimal treatment ends up consuming scarce resources and often with an unfortunate outcome. While working in Mayo Hospital in Lahore, I saw many patients turning up in a serious condition after being treated by non-qualified medical practitioners for an extended period of time.

The second problem is that many patients receive unneeded injections given to them by these ‘practitioners’. Besides the usual problem of improper treatment the real danger is that needles and syringes are reused without proper sterilisation leading to spread of blood borne diseases especially Hepatitis B and C. As it is, anywhere between five to ten per cent of our population is already infected with these possibly lethal diseases. If ever the AIDS virus enters this patient pool, the spread of that disease through these inappropriate injections can become a horrendous public health problem. As such the provision of proper medical care at the local level must also be combined with the elimination of unqualified medical practitioners.

The next aspect of medical care for many patients, especially those from villages and small towns, is the question of accessibility. This becomes important in patients that are seriously sick including small children. The ongoing ‘Measles’ epidemic makes this pretty obvious since many of these small children arrive in major hospitals in a serious condition after being treated inadequately by local non-qualified practitioners. Some obvious categories that would benefit from quick access to appropriate medical care are women in ‘difficult’ childbirth, patients with surgical emergencies, trauma patients and patients with cardiac emergencies. In my opinion this is one of the more difficult problems that rural patients face.

The obvious way out is an efficient system of transport through well-equipped ambulances stationed in the DHQ hospitals, but that is an expensive alternative. As far as communication is concerned, virtually everybody has access to a cell phone these days.

The other option is to provide a higher level of care in the Rural Health Centres as well as the Basic Health Units. This again is a matter of resource management that requires careful evaluation and manpower allocation. I have discussed this in a previous column. Clearly the need to strengthen, fully man and equip the local health care system must be the priority of any government that wishes to improve healthcare delivery for our rural and semi-urban population. However, even if we are able to provide an efficient ambulance system as well as improve local healthcare, there will still be patients that ‘fall through the cracks’. Often this is a combination of lack of education and cultural constraints about transporting women for medical care. This last problem is a complicated one requiring a multidisciplinary approach through education and a reliable network of midwives that can act as facilitators.

And now something about the ability to pay for medical care. In a country where a majority of people subsist at or around the poverty level, even the very basic types of medical care can throw a family into total penury. Many families with patients that require daily medications and regular ‘tests’ will often have to make a choice between paying for medicine or food. The choice for them is obvious.

When it comes to more expensive types of treatments including surgery or treatment for heart problems, cancer and trauma, the costs can be prohibitive and I often heard of families that sold their homes, their daughter’s dowries, cattle or other important assets to pay for such treatment. It is, therefore, imperative that most of the treatments for such conditions should be provided free of cost. An added but rarely discussed cost to patients and their family besides loss of work is the fact that many family members accompany these patients to the hospital and have the added burden to feed themselves and pay for a place to stay during prolonged course of treatment.

Mayo Hospital has two large ‘musafir khanas’ (traveller’s homes) for such families but then, during my years in Mayo Hospital I rarely saw the families use these facilities and they often preferred to camp out in the hospital lawns and hallways creating serious public health issues. Whether this is a socio-cultural problem or was due to some problem with living in these premises is difficult to say but still is an important issue that should be considered and addressed.

Now back to the question of health cards that we started this discussion with in the first place. So what exactly will these cards do if there is no availability or access to medical care to start with? And then, how much of the actual cost of treatment will be paid by the government, all of it or some of it? And what will determine the amount to be paid, the income level of the patient or some other criterion and who will determine what those criteria should be and enforce them?

It is a difficult problem but with proper resource management and increased funding a lot more can be done than is being done right now.

[I]The writer is former professor and Chairman Department of Cardiac Surgery, KEMU/Mayo Hospital, Lahore: [email]smhmbbs70@yahoo.com[/email][/I]