policy shift
New security paradigm
While the ruling party underplayed the issue of terrorism during its election campaign, two months in power have demonstrated that governing Pakistan without a redefined national security paradigm will not be possible
By Raza Rumi
Pakistanis have been informed that there will be a new security paradigm that would drive the policy and strategy of the federal and provincial governments in countering terrorism and extremism. This is good news for Pakistanis given the high levels of insecurity as well as repeated attacks on the state and its key institutions.

policy
The status of Fata
Despite promises that the process of reforms in Fata would continue to integrate tribal people into the mainstream of national life, the reality is so far removed 
By Ashrafuddin Pirzada
Amendments in the Frontier Crimes Regulation (FCR) on August 12, 2011 were no small event in the history of the Federally Administered Tribal Areas (Fata) of Pakistan.

Education, not a priority
Budgetary allocations for education show lack of political commitment
By Sajjad Malik  
In terms of commitment and spending, education sector traditionally stands at the lowest rung of priorities of politicians and bureaucrats in Pakistan. The present governments, federal and provincial, are not much different from the previous when it comes to improving the state of public education. Some of the parties made tall promises during election campaign before May 11 polls to invest in education for building a quality human capital. It seems they have forgotten all this and once in power they think in the same rotten pattern which helps strengthen the “national security state” syndrome at the cost of millions of “brilliant youth” who are utterly useless to the country as majority of them are not educated or trained to contribute in the gigantic but important task of national development and progress.  

healthcare
Backbone of medical care
While surfing around for a hospital for treatment of a complicated medical problem the more important question is what hospital has the best
nursing care available
By Syed Mansoor Hussain
Whenever we think of medical care we think mostly about doctors and what they do. If any one comes to me to ask for a recommendation for a surgical procedure, the one thing they want to know about is the reputation of the surgeon and his results. Of course most major medical centres in Pakistan as well as those in more advanced medical countries thrive on the reputations of specialist physicians on their staff. 

In the name of honour
Four recent cases of honour killings in KP call for removal of loopholes from the law and amendment in provisions which go in favour of alleged killers
By Akhtar Amin
Despite hard work of numerous legislators and human rights activists, cases of ‘honour killings’ keep coming up. Four honour killing cases were reported in the Khyber Pakhtunkhwa within one and a half month.
In three honour killing cases, fathers were the killers of their daughters along with their boyfriends and others. The first case was reported at Mardan district on August 11, 2013. According to first information report lodged at Ghari Kapora police station, one Abdul Zaman, son of Abdul Manan and resident of Ghari Daulatzai shot dead his young daughter Afshan along with her lover Rizwanullah when he found the boy at his house along with his daughter.

finances
Setting a high aim
Universities are not in a good shape financially and call for a serious look into how the situation can be reversed
By Dr Noman Ahmed
As reported in the third week of July 2013, the Higher Education Commission (HEC) has informed the University of Karachi that the university will not get the required funds this year to cover the salary bill of its employees. 

Spatial shrinking of the government
A validation of the proposed plan of spatial reorganisation of the Punjab Government through automation with some added suggestions
By Asif Mehmood
This follows a recent media report that the Punjab Government is set to slash its staff strength of around 0.8 million people working in different departments at various levels. The initiative that is in the pipeline aims to increase efficiency and to cut its administrative expenditure.










policy shift
New security paradigm
While the ruling party underplayed the issue of terrorism during its election campaign, two months in power have demonstrated that governing Pakistan without a redefined national security paradigm will not be possible
By Raza Rumi

Pakistanis have been informed that there will be a new security paradigm that would drive the policy and strategy of the federal and provincial governments in countering terrorism and extremism. This is good news for Pakistanis given the high levels of insecurity as well as repeated attacks on the state and its key institutions.

Nearly 50,000 Pakistanis have lost their lives in the last decade including thousands of security personnel. While the ruling party underplayed the issue of terrorism during its election campaign, two months in power have demonstrated that governing Pakistan without a redefined national security paradigm will not be possible. Sixty terror attacks in first two months could shake any government let alone a civilian administration that enjoys side support in the parliament.

One of the key features of the National Security Policy (NSP) will be the establishment of a Joint Intelligence Secretariat, which will comprise all civilian and military intelligence agencies, with the primary job of coordinating intelligence operations and sources of information. The Interior Minister, Chaudhry Nisar, has assured that the secretariat will start working within six to seven months.

The NSP will also establish a Counterterrorism Rapid Deployment Force at the Federal level, which will eventually be replicated at the provincial levels. Staffed with serving and retired military personnel, this force will be 500 strong and over time shall increase to 2000 serving personnel, with the primary job of securing and responding quickly to terror threats.

The lame duck institution, National Counterterrorism Authority (NACTA), is being envisaged to act as a focal point of the new security policy. Increasing its capacity and making it fully operational has rightly been identified as one of the first few steps.

The NSP will also be divided into two broad sections: one that deals with internal threats and another that deals with foreign threats. The draft NSP also aims to deweaponize Quetta, while at the same time providing police in Balochistan with over 5000 SMGs and the requisite training to use them in fighting terrorist and sectarian elements.

Though the formulation of a NSP is vital and has been long overdue, criticisms of the scope of the NSP have been widely expressed. The proposed NSP postulates that with NATO troops’ withdrawal, terrorists in Pakistan will cease to function as effectively as they do now. This postulation however, as Ayesha Siddiqa argues, does not take into account the existence of sectarian and extremist networks in Punjab that have operated independently of the TTP and Afghan Taliban.

By claiming that terrorism in North Waziristan drives extremism in Punjab, an erroneous narrative has been constructed which ignores the devastating reach and impact of localised sectarian and militant groups. These groups are now a substantive threat since they are propelling communities in these areas towards radicalisation.

Siddiqa has also argued in a series of articles that the NSP fails “…to see the growing trends of radicalism and radical movements in non-Pashtun Pakistan that takes various shapes and forms.” (Fighting Terrorism, August 7, 2013, Express Tribune). There is little (if any) focus on the NSP in this regard, with networks such as Hizb-ut-Tehrir (HuT) — which perhaps don’t encourage violence, but financially support other organisations and disseminate religious literature, which seeks to radicalise middle class elements in the society.

Though the NSP contains provisions for capacity building of the police forces, it needs to include broader reforms to include the judiciary and anti-terrorist courts. That said, however, there are still not viable methods the NSP lays out that deals with those who are sympathetic to militancy within the police or the judiciary.

The assumption that US exit from Afghanistan will tackle the issue of extremism is flawed at best. A recent report prepared by the Home Secretary, Khyber Pakhtunkhwa has also advised against the idea that NATO troops withdrawal will lead to reduction in terrorism, arguing instead that the withdrawal will be seen as a victory for the Afghan Taliban and would further boost the morale of Pakistani Taliban (TTP). Azam Khan, the architect behind the document, argues that, “With the departure of the US troops, the TTP and its multiple partners will pursue their ‘jihad’ with renewed vigour under the banner for setting up a true Islamic Caliphate in Pakistan.”

The TTP, as KP’s secretary argued, are, firmly entrenched in the region and have institutional support from the Afghan Taliban, since the Taliban do not recognise state boundaries due to their belief in the idea of a borderless Caliphate. Additionally, they are organised and have specialised wings for training, finance, operations and justice, and are likely to pursue their stand against a Pakistani government they view as unIslamic.

It is vital to expand the scope of NSP with a view to correct the civil-military imbalance. The key institutions such as the Defence Committee of the Cabinet (DCC) and the Defence Council, both of which are almost permanently handicapped due to the lack of a permanent Defence Minister, need to be reconsidered. Though the DCC is criticised as not having any military representation, the Defence Council makes up for that by being the primary advisory body to the DCC and having more than adequate military representation.

As envisaged by the constitution, the existence of these two bodies is perfectly workable with a few changes. First and foremost, a permanent Defence Minister is required so as to alleviate the PM of contrasting and contradictory roles — e.g. the PM cannot make recommendations to himself nor should he be expected to sit in advisory board meetings.

Secondly, both bodies have separate secretariats (the Joint Chiefs have their own, while the National Security Adviser has his own) and their resources should be pooled together to undertake policy recommendations made and enacted by the DCC. If comprehensively implemented, these reforms would help provide the National Security Adviser and the PM with detailed, expert and comprehensive analysis of defence — and foreign policy — issues.

Similarly, there is a broad need for institutional policymaking arrangements that bridge the civil-military divide and leads to greater coordination between the two spheres of government. Currently any coordination between the two exists on a purely informal basis, with the Joint Chiefs’ meeting the PM and the President directly, rather than through institutions such as the Defence Ministry.

Dr Hasan Askari Rizvi, a noted expert in this area, has observed that the appointment of a permanent National Security Adviser, as an autonomous civilian position rather than a military one, would help further civilian ownership of Pakistan’s internal and external security policies as it would require interaction with the Joint Chiefs and keeping the PM abreast of all recommendations and analyses.

The Ministry of Defence also needs to be strengthened, particularly by stripping it of its military inflexions and running it in an autonomous manner. Since the Defence Council is headed by the Defence Minister, it is imperative that civilian bureaucrats run the Ministry so as to effectively analyse and implement recommendations made by the military. Think-tanks and other research organisations that pepper Islamabad should also be used as viable platforms to explore and research policies.

The time has come when the civilian government needs to take charge of the security policy and take it beyond the military domain. Pakistan needs to move towards a human security paradigm where public welfare, justice and inclusion gain precedence over containing the archenemy India and the three decades long policy of acquiring ‘strategic depth’ in Afghanistan. A security policy is much needed but as the Prime Minister said recently in his address to the nation, our foreign policy requires a radical review. We need to focus on the region and building economic ties rather than remaining in a state of perpetual conflict and fear.

Raza Rumi is a policy advisor, writer based in Islamabad. He is the author of “Delhi by Heart: Impressions of a Pakistani Traveller” (Harper Collins, 2013). www.razarumi.com

 

 

 

 

 

 

policy
The status of Fata
Despite promises that the process of reforms in Fata would continue to integrate tribal people into the mainstream of national life, the reality is so far removed 
By Ashrafuddin Pirzada

Amendments in the Frontier Crimes Regulation (FCR) on August 12, 2011 were no small event in the history of the Federally Administered Tribal Areas (Fata) of Pakistan.

The reforms package came after years of deliberations by legal experts and political workers from Fata to improve the FCR, which would eventually bring the people of Fata into the national mainstream — by securing their legal, constitutional and basic human rights.

The 2011 FCR reforms, promulgated by the PPP-led government, included the extension of Political Parties Order (2002) which was not only warmly received by much of the Fata people but was accompanied by the demand for speedier changes to the century-old set of British-era legal regulations.

While the overarching structure of the FCR and its legal concepts remain intact, some of the changes introduced in the 2011 reform package were: protection of women and children under the age of 16 and tribesmen above the age of 65 from arrest and detention under the FCR act of “collective responsibility” clause; prohibition against arresting an entire tribe under the “collective responsibility” clause; appellate authority power to review and revise decisions and orders; provision for an independent appeals process; strengthening of the newly-established Fata Tribunal; reference to “Qaumi Jirga” (council of elders); fixed time limits for the disposal of cases; power to transfer cases to the assistant political agent; introduction of the concept of bail; introduction of jail inspections; fines on communities in the case of murder; acceptance of local customs and traditions; checks on arbitrary powers to arrest by the political administration; compensation for false persecutions; audit of political agent funds by the Auditor General of Pakistan.

Although the FCR amendments were viewed by many as insufficient and additional reforms continue to be demanded, it was hoped that if the 2011 reforms were implemented in their true spirit, the reforms package would bring about a positive change to the existing governance system in Fata.

But, these aspirations of the people of Fata are far from being fulfilled.

More than two years since the enactment of 2011 reforms, political agents across Fata continue to wield unbridled powers and tribal people are still waiting for justice. Thousands of diverse cases await disposal at the offices of the political administration while the concerned officials fail to show any interest in addressing them on a speedy basis, as is advised in the 2011 reforms package.

Hundreds of tribesmen are waiting to get their civil documents like domicile, Nikahnama, birth and death certificate etc. issued but the political muharrers in Fata and FRs (Frontier Regions) either do not know how to prepare these documents or are not willing to serve dozens of applicants.

Zahir Shah Afridi, senior journalist based in Khyber Agency, says none of the reforms brought in 2011 were implemented in Fata, except the Political Parties Act, in the 2013 elections.

“Hundreds of appeals against false judgments issued by the political administration are filed with the newly-established Fata Tribunal on weekly basis, yet the locals have seen not a single case whereby an aggrieved party has been compensated,” Afridi tells TNS.

Wali Muhammad Shinwari, chief executive of Rural Community Development Organisation( RCDO) says lack of awareness about reforms in FCR is the main hurdle in its implementation. “Tribal people have no clear idea about the reforms,” he further adds that the political administration has not formally implemented reforms because “a few days ago the Khyber Agency administration arrested a child of 9th grade during search operation in Jamrud subdivision.”

Shinwari says awareness sessions and seminars across Fata are being held to build consensus to pressurise the concerned authorities to implement reforms in full spirit.

According to the political party leaders and some of the local elders, despite recommendations in the 2011 reforms package, political agents are either not ready or not willing to surrender the powers.

A hand-picked pro-government tribal Maliks continue to enjoy political privileges. In fact, they consider the 2011 reforms as infringement on the privileges they receive from the political administration. As a result, many Maliks oppose changes to the FCRs and the extension of the Political Parties Order. They supported independent candidates in the May 2013 general elections.

Malik Darya Khan, who belongs to Zakhakhel Afridi tribe and is a Awami National Party (ANP) leader, says the Fata people are still victims of the draconian British-era regulations.

On the other hand, some pro-administration tribal elders are awarded a majority of the development funds allocated to the region via the Fata Secretariat and elected Fata members of the National Assembly. The political agents in Fata rely solely on this closed group of local allies to resolve all major tribal issues.

Further, the political agents rely on the much-abused system of “nomination” (selecting preferred contractors) and ignore prescribed rules for inviting open tenders for all development projects. Many of these contractors are the same pro-administration elders mentioned above and are more than happy to engage in quid pro quo to secure their share of development projects. As a result, the quality of construction for most development projects is poor. In some cases, projects only exist on papers while no work is actually done on ground.

Tribesmen welcomed the exemption of elders from arrest under the FCR “collective responsibility” clause. They were equally pleased with the new prohibition on sealing or confiscating residential and commercial property under the same clause. Unfortunately, however, tribesmen are still intimidated and penalised under this notorious and abused clause.

Prior to the announcement of the 2011 reforms package, the President of Pakistan, Asif Ali Zardari enacted another regulation on Fata governance. In June 2011, the Actions in Aid of Civil Power Regulation was decreed, thereby empowering security forces to arrest any tribesmen on suspicion of his or her association with an outlawed militant group or suspicion of involvement in any terrorist-related act.

The promulgation of this Civil Power Regulation cancelled the prohibition against arresting elders as was enacted in the amended FCR “collective responsibility” clause. In the intervening years, a number of Fata people have disappeared, whose relatives are still searching in vein for clues as to their loved one’s whereabouts.

Local political party leadership has also been unable to see the benefits of 2011 reforms, perhaps due to the strong opposition from the Fata status quo supporters.

Besides, the political leadership feels insecure in the current law and order situation and therefore rarely organises meetings or assemblies.

Akhunzada Chattan, former MNA from Bajaur Agency, says low levels of literacy and political awareness have also meant that most of the Fata residents are not aware of the 2011 reforms package or its detailed contents.

He says this political ignorance can be gauged from the fact that six out of the ten MNAs elected from Fata in 2013 were independent, not belonging to any political party. After the elections, he says, one independent MNA from North Waziristan joined PML-N while the remaining five chose to remain independent, pledging to work for strengthening the existing “tribal system”.

Despite assurances in the 2011 reforms package, the government has thus far failed to conduct an impartial audit of the funds accumulated and utilised by political agents in Fata. Neither do tribesmen in the area have access to administrative records nor are they permitted to challenge powers of political agents regarding the utilisation of funds.

Tribal elder Malik Ikramullah Jan alleges that corruption at all levels of the political administration is rampant. “The Khasadar and levies forces are not concerned. They fleece local residents at security checkpoints rather than provide security to the local people,” he says.

Jan says it is no secret that the money collected by Khasadar forces at the security checkpoints is distributed among political administration officials, while this collection is supposedly for the Agency Development Fund. “No receipts are issued for money collected,” he adds.

It is also no secret, Ikramullah Jan says, the post of political agent is auctioned and rewarded to the highest bidder.

Mosam Khan, PML-N central council member, says the condition of lock-ups and prisons in several agencies is pathetic — as prisoners are often kept in inhuman conditions, provided sub-standard food and provided limited access to medical facilities. “There is no centralised jail facility in any part of Fata and all prisoners are sent to Peshawar, Haripur, D.I. Khan or other central prisons in settled districts,” he says.

He adds an independent committee of local elders, media persons and political leaders should be constituted to regularly report on the reforms being implemented.

The PML-N leader says Pakistan Electronic Media Regularity Authority (PEMRA) laws have not been extended to Fata and thus it is not permissible to publish any newspaper or journal in the tribal areas. “This is an obvious affront to the democratic principles of access to information and freedom of speech,” the PML-N leader adds.

To guarantee basic human rights and fundamental constitutional rights in Fata, urgent action must be taken to ensure the true implementation of the 2011 Fata reforms package and the enactment of substantial additional reforms for the tribal areas.

Contrary to the views of the political leaders, tribal elders and civil society members, assistant political agent in Khyber Agency, Jahangir Azam Wazir, tells TNS they have directed the administration staff to follow the reform package. “We are producing arrested persons in court within 24 hours. We are avoiding arrest of elderly persons and children less than 16 years of age.”

 

Education, not a priority
Budgetary allocations for education show lack of political commitment
By Sajjad Malik

In terms of commitment and spending, education sector traditionally stands at the lowest rung of priorities of politicians and bureaucrats in Pakistan. The present governments, federal and provincial, are not much different from the previous when it comes to improving the state of public education. Some of the parties made tall promises during election campaign before May 11 polls to invest in education for building a quality human capital. It seems they have forgotten all this and once in power they think in the same rotten pattern which helps strengthen the “national security state” syndrome at the cost of millions of “brilliant youth” who are utterly useless to the country as majority of them are not educated or trained to contribute in the gigantic but important task of national development and progress.

The federal government used to take lead in education in the past but after the 18th amendment, the provinces have control over education, especially the primary and secondary education, as the higher education is still controlled by Islamabad through Higher Education Commission (HEC). The federal government has allocated total Rs. 67,415.07 million for education for 2013-14 fiscal which includes 46,317.39 million for current expenses and 21,097.68 million for developmental purposes.

Bulk of the money — 39 billions — will go to the higher education and given to HEC to spend for universities and scholarships. The total education budget is far below than the defence budget which is 627 billion after 15 percent increase to the previous year allocations. The education budget has also been increased from the previous 52 billion but there is no comparison between the defence and education spending of the federal government.

The provincial governments are not encumbered by the defence like expenditures and it is their primary responsibility to divert more money to education and seriously try to address the perennial issues of “quality and quantity” in education. Some of provincial governments are headed by leaders from the political parties that have been highly critical of previous regimes.

For example Pakistan Tehreek-e-Insaf of former cricketer Imran Khan controls the Khyber-Pakhtunkhwa province in the north-west. Khan in many tv interviews and election speeches said that a uniform and quality education system will be introduced if his party won the polls.

PTI’s government allocated 83,678.09 million for education in 2013-14 budget, which includes 69,848.40 million for current and paltry 13,829.69 million for development expenditures. The total allocation is higher than the previous year but the allocation, apart from school education and higher education, also includes budget for district education and provincial programs which will eat away vital resources for basic and higher education. Another drawback in allocations is that lump-sum amounts have been placed on the discretion of finance department including 3.14 billion for School Education, 200 million for Provincial Programs, and 762 million for General Colleges without mentioning of the nature of their usage. The discretionary use of funds is highly problematic and dependent on vagaries of the disbursing officers.

In the biggest province of Punjab the total budgetary allocation in the current years for education is 73,720.58 million, which is lower than both Khyber-Pakhtunkhwa and Sindh, and only higher than Balochistan, which is just a fraction of Punjab in terms of population. The province has set aside 38,314.95 million for current and 35,405.63 million for development sectors. Budget books of Punjab do not provide District Education Budget, so it is not included in this figure.

While the Education budgets of Sindh and Khyber Pakhtunkhwa include district budgets as well. But the Punjab education budget includes spending for Special Education, School Education and Higher Education. In Punjab, the ratio in development and current expenditures is not wide which shows that more money will be available for new initiatives.

Sindh is leading the rest of the county in education budget with 131,985.58 million. But the problems is that hefty 118,743.13 million are just for current expenses like salaries etc and only 13,242.45 million have been spared for development which also means fewer new institutions or minimal additions to existing facilities. Another serious problem with this “huge allocation” is that the current budget of education as reflected in the Budget books of Sindh also includes 519.79 million for Culture and Tourism, 3636.02 million for Health and Medical Education, 268.47 million for Antiques Department, 280.66 million for Planning and Development department and 215.39 million for Chief Minister. Deducting these bring the current budget for education to 113,822.8 million and total education budget to 127,065.25 million.

Balochistan has allocated 34 billion for education which shows the highest 42 percent increase in terms of allocation for education in any province as compared to previous years. But the problem with the province is rampant corruption and dominant tribal and religious mindset, which in the past created hurdles in the spreading education and improving its quality. Only effective and targeted use of money can help increase literacy in the province.

Pakistan’s total education budget though higher than the outgoing fiscal year is still far below the minimum 3 percent of GDP target which is considered as the first step towards official realisation of importance of education. The political bosses should know that the allocation itself is not a guarantee to mass literacy and improved higher education unless the micro managements of expenditures is done properly to account both for quantity and quality. They should realise that it is equally important to provide funds for district education officers to travel to remote areas carry out unannounced visits and monitor the teachers in villages, along with hefty allocation for setting up computer labs. Regular revision and updating of syllabus is also important to keep pace with the needs of changing world. So far it is not clear whether the new budgetary allocations for education provide any money for research to improve the syllabus.

The political parties should create liaison with the civil society which can play vital role in increasing enrolment, imparting training to the teachers and improving the standards of education. Non-profit organisation like Pakistan Coalition for Education (PCE) are active in education and can help government efforts. Serious efforts are needed to fulfil the constitutional requirement of providing compulsory uniform and quality education to the poor people of this country and can only be done by the joint efforts of government, media, donors and civil society.

The writer is a journalist and researcher and can be reached at sajjaad@gmail.com

 

 

 

 

 

healthcare
Backbone of medical care
While surfing around for a hospital for treatment of a complicated medical problem the more important question is what hospital has the best
nursing care available
By Syed Mansoor Hussain

Whenever we think of medical care we think mostly about doctors and what they do. If any one comes to me to ask for a recommendation for a surgical procedure, the one thing they want to know about is the reputation of the surgeon and his results. Of course most major medical centres in Pakistan as well as those in more advanced medical countries thrive on the reputations of specialist physicians on their staff.

Every so often, magazines in the US put out lists of the ‘best’ doctors in a particular state who are then parlayed into advertisements for the medical institutions where these doctors practice. 

Physicians who develop a reputation for excellence more often than not deserve it. But then as the saying goes, behind every successful man there is a woman, and for successful doctors it is often not just one woman but many; these women are called nurses.

Medical care is no longer a one-man show. The days when Avicenna or Al Razi strode the earth as giants of medicine are long gone. Even in their times these great physicians needed apothecaries to compound the medicines, tinctures and elixirs they ordered; if the apothecary did something wrong, the great doctor’s attempts at healing could fail.

Modern medicine has advanced to the point where it has become a ‘team effort’. The doctor, or more often the senior doctor or surgeon, is still the person in overall charge of a patient’s care, but he or she needs a lot of help and support to take care of a sick patient. In most major multispecialty hospitals, especially teaching hospitals, there are many junior doctors besides the senior doctor who work under supervision to provide direct care.

Besides these junior doctors, perhaps the most important component of direct medical care is the nurses. Without good nursing care, patients cannot do well. In addition there are now other very important parts of the health care team: the pharmacy department that that fills out the prescriptions, the laboratory personnel that perform all the tests required for diagnosis and treatment, physiotherapists, social workers, dieticians and the entire maintenance crew that keeps the hospital working and the machines humming.

But it is about nurses I want to write about today. More than forty years ago when I started my house job in Mayo Hospital, out of curiosity I looked at the ‘note book’ one of the student nurses was carrying. On the first page, on the very top in bold letters she had written: “You will obey the doctor’s orders at all times”. That was the nursing paradigm then; the nurse’s primary function was to carry out the orders she received from the physician, even the lowly house physician. Even so, many basic medical activities like starting intravenous solutions, drawing blood for blood tests, giving injections, inserting feeding tubes etc. are things I learned from the nurses. And the experienced nurses, especially in the operating theatres, were really a major learning resource for junior doctors like me.

Within a year I was in the US, starting my training as an ‘intern’. There also nurses were still pretty low in the medical hierarchy but there was an important difference. In Pakistan most nurses were from the poor segments of society and often from minority classes. However, in the US, many nurses came from the well established middle class families and quite a few were daughters of physicians. So perhaps there was a cultural difference.

The major difference I noted, however, was that nurses were much better educated and trained in the US and their services were valued at a much higher level. Frankly, during my ‘internship’, it was the nurses who taught me about the basics of medical care in the US. Over the next couple of decades nursing developed rapidly and soon we were seeing nurse clinicians, specialist nurses and eventually nurse practitioners. The latter in the US today fulfil many of the ‘primary care’ functions that doctors used to provide just a few decades ago. 

I remember a time during the 1980s when I was running an intensive care unit (ICU) for cardiac surgical patients, some of my training fellows, especially those from the Subcontinent and the Middle East would often complain to me about the ‘haughty’ behaviour of nurses towards them. I had to explain to them that it took the hospital at least a couple of years to train a specialist (ICU) nurse and then we expected her to work for us for five or more years so the hospital would very much like to retain them while the ‘fellows’ were there for only a year or two. So from the hospital’s perspective as far as patient care was concerned, a well-trained ICU nurse was more valuable than a trainee doctor! Frankly a well-trained nurse was hard to come by and trainee doctors were easy to find.

Fast forward a couple of decades and I am running the department of cardiac surgery at Mayo Hospital in Lahore. The first thing I noticed was that the nurses were no longer primarily from a minority community but a majority were Muslims from an emerging lower-middle class. Even so, most of them still suffered from considerable gender discrimination. Often the nurses complained to me that the doctors treated them badly.

As I compare nursing in the US with that in Pakistan today, two differences are obvious. First, the nurses are not as well-trained or educated as they are in the US and second, women whether they are nurses or not are still held to be of an ‘inferior’ position in our society. Some progress has been made in this regard but obviously not enough.

Going back to the beginning, medical care is a team effort in the modern world and nurses are one of the most important part of such care. When somebody asks me which hospital they should they go for treatment of a complicated medical problem, as far as I am concerned, most doctors are within a couple of percentile points as far as ability is concerned; so a patient will probably get a doctor who can diagnose and prescribe appropriate treatment in most well staffed hospitals. But for me the more important question is what hospital has the best nursing care available. That said, sadly nurses are not provided the educational opportunities or professional support that can make them feel confident enough to act like the important medical care-givers that they really are. Let us not forget that for a patient lying in a hospital bed the nurse is the person who provides direct and immediate bedside care. 

So, if we really want to improve the quality of care in our hospitals, we must make sure that nurses are well-trained and above all get the respect they deserve as medical professionals. 

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

 

 

 

 

In the name of honour
Four recent cases of honour killings in KP call for removal of loopholes from the law and amendment in provisions which go in favour of alleged killers
By Akhtar Amin

Despite hard work of numerous legislators and human rights activists, cases of ‘honour killings’ keep coming up. Four honour killing cases were reported in the Khyber Pakhtunkhwa within one and a half month.

In three honour killing cases, fathers were the killers of their daughters along with their boyfriends and others. The first case was reported at Mardan district on August 11, 2013. According to first information report lodged at Ghari Kapora police station, one Abdul Zaman, son of Abdul Manan and resident of Ghari Daulatzai shot dead his young daughter Afshan along with her lover Rizwanullah when he found the boy at his house along with his daughter.

After killing his daughter and her boyfriend, the accused went to the police station and offered his arrest along with the pistol. The police booked him in double murder case.

The second honour killing case took place in Dera Ismail Khan on July 27. A man killed his daughter and her alleged boyfriend after he found them in a room inside his house in Kathar Yanwalla Mohala.

A city police official, Ghulam Abbas said that the father came to the police station following the incident and confessed his crime. Abdur Rauf Khattak told the city police he woke up to go to the washroom during the night when he saw a light switched on in one of the rooms. When he entered the room, he saw his 15-year-old daughter, Sabina, sitting with an unidentified boy. Seeing this, the father got furious and killed them both.

The accused said he suffocated the boy to death using a pillow and strangled his daughter using a rope. The boy was later identified as Asad Abbas, 20, a resident of Gass Mandi Mohala. The fatha is currently being held in a lock-up at the city police station and a murder case has been registered against him.

The third honour killing case was reported from Swabi district on June 26, 2013, in which Gul Rehan allegedly shot his daughter along with her husband and father-in-law in Chauta Lahor tehsil.

According to Chauta Lahor police official Fazal Malik, police were informed of a shootout in Bazaar Kallay that Sabz Ali reported Gul Rehan, Mustafa and Yousaf, residents of Manki, allegedly barged into his house and opened fire at Rehan’s daughter Shaista, Ali’s brother Sadiq and father Abdur Rasheed, killing them on the spot.

Sabz Ali explained that Shaista had eloped with his brother Sadiq three years ago and they got married in Karachi. The couple had recently returned to their village when her father allegedly killed them both along with Ali’s father Abdur Rasheed. The three accused escaped after the incident.

Earlier, Rehan had demanded the family return his daughter to him, said Ali. According to him, Abdur Rasheed refused and replied Shaista was now his son’s wife. Ali alleged Rehan had then threatened to kill the entire family.

In the fourth honour killing case on August 16, in Swabi district of Khyber Pakhtunkhwa, three people, including a woman and her daughter were killed in the name of ‘honour’ in Kala village.

The Swabi City Police Official Akhtar Syed Ghani Asghar, a former army serviceman, gave his arrest to the police and confessed he suspected his wife Rukhsar Bibi of having an illicit relationship with Inayat Rahman who lived in the neighbourhood.

To confirm his suspicion, Asghar told his wife and daughter Zahra that he was going to Rawalpindi for some work, but instead went and hid on the roof armed with an AK-47. Around 12:30am, Rahman knocked at the gate and his wife let him in, Asghar claimed.

When the two were in the garden, Asghar opened fire on them. Hearing the gunshots, Zahra also came out of her room, where she was sleeping, and was shot accidently, Asghar said.

All three were killed on the spot after which the accused handed himself over to the police. The AK-47 was seized from him.

Legal experts dealing with criminal cases say that the Pakistan Penal Code does not contain any provision which can mitigate the offence of murder committed in the name of honour. The PPC was enacted in 1860. Earlier, Section 300 of the PPC contained a provision of ‘grave and sudden provocation’ that provided lesser punishment for crimes committed in the name of honour.

To check honour killing the parliament enacted the Criminal Law (Amendment) Act 2005, through which amendments were made in some provisions of the PPC and the Criminal Procedure Code.

For the first time a definition of honour-related crimes has been incorporated in the PPC, which now provides: “Offence committed in the name or on the pretext of honour means an offense committed in the name or on the pretext of Karo Kari, Sipah Kari or similar other customs or practices.”

Following this amendment the courts are now bound to sentence to death or life imprisonment a person after he/she is proved guilty of murder on the pretext of honour. However, still in different cases the courts adopt lenient view towards perpetrators.

An amendment has also been made in Section 311 PPC dealing with the principle of Fasad fil Arz (mischief on earth) and the courts have been empowered to sentence a person to over 10-year imprisonment in honour-related offenses. The offense shall also be considered as Fasad fil Arz. That provision has also been rarely invoked by courts.

Legal circles believe that the legislature should remove loopholes from the law and amend provisions which go in favour of alleged killers. They believe that existing provisions of the law should also be fully implemented.

The HRCP in its annual report 2011 mentioned that at least 943 women were killed in the name of honour. The report stated the purported reasons given for this were illicit relations in 595 cases and the demand to marry of own choice in 219 cases. In 180 cases the murderers were brothers and in 226 cases husbands of the victims. Only 20 women killed in the name of honour were reported to have been provided medical aid before they died.

Advocate Noor Alam Khan said that some segments of the society still support this practice. He said there is difference of opinion on this issue, which is evident from judgements of the superior courts.

The lawyer said that in some cases the courts favoured the accused on the grounds of “grave and sudden provocation”, whereas in other cases the courts didn’t accept this ground for an honour-related murder. He said the provision of “grave and sudden provocation” had been omitted from the law, but the judges of superior courts often extended concession to the accused on the same grounds.

The Aurat Foundation conducted a study on honour killings in Pakistan in 2012 which showed that many cases were not reported to the police and if reported, were not classified as honour killings. The study said the courts usually gave verdicts in favour of the killers by invoking the provision of “grave and sudden provocation”.

 

 

 

 

 

finances
Setting a high aim
Universities are not in a good shape financially and call for a serious look into how the situation can be reversed
By Dr Noman Ahmed

As reported in the third week of July 2013, the Higher Education Commission (HEC) has informed the University of Karachi that the university will not get the required funds this year to cover the salary bill of its employees.

Similar response is given to other universities, many of which are facing grave financial problems due to multiple reasons. Increase in the number of students and teaching departments, rise in the number of employees, overall inflation and price hikes in goods and services consumed by universities are some of the reasons.

The previous government had advised the universities to raise their own finances. The staff and management of universities replied that such a move will take some time. Development projects, programmes of faculty development and research initiatives were drastically affected.

In the present budget, allocation for higher education has been only marginally raised. The momentum of growth and progress in the expansion of research work certainly received a big shock. It was particularly harmful for such departments that deal with research, engineering, medicine and applied knowledge, etc. The staff unions are still protesting to restore the old format of university support as existed in the Musharraf regime.

The prevailing situation demands a dispassionate review of the situation and what is expected to come. The federal government, which has spent only few weeks in the power corridors, is reported to have paid circular debt of the power sector. It has also made headway in respect to the affairs of Pakistan International Airlines and Pakistan Railways, two important but financially ailing state bodies.

The government is reported to be planning initiatives to bail out crucial sectors and enterprises. It will be appropriate if a bailout package for public sector universities and degree awarding institutions may also be considered.

This move will have multiple impacts. These institutions extend affordable education and prospects of educational qualifications to the youth even from most disadvantaged backgrounds.

As a country, which has a majority of its population belonging to the young people, increase in this investment is desirable. Two, the relative neglect experienced during the past five years by the universities has contributed to the accumulation of financial liabilities. If this stalemate persists, the quality of education imparted to our future generations shall be affected.

Three, the opportunity of subsidised higher education is perhaps the only worthwhile support from the state to the deserving but needy youth of the society to socially develop and position them to compete for a career.

If the universities are incapable of educating the poor youth, the social frictions in the society will continue to haunt us. And four, with the passage of 18th Constitutional Amendment, provinces shall have the ultimate ownership of higher education sector.

The federal government will do well to scale up the financial health of universities to set a healthy benchmark for centre-province cooperation. If deemed appropriate, a special parliamentary committee can be constituted to look into this matter and submit recommendations to the federal cabinet.

Universities will have to raise their competence level for getting more financial resources on their own. A tried and tested recipe for financial health of universities is the creation of endowments and trust funds.

Almost all the top universities in the world have resorted to this approach. Harvard University had an endowment worth more than US $ 32 billion in 2012. This amount is about twice the foreign exchange reserves of our country. The National University of Singapore has also established sizable endowment finances.

There are at least half a dozen universities in Pakistan that have an existence originating from the British India. Multiple types of endowments can be considered after an intensive interface with prospective philanthropists and donors.

Certain prerequisites need to be fulfilled in this respect. The respective provincial legislatures and governors will have to be approached through the right channels to promulgate necessary bills and statutory instruments to steer this process in a smooth manner after the administrative spade work is done.

Generation, management and release of funds will require utmost transparency and fund management skills to attract progressive donors. There is enormous expertise available in the corporate and even public sectors which can be approached for advice.

Universities imparting technical education have the unique advantage of connecting with corporate magnets. There are many corporations and groups that benefit from the universities in various ways. Induction of young professionals, conduct of basic events and provision of technical advice are a few examples. A more meaningful relationship with the corporate sector can be envisaged by drawing common agendas.

A two-way need analysis to examine the needs and requirements could be the first step. After consulting with institutions, such as the Federation of Pakistan Chamber of Commerce and Industry, (FPCCI), mechanisms can be evolved to develop mutually beneficial collaborations. Assorted consultancy assignments, product development and extending innovative ideas to corporate sector are some of the possibilities.

Every university possesses well-developed space and software, which could be rented out for revenue generation. Auditorium complexes, exhibition halls, video conferencing infrastructure and sophisticated IT hardware are a few examples.

The HEC can convene a series of meetings to gather ideas and feedback for evolving a worthwhile strategy in this direction. 

 

 

 

 

 

 

Spatial shrinking of the government
A validation of the proposed plan of spatial reorganisation of the Punjab Government through automation with some added suggestions
By Asif Mehmood

This follows a recent media report that the Punjab Government is set to slash its staff strength of around 0.8 million people working in different departments at various levels. The initiative that is in the pipeline aims to increase efficiency and to cut its administrative expenditure.

If productivity and austerity are the goals, there is another way out too; that is to think about spatial shrinking of the government — from real to virtual space. Imagine a compact civil secretariat at the same location housing all the ministries with paperless offices; you will be half way out of the maze of Kafkaesque bureaucracy of the largest province of the country.

Today, there are 38 departments, 27 attached formations and an increasing number of autonomous and special institutions scattered all over Lahore. In many cases, even one single agency is located at different points. Many ministries occupy vast estates in the heart of the city and others pay heavy amount to house their portfolios in rented buildings e.g. almost all the arm’s length bodies and project management units (PMUs) etc. Even in the Secretariat, irregular and unjust internal distribution of space and resources among various departments further reinforce thick layers of hierarchy and favouritism instead of cultivating good working environment.

The problem is worsened by the existence of huge dry record and manual handling of files and dossiers in every department that are a source of corruption. For evidence on the case of complex dynamics of space, secretarial records and (in)efficiency, a short random visit to a government department is suggested for the reader.

The net impact of this enormity and fragmented existence is reflected in (i) ever-growing operational costs arising out of inefficient use of resources i.e. from stationery to energy and (ii) undesired low productivity of daily business because of redundant procedures, lack of inter-agency coordination and consequent lack of motivation besides other factors.

The ongoing personnel rationalisation would not prove to be a wholesome policy solution. Consider merger of Energy and Mines and Minerals Departments, the resultant abolition of slots and redistribution of tasks will not reduce costs to a considerable size. Both the ministries will still retain their spaces and use the resources being allocated to them.

The answer lies in reducing real space of these enterprises through automation of records and daily business which will automatically rationalise the staff strength. Shifted to the electronic transactions, you will not need adaftri,          a diary clerk, a stenographer and a personal assistant any more in a standard section of a department. The same pattern will go to the top.

Broadly, an administrative department carries out four functions; internal administration, human resource management, budgeting and developmental planning. The first two are its original tasks. The latter pair is compilation and review of the data received from the field formations. It is relatively easier for these policy exchanges to be shifted to electronic mode as informed civil servants are involved in these transactions. Piloting of the project, the smaller departments should be taken in the first phase.

Still the sailing is not so smooth. The departments will have to decentralise powers to their directorates that interact with public for policy implementation. The existing pool of civil servants will have to accommodate innovation in the public interest and to be ready for training to make this policy a success.

Probably, the biggest challenge would be the new staff rationalisation being born out of new administrative tools and technologies. It would follow massive surplus and lay-offs that have obvious political consequences. The new slim size of the government will also bring in a fresh cadre rift between the federal and provincial services.

Obviously, the trade-offs involved are tough to choose but the outcome is highly desired. The economic situation of the country calls for an immediate reduction in non-development expenses. The donors always press for institutional restructuring and the public wants a speedy delivery. Against the odds of bureaucratic resistance, this is an ideal time for the political leadership to go ahead for such kind of redesigning.

The good news is: the government is already on its way to accommodate innovation in its administrative design. For example, creation of public sector companies to handle policy implementation with a corporate outlook, public private partnership, land record automation and stakeholder consultations in urban affairs are laudable steps. The proposed plan of spatial reorganisation of government through automation would also be a great leap forward.

The writer is an urban policy analyst

 

 

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