All posts by Zubeida Mustafa

Nine nations vow to end illiteracy by AD 2000

From Zubeida Mustafa

NEW DELHI, Dec 16: In a colourful ceremony held amidst tight security measures, the leaders from the nine high population countries pledged to ensure a place for every child in school by the year 2000 or at the earliest possile moment.

The Thursday morning session was devoted to policy statements in which the participats reaffirmed their commitment to the goal of Education for All (EFA). In the afternoon they adopted the declaration and framework for action.

Inaugurating the summit, Indian President Dr Shanker Dayal Sharma described the EFA as the most important endeavour being undertaken in the world which should accelerate the emergence of a higher level of civilisation in this planet and foster the spirit of humanism, peace and friendship between nations. Continue reading Nine nations vow to end illiteracy by AD 2000

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Pakistan to repeal discriminatory laws against women

By Zubeida Mustafa

NEW DELHI, Dec 14: Women were the focus of discussion on the second day of the pre-summit ministerial meeting on education for all organised by UN1CEF, UNESCO and UNFPA. But all that was highlighted about the low status of women has been said ad nauseam at conference dealing with women and female education.

UNFPA executive director, Dr Nafis Sadik, spoke of the link between women’s education and low fertility and low infant mortality. She called for literacy and education being made easily accessible to women.

It fell to Shabana Azmi, the Indian film personality and social activist, to explode the myth that education by itself improves the status of women.

In a hard-hitting and powerful speech, she said economic emancipation does not come automatically for a woman who earns. Women’s education should be so designed as to lead to their liberation and empowerment, Shabana said. Continue reading Pakistan to repeal discriminatory laws against women

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Health care The haves and the have-nots

 

 

81-19-11-1993c

81-19-11-1993d

 

 

 

 

 

 

By Zubeida Mustafa

A visit to a government hospital in Karachi can be quite a sobering experience. The overcrowding, the dirt, the air of despondency and the staff’s nonchalance towards the ailing hit you in the eye. In contrast, there are the private health institutions which exude affluence and professionalism and have an abundance of manpower to attend to the patients.

The key factor which makes all the difference between the two is finance. Money power can, after all, buy the best talent and help devise and operate the most efficient system. But the dilemma is that the latter works exclusively for those who can pay for it. Hence the big question being posed by health planners today the world over is: “Who should pay for medicare?” The message being conveyed — at least to Third World countries — is that when governments are required to pay from the taxpayers’ money for running the health care system, medical institutions are starved of funds and that affects their performance. Health, like any other consumer item, must therefore be purchased by the user at market prices.

According to the World Bank’s Development Report 1993 titled Investing in health, the government should not be burdened with the expenses of providing comprehensive health cover to the entire population. Broadly speaking, the World Bank suggests that the governments should concentrate more on fostering an environment that enables households to improve the health of their members, while channeling official health spending on a package of essential clinical services, envisaging pregnancy related care, family planning services, TB and sexually transmitted disease control and care for the common serious illnesses of children. For other medical services, the Bank considers it best to promote ‘diversity and competition’.81-19-11-1993b

On reading the finer print, one finds the anomalies too striking. On the one hand, who would argue with the Bank’s suggested strategy of poverty alleviation, promoting education and raising the status of women to improve the health of the people? It is now universally recognised that these are key determinants in the incidence of disease and the physical/ mental well-being of populations.

But on the other hand, the Bank intriguingly does not consider it necessary to categorically suggest an enhancement in the official expenditure on health. What it wants is a redistribution of the existing allocations (most niggardly by any standard) to make them cost-effective. By slashing their expenditures on tertiary health facilities, it is suggested, governments can release scarce resources for the prescribed package of public health interventions.

Public sector hospitals would be left with the job of providing treatment for minor infections, trauma, alleviation of. pain and medical advice to the poor. As for the health outlays on ‘discretionary, less cost effective interventions’, these will be assigned to the private sector. In other words they will be only for the rich who can pay for them while rhe governments’ limited health budgets will provide coverage of a rudimentary nature to the 81-19-11-1993apoor.

How would this strategy work in Pakistan? No one would deny that this country’s approach to public health has failed to produce the desired results the basic health related statistics for Pakistan are dismal and the World Bank report gives ample testimony life expec- tancy at birth was 56 years in 1990 while the median age at death was seven years (which indicates a very high infant mortality rate of 97 per 1000 births). The prevalence of malnutrition in children under five was 57 per cent.

Not surprisingly, the picture of the health infrastructure in Pakistan also emerges as being far from satisfactory. One doctor serves 2940 people and there is one nurse for 6,600 people and 0.6 hospital beds per 1,000 people. Only 25 per cent of the births are attended by medical personnel.

But what one needs to ask is whether it would improve the situation if the already meagre health budget of the government is shifted away from the existing institutions anp! the private sector is inducted “further into the health sector to promote “diversity and competition”.

Dr Haroon Ahmad, who has been involved in the PMA’s policy planning exercises, believes that this will not cure the ills of Pakistan’s ailing health sector. First of all, he emphasises, the slogan of privatisation is a fraud. Since by its very nature the private sector opts for projects which are profitable, this will amount to more and more resources being directed towards curative medicine. Hence, paradoxically, privatisation will amount to deemphasising preventive medicine. Can one imagine the private sector taking up vector control or mass immunisation programmes? At the same time there is no way to ensure that the local governments will step up their contribution to preventive medicine.

Dr Haroon also strongly opposes the strategy of downgrading the tertiary facilities in the public sector to generate funds for community projects. For that he staunchly advocates the enhancement of the national health budget to at least five per cent of GNP. On this there should be no compromise. As it is, Pakistan is spending an abysmally low amount on health. The health budget is barely 0.7 per cent of the GNP. According to the World Bank Pakistan’s per capita health expenditure in 1990 worked out to 12 dollars. It was one of the lowest in the world, the Third World average being 41 dollars. (India spent 21 dollars on the health of each citizen).

After the enhancement, even if the hospitals are given only a fifth of the health budget it would more than double their present resources. The remaining four per cent of GNP which would be set aside for primary health care and preventive medicine would be a massive sum, compared to the peanuts this subsector at.present receives. But without a feasible policy framework, it would be futile to attempt an effective and efficient redistribution of resources. That can be done only when the goals have been clearly spelt out and the strategy defined in a health policy, which is followed by the establishment of a monitoring machinery to ensure honest implementation.

The fact is that the privatisation of the health sector, especially on an ad hoc basis, will impoverish it even further and intensify the inequities in society. It is a myth perpetuated by those calling for an axing of funds to government hospitals that subsidies to them benefit the affluent classes who can afford to pay for the services they use. The state of the public sector hospitals should clearly convince the skeptic that only the indigent visit them. Would it be fair to deny them the few facilities that are accessible to them?

As for the belief that privatisation will promote greater efficiency and equity, nothing could be further from the truth. One has to compare the ratio of the private investment and government spending on health in different countries and their performance to assess the validity of the World Bank’s thesis. Take the example of the United States and Canada. In the former more than 55 per cent of the health expenditure is in the private sector while in Canada the government spends more than 75 per cent of the health budget. According to the World Bank’s logic, the US should be a paradigm of efficiency compared to Canada. On the contrary, America’s number one problem today is the inadequate functioning of its health sector. It is expensive, wasteful and leaves 40 million Americans outside the pale. Canada’s performance appears to be far more impressive than its neighbour’s as its health-related statistics testify.

The real test of the efficiency of a health delivery system is the optimum good it does to the optimum number of people. This is at once reflected in the health related statistics for that country. Simply providing the most modern and sophisticated medical technology and clinical services to a small elite class which can afford to pay for them should not be the goal of a health delivery system.

In Pakistan, already the private sector has emerged as the major investor in health. The Burhanuddin Commission noted in 1984 that 71 per cent of the national health spending came from private sources. According to the World Bank the government’s spending accounted for 53 per cent of the country’s health expenditure in 1990. Why is it that the private sector’s massive financial share has failed to produce results and half the population still has no access to health care?

According to the administration of the Civil Hospital Karachi, the cost of providing care to one patient works out to an average of Rs 5000. But less than Rs 50 is recovered from the patient by way of user charges which were imposed in 1985. As a result the standard of services is poor and the patient is forced to spend outside the hospital on medicines and other supportive services. But it would be a futile exercise to attempt to reduce this gap. True the user’s charges are nominal today but enhancing them to match the actual cost would be criminal. The disadvantaged classes who queue up in our government hospitals in quest of some relief from their agony can hardly afford to spend Rs 5000 on themselves for combating one bout of illness requiring hospitalisation.

Pakistan’s health sector, specially the private component, is badly distorted because of the massive presence of quacks and those claiming to practise alternative systems of medicine such as homoeopathy and tibh. There are estimated to be about 50,000 quacks — as many as there are doctors — in the country today. They provide service to a larger number of patients. The organised sector and the government have failed to eliminate the quacks or regulate the homoeopaths and hakims. The key to their success lies in their accessibility, availability and affordability. Even though their .treatment can be positively harmful at times, they flourish because there is no other option available. Besides they are reassuring and that makes all the difference to gullible and ignorant people who are in search of relief from pain.

It is time to dig out some of the old reports of commissions set up years ago to reform the health sector. These reports lie buried under dust on some bureaucratic shelf. They may still be relevant and could offer a feasible solution to the problems of the health sector. Since the recommendations they contain have never been published or implemented, they cannot be dismissed as being obsolete. The proof of the pudding is in the eating.  

Source: Dawn 19 November 1993


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The price of neglecting social sectors

By Zubeida Mustafa

The state of the social sector in a country is an accurate measure of the value it attaches to human life. For howsoever strong a state might be in terms of military power and rich in economic resources, its institutional greatness will be judged by the quality of life it ovides its citizens.

This is basically determined by the social policy of the government, that is, the priority it gives to providing education, health care, housing and family planning facilities to the people. Pakistan’s performance in this context has not been one of which one can be overly proud. Of course, it depends on how one defines progress. If it is simply a matter of moving forward in terms of absolute numbers from a given baseline — a very low one at that — the country’s achievements over the decades since 1947 might appear to be very impressive. Continue reading The price of neglecting social sectors

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Allocations fail to match verbal commitments to social sector

By Zubeida Mustafa

76-26-06-1993A

In his budget speech, the Federal Finance Minister emphasised that a key element of the government’s economic strategy was “continued priority to development of education, health, nutrition, housing, population welfare and other social facilities”. But the thrust of the budget and the performance in the social sectors in the outgoing year as documented in the Economic Survey, 1992-93 belied any serious official commitment to human resource development.

76-26-06-1993B

Although some sectors such as health and education are financed and managed mainly by the provinces, the federal budget was a fair indicator of the progress to be expected in these areas of national life. It was plain that in actual fact human development figured low in the government’s priorities. There is now greater reliance on the private sector for filling the enormous gap in education and health. Thus of the Rs 257.7 billion federal revenue expenditure only Rs 6.9 billion (2.6 per cent) is to go towards financing the social services. As usual debt servicing and defence will take away the biggest chunks. On the development side, the social sectors will receive a bigger percentage (3.4) but the amount will be smaller in absolute terms (Rs 1.8 billion).

Education has been badly downgraded. The allocations for this sector in both the revenue and development budgets have been reduced. In fact the allocation for education in the Continue reading Allocations fail to match verbal commitments to social sector

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Why not organs from cadavers?

By Zubeida Mustafa

75-18-06-1993.AOrgan transplantation technology was introduced in the West in 1904 when the first corneal graft operation was performed in a New York hospital. The first kidney was transplanted in Boston in 1954. Today, surgeons in the Third World have adopted the technology with a growing measure of confidence and success. Nearly 40,000 transplantations are being performed every year all over the world and this technology has come to stay.

As happens in the case of any scientific breakthrough, many related issues, especially of an ethical nature, are now being debated. The 1 Institute of Urology and Transplantation, Civil Hospital Karachi, which has kept up a constant exchange of views and expertise with transplantation surgeons in Western centres, recently played host to two eminent gentlemen from the Royal Free Hospital, London. Dr Oswald Fernando, a surgeon from Sri Lanka, and Dr Zac Verghese, a basic scientist from India, have worked in Britain since 1963. They are therefore well placed to understand the challenges transplantation technology faces in the socio-economic conditions of the Third World. Continue reading Why not organs from cadavers?

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Education Foundations off to a poor start

By Zubeida Mustafa

IT WAS in his budget speech in May 1991 that the Federal Finance Minister first broached the idea of setting up education foundations to “expand the opportunity for private investment in education”. At that time the proposal had proved to be highly controversial, mainly in conceptual terms. Many found it unacceptable that public funds be channelled into private hands for educating children, presumably for a fee.74-12-06-1993

Two years later, when the veritable thrust in the government’s policy towards the privatisation of the national economy and the social sectors has been unequivocally established, it is plain that the education foundation scheme is here to stay. It still has a number of detractors, though. But this time the criticism is not so much on ideological grounds, with the exception of the voices raised from some diehards on the Left. It is the government’s handling of its own brainchild that is the cause of serious concern. Continue reading Education Foundations off to a poor start

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Population control: the ‘woman factor’

By Zubeida Mustafa

Population planning has been a highly contentious issue eversince men — as well as women — decided to intervene in the natural process of procreation to regulate demographic trends. The controversy has centred round the strategies adopted and the rationale advanced for slowing down population growth rates.

A new dimension was added to the debate when population became a North-South issue, as the industrialised states afraid of being swamped by Third World immigrants, refugees and asylum seekers began demanding that the developing countries take measures to check what has been termed as the population explosion. Continue reading Population control: the ‘woman factor’

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The cheating syndrome

By Zubeida Mustafa

72-26-03-1993.ANine years ago, a fresh medical graduate who had been deeply perturbed by the unabashed resort to cheating by his fellow- students in the final professional MBBS examination requested me to write about it. His greatest concern was that doctors who became doctors by copying in exams and not on the strength of their knowledge would be a serious health hazard.

What began as a scourge in the medical colleges of Karachi is rampant in practically all examinations in Pakistan today. Only a few private institutions now manage to conduct examinations honestly. The magnitude of this problem is coming to be recognised, not so much because of a realisation that it is eating away at the base of our education system and undermining the credibility of our academic institutions, as on account of the outcry from the foreign aid donors.

What leaves no room for optimism, though, is the fact that many of those who alone are in a position to eliminate this evil have been its beneficiaries. Thus how can one really expect any improvement in the system when many of the university and college teachers who conduct examinations and the bureaucrats in the Education Department who formulate policies could be holding the positions that they do by virtue of their having themselves had recourse to unfair means in examinations.

The fact is that in the last few years the cheating virus has found its way into the universities and the civil services exams as well. What is even more disquieting is that those who are expected to reform the system have failed to understand the dynamic of the cheating syndrome. Hence the bizarre strategies that are being suggested. The Prime Minister has been speaking of taking drastic measures against those caught resorting to malpractices, such as trying them in speedy trial courts.

The Masood Nabi Nur Commission appointed by the Punjab government to evaluate the examination system and the eradication of malpractices suggested severe and exemplary punishment to cheaters. Recently the education authorities in Punjab even proceeded to disqualify 6000 students who resorted to malpractices in their examinations — though one cannot be too sure that they have not already used their connections to get the cases against them withdrawn.

But will such ad hoc measures, even if they are very harsh, by themselves help restore credibility to the examinations conducted in the country?

Given the fact that every sector of national life is being seriously eroded as unqualified graduates, engineers, doctors, administrators and other professionals enter the mainstream of the economy, administration and the health and education sectors, the need to tackle the problem of cheating in examinations needs to be addressed in ‘earnest. With the large majority of the students who pass out of our schools, colleges and universities not academically fit for the degree or certificate they have obtained by clearing their examinations by fraudulent methods the country is heading for total collapse

The blame for this phenomenon is placed largely on the examination system which is not a true test of a candidate’s intellect, creativity, academic ability or knowledge. But one can well ask, was our testing method ever an accurate yardstick of a student’s scholarship and creative thinking? Yet previously the cheaters were the exception to the rule. By and large most students attempted to solve their question papers to the best of their ability. The few who did use unfair means were invariably caught and debarred.

The rise in the incidence of cheating in examinations points to two basic facts of life in Pakistan. First, it is.a manifestation of the process of disintegration of the moral fibre of Pakistani society. If the norm is for a customs officer to accept bribe to exempt some goods from the duty that must lawfully be levied, for an income tax officer to accept illegal gratification to help a businessman evade taxes, for an MNA to obtain licenses and bank loans by virtue of his clout, or for a policeman to use his gun to commit dacoity, what is so unusual about a student who cheats in his examinations? All of these are cases of people seeking the easy way to material advancement without any regard for morality and honesty.

Be that as it may, corruption should not be condoned in any sector, including examinations. But cheating in exams is symbolic of something more: the erosion of our education system and its irrelevance to the needs of the people. Since the valueless degrees are linked to the limited employment market, the paper chase and not the acquisition of knowledge has become indispensable.

One must commend the authorities in the Punjab for at least showing more concern at the erosion of the education system which is signified by the cheating syndrome. Whether they will succeed in finding an answer to the problem is not so certain. The province was the first to set up a commission to look into the malpractices in examinations. The Masood Nabi Nur Commission has come out with a report that is interesting and instructive but will not take us far.

One of the most damaging aspects of our examination methods it has identified is: exams have become trendsetters for classroom instruction and home studies. Since schools and colleges teach not to impart knowledge but only to guide their pupils in passing the Board and University examinations the standard of education has gone down.

The Commission comes out with imaginative testing strategies, including a model question paper, as well as other recommendations to instil discipline in the students, such as holding of Zuhr prayers in school and the introduction of a two-year compulsory military draft for all students of 17 years of age.
Methods such as changing over to the objective type of questions, introducing mechanisation in issuing roll numbers and compilation of results, check on the character of paper setters and invigilators, etc will help reduce examination malpractices to an extent only. Many of them have been tried before and have been found to be impracticable in our circumstances. Moreover, it needs to be stressed that if the underlying causes remain unchanged, the candidates will find novel methods to get round the new restrictions.

While recommendations to eliminate cheating in the examination halls and to check examiners, paper setters and result compilers from leaking question papers, giving wrong marks or changing the marks of candidates should be welcome, they can at best be stop-gap measures. What is essential is that the entire education system is revamped so that it becomes a compulsion for the students to study and acquire knowledge rather than obtain a paper degree by fraudulent means.

There is need to vitalise education and link it to the functional needs of society. A glance at our shoddy textbooks which have no bearing on the students and the life they lead is enough to convince anyone of the futility of sending a child to school. Added to this is the factor of corruption and ineptitude of many of the teachers which compounds the situation. A product of the same system, they fail to inspire their pupils or motivate them to acquire knowledge. They exert no moral influence on the young minds, hence they cannot be expected to serve as a force in eliminating cheating.

It is time the citizens took matters into their own hands. Obviously the government’s roie is basic because as the controlling authority it alone can implement the changes which are perceived to be necessary. But citizens, especially the parents of children who are suffering from the rot in the education sector, should come forward to form pressure groups. A concerned father suggests that a citizens’ committee on the pattern of the Citizens- Police Liaison Committee should be set up to make the education authorities accountable for their policies.

The first step it would be required to take would be to tackle the cheating syndrome but this should be in the wider context of education reforms. Otherwise not much would be achieved. The committee should not operate as a parallel education authority. It should seek to get the reforms formulated and implemented through the existing education authorities, heads of institutions and the teachers’ bodies, putting pressure on them to act where action is necessary.

For instance, a beginning could be made by having the curricula redesigned and the textbooks rewritten accordingly. This would obviously apply to the teachers training courses too. But it would take years before enough teachers are produced who are motivated enough and trained in the new teaching methodologies to create an impact on the.existing system. The country cannot afford to wait that long. Hence in the meantime, crash courses and workshops to reorient our teaching methods should be devised. Thus in-service training of the teachers should be made compulsory so that the beginnings of change become perceptible. The stage has been reached where parents and the public have begun to show concern. This concern should now be channelled into tangible action.

A student speaks

“I did not cheat in my last examinations. But I was one of the few exceptions — one of the five out of 275 students in my class. But I can tell you that it was very frustrating being scrupulously honest because I got no immediate rewards for my integrity.

“In order not to cheat I had to study and work hard. That was something I was not really expected to do. For instance, I remember I really slogged over my journal to make it perfect. When I went for my practical examination, the examiner could not even be bothered to look at the journal. He just marked me . without as much as opening the journal. I felt badly let down that he did not even want to see my work.

“Even though I did not cheat I can quite well understand why my colleagues cheat. Many of our teachers are hopeless. What is worse they do not want to take their classes. You will not believe, we did not have a single lecture in some of our subjects. When we complained, no one would listen. How would you expect the students who have not been taught anything not to cheat. “As for the moral aspect, I think they couldn’t care less. Since no teacher is a role model, the students are not motivated to be honest. Besides, many of the teachers are so dishonest themselves that they are not on a moral highground from where they can ask the students not to cheat.

“I admit that the students are also at fault. They don’t attend classes, which would be discouraging for the rare teacher who wants to teach. The student parties create problems of indiscipline and terrorise the teachers as well as the students. That gives the teachers a pretext not to teach. It is a vicious cycle which will have to be broken somehow.

“The whole system is corrupt. I didn’t cheat because I think one can criticise others only if one has been honest oneself. I don’t want to be a part of the system which I want to change. For that I tried to keep myself out of it. I felt extremely isolated. But now I can point out what is wrong, and my moral position is strong.”

Source: Dawn 26 March 1993

 

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No longer the rich man’s disease

By Zubeida Mustafa

70-30-12-1992There was a time when diabetes mellitus was regarded as the rich man’s disease. Not so any more. In fact, the data collected by epidemiologists indicate that today there is a higher incidence of this disorder in the developing countries.

Dr Peter Bennett, who is the head of the Epidemiology and Clinical Research Branch of the National Institute of Diabetes, Digestive and Kidney Diseases of the National Institute of Health, USA, has been investigating the prevalence of diabetes among the Pima Indians in America. His studies have extended.to other societies as well. “Surveys conducted over the last 15 to 20 years give very clear evidence that diabetes has been on the rise in the Third World,” Dr Bennett told me recently. He was in Karachi to attend the Regional Congress of the International Diabetes Federation. Continue reading No longer the rich man’s disease

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