Sunday, November 9, 2008

Health Sector in Pakistan - 7


In view of the many forms of deprivation that people from lower income households suffer, the NatRep emphasized the need for a multi-sectoral strategy to facilitate common man’s access to productive assets, technology and raw materials, in addition to common man’s greater participation in decision making at the policy, planning and implementation levels. Improved research is a must on self-employment opportunities, and a special focus on the needs/development of rural and agricultural sector as well. Poverty and the economy are precisely such areas since they cut across and impact all others. In fact, it may not be an overstatement to categorize them as the very foundation of all sectors of national development.

They are obverse images of one another, inter-linked in an inverse relationship – the higher the levels of poverty, the lower the indicators of economic progress, and the more difficult to quantify "progress". It is also very difficult to discuss progress achieved over the past five years when essentially nothing has changed a great deal over the past five decades. Despite some tinkering around the edges of the economy, and despite the veneer of "modernization", industrialization and information technology, the underlying macro-economic system remains intact and untouched. Rooted in feudalism, and increasingly negatively impacted by globalization, it is inherently biased against the interests of rural areas, women, peasants and urban workers. Hence, it is not surprising that poverty levels have demonstrably and measurably risen.

Concurrently, the economy has plummeted, with the foreseeable result of lender/donor-imposed structural adjustment programmes and stiff IMF conditionalities. These have affected the poor most of all – the vast majority of whom are rural agricultural and low-income urban/slums. The current economic situation in Pakistan has its historical roots in the introduction of western farming methods that led to the "Green Revolution" producing unprecedented bumper crops. In the preparatory stage towards industrialization, it was decided that large-scale farming and capital formation (in this case in the agricultural sector) was necessary, even to the detriment of the social sectors and the less-advantaged citizenry. Thus, rural, and subsequently urban, poverty was exacerbated by conscious state policy (with technical assistance from the US-based Harvard Advisory Group) in the 1960s.

This ill-advised pattern of development and continued neglect of the rural areas set off a migration to the cities in search of livelihood that continues to this day. Small land-owning farmers either sold off their land to the large landowners or were relegated to tenant farming or waged labour. While entire families suffered, women and children were the most hard hit for they were no longer able to benefit from the food they themselves produced even as sharecroppers, resulting in under- and malnutrition and greater poverty. The situation was further complicated by sustained macro-economic growth rates, along with agricultural production and rapid industrialization in the 1960s-1980s. During this period, the imbalances in income distribution and poverty levels tended to be masked by using the conventional indicators of "hard core" economic development, by ignoring the glaring disparities among and within the provinces, rural and urban areas and in the social sectors; and also, by heavy infusions of expatriate workers’ remittances and external economic assistance (both loans and grants) from donors. These issues only surfaced in the 1990s when the traditional World Development Report indicators were overshadowed by the UN’s Human Development Reports, with the socio-economic indicators used in the HDI.

With the start of the economic downturn in the mid-to-late 1980s and the visible effects of the IMF-led Structural Adjustment Programme, which slashed social sector budgets, and the macro-economic "reform" agenda, came the realization of the "shocking" nature of social indicators, particularly the statistics on gender inequalities. The most unfortunate feature of successive Governments’ economic policy is that there has been no concerted move towards the uplift of the masses below the poverty line, or in restructuring the economy to launch self-help activities, while simultaneously correcting economic and social damage. The focus has hitherto been primarily on (a) macro-level "crisis management", "damage control" and "stabilization" of the economy – primarily on balance of payments - through monetary controls to revive foreign investment, which had decreased, inter alia because of political and bureaucratic corruption and lack of security, both physical and financial; and (b) tokenism for the masses.

Emerging Trends, Initiatives and Constraints:

The incidence of poverty has been see-sawing, but is back on the increase. Various reliable estimates put it at 38% in 1980, down to 20% in 1990, back up to over 30% in the mid-90s, to a current estimated range of 35-38% (but with a Poverty of Opportunity Index of 44% in 1995). The bulk of the poor are rural and female. With an annual population growth rate of 2.4-2.6%, and an estimated annual economic growth rate of around 3%, any macro-level gains achieved are negated by the sheer size of numbers being added every year. The urbanization rate is close to 4% per annum, putting increased pressure on already weak social sector services in cities and towns (rural-urban ratios are 67.5:32.5%). Mounting debt service payments and military expenditures leave very little for social sector investments. Government expenditures on the social sectors have averaged less than 3% of GNP. This explains to a large extent why economic growth in Pakistan had little or no impact on human development. In addition, factors such as skewed income distribution; the absence of land reforms and agricultural income tax; an overwhelming reliance of fiscal policy on indirect taxes; rampant inflation; a weak public sector and weak or mal-governance have caused gender and social indicators to remain unacceptably low and have perpetuated and exacerbated geographic disparities.

Government Policies:

Pakistan’s having become party to the World Trade Organization in 1998 (without any public debate or consensus) has

(a) imposed unfair rules and quota systems, and

(b) forced open Pakistan's markets, industry and the entire territory to foreign investment. Large-scale chemical/High Yield Variety/mechanized, cash (vs. food) crop agriculture continues to be intensified to earn foreign exchange for external debt repayment.

There appears to be very little scope for alleviating the abysmal conditions of the poor. During the 1990s, promises of land reform were unfulfilled and attention was diverted by distribution of small parcels of state land to poor land-less agriculturists.

Poverty Alleviation and Social Action Programmes:

Over the past five years, the initiative of the Poverty Alleviation (note: not ‘eradication’, as pledged by the Government at the WSSD/Copenhagen 95) Programme, like the vague term "social safety nets", is perceived by many as being another attention-diverting gimmick, as it would be spreading relatively too little money too thin. The requisites for poverty alleviation are no different from those of basic development: primary and reproductive health care, potable water and sanitation, education and skill training, employment, and credit. They must all proceed in tandem - providing one or two without the other will produce poor or no results. If the Poverty Alleviation Programme is restricted to artificial job-creation with no permanent prospects or to extending micro-credit alone, the prospects for success are dim. As long as the concept of poverty alleviation lies in making a little discretionary funding available to the poor majority after having allocated most state/taxpayer money to infrastructure and services for the middleclass and upper class minorities, the programme will be little more than tokenism, because the same outlook pervades planning today that was introduced by the Harvard Advisory Group decades ago.

The objective of the Social Action Programme (SAP) launched in 1992, at a total cost of US$7.7 billion, of which donors provided 10%, was to expand and improve the delivery of social services in four major sectors: basic education, primary health care, population welfare, and rural water and sanitation. The second phase, SAPP-II (1998-2002) has now evolved to consolidate and improve upon the outcomes of the first phase. Though this appears to have had a positive impact in specific areas of health and education, there is no visible impact and all seems to be gone in vain. A common problem in poverty alleviation and creating economic employment for common poor folks in the countryside is that they can only be solved by addressing long-standing structural problems: the lack of the basic infrastructure and services which middle-class urbanites (also rapidly vanishing) take for granted. The other obstacle is that providing infrastructure and services separately will not kick-start economic activity either unless they are created simultaneously.

Future Actions Needed which will ultimately some difference not only in Health but in every sphere:

1. Redistribute available arable state land with access to water, credit and roads, to landless peasants.

2. Carry out land reforms and provide disincentives and incentives for effective implementation; (e.g., strict non-availability of credit to large landowners who have not repaid previous loans; no credit for tractors and harvesters purchase)

3. Encourage gainful employment of rural people by providing a cash incentive (such as partial interest refund on bank-credit) for those who pursue labour-intensive cultivation.

4. Levy a progressive agricultural income tax on all landowners of holdings above subsistence acreage, care being taken to keep taxes on smallholders low and affordable. For example tie tax rates to size of acreage farmed, and substantially increase the rate for those using tractors.

5. Create employment for the rural skilled and unskilled, through projects of needed physical infrastructure (e.g. farm-to market roads, storage silos, wholesale market facilities.

6. Provide credit and incentives for peasants/smallholders growing food other than wheat and sugarcane (vegetables/fruit for at least one season) and cash crops strictly for the domestic market.

• Provide greater credit and incentives for those who exclusively grow food crops.

• Make credit available for other agro-based entrepreneurships.

• Make personal credit available to eliminate the ills and steep charges of non-formal moneylenders (up to 120% annually) that entrap men and women in perpetual debt in rural and urban areas.

1. Help combat water-logging, salinity and soil deterioration by avoiding the causes, namely use of High-Yield Variety seeds that require huge quantities of water; and the use of chemical fertilisers, pesticides, herbicides and weedicides, that destroy vital organisms and nutrients in the soil that are essential to soil health.

2. Remove (a) heavy subsidies to big farmers that virtually amount to free credit and are a disincentive for diversification in commodity agriculture towards value-added goods, b) Institute proportionate cash rewards/incentives to revenue and irrigation officials by performance as measured by criteria requiring the receipt of water entitlements by all farmholdings (including the smallest) falling under their jurisdiction.

3. Adopt a new concept in multi-purpose education/training/ extension services in the form of primary agricultural schools/centres with a rural/agricultural based curricula that includes organic farming, livestock management, soil and water management, and nutritional and self- healthcare knowledge.

• These would double (by shifts) as children's schools and adult training centres.

• building/s should be low-cost and of indigenous materials and built by local contractors using local labour.

• A minimum of 50% of the trainees/pupils/ beneficiaries must compulsorily be women and girls.

• They must compulsorily be located in the village-centre and not on any feudal/private landholding.

1. Ensure 50% allocation for female headed households in all public and private sector land and housing programmes.

2. Take into account the special needs of women with disabilities in the aforementioned macro- and micro-level agricultural policy and programme measures.

Other poverty reduction measures (N.B: recognizing that these are only temporary stop-gap measures and not a substitute for socio-economic development programmes).

1. Take affirmative action to accord priority to low-income members of the society in disbursement of funds and provision of social services, e.g., Zakat and Bait-ul-Maal funds,

2. Promulgate labour laws and rights to cover the majority of Pakistani labour, i.e., low-paid contract and informal home-based workers, or non-unionized industrial workers, who are denied minimum wages and facilities under sub-contract mechanisms arranged by large and medium industrial concerns, including multinationals, to circumvent the law.

3. Reduce or alleviate the triple burden of women’s work: reproductive, domestic (unremunerated) and productive (remunerated), through sharing and reducing child-care responsibilities and household work, including water, fuel, fodder, food preparation, preservation and storage, livestock and traditional craft-work.

4. Provide support to urban working women, especially factory workers, in the form of facilities e.g. child-care, transport, hostels, trade unions, relaxation of age of entry/re-entry into the labour market.

5. Recognize and address the special needs of female-headed households, including the right to formal record, title deeds of land ownership, credit, education, vocational skills training and affirmative action in employment. Also, extending these rights to women in traditional maleheaded households.

6. Address other dimensions of poverty, including bonded labour . Establish public-private-NGO partnerships to enlarge, expand and replicate some of the successful NGO initiatives and pilot programmes over the past 5-10 years.

7. People with Disabilities:

• Ensure that all poverty alleviation programmes specifically address the needs of people with disabilities;

• Devise alternative employment that requires skills that can be adapted in line with the limitations and special needs of peopel with disabilities;

• Make available skills training to all disabled people;

• Provide credit to those with disabilities on softer terms.


Pakistan owed $2.07 billion to the IMF at the end of March 2003. This represents a sharp rise from $1.55 billion in June 2000. The power that the IMF exerts on our policy formulation as a result of this immense and increasing indebtedness cannot be underestimated. Almost everyday, newspapers report the pressure that the IMF is exerting on Pakistan to make policy decisions that have become a dogma with the IMF and are recommended to country after country regardless of its particular situation.

Just in the month of May,the IMF has linked disbursal of loans in Pakistan to privatization of a bank, submission of a fiscal responsibility law in parliament, and elimination of tax exemptions. IMF has also asked the Pakistan government to impose 15 per cent General Sales Tax in the 2003-04 budget on bricks, cement blocks, computer hardware, software, specific machinery etc. Predictably, a recent World Bank and IMF Joint Staff Assessment (JSA) report cited by local several newspapers identifies four risks to the implementation of reforms in Pakistan, including political opposition to reforms, lack of continuity, insufficient institutional capacity and exogenous shocks. No mention of the failure of these policies in countries all over the world from Latin America, to South East Asia. Argentina is a prime example of a country that followed the policy recommendations of the IMF to the letter and now that the country is economically, politically and socially a complete basket case, the IMF has, as in other cases, abdicated all responsibility. We can do no better than to learn from the experience of Argentina to temper our enthusiasm for the IMF and a blind obedience to its dictates.

When Argentina erupted on the international news scene in 2001 for committing the biggest default by a sovereign country on an international loan corporate media focused on fixing the blame on Argentina. In reality, Argentina’s case is a particularly good illustration of how a healthy, rich country was devastated under IMF tutelage. Conversely, Argentina today can also be an inspiring example of how ordinary citizens can organize themselves to rise above the problems created for them by local and international elites.

Argentina’s economic and political health was dealt a deathblow not because it did not follow the IMF dictates closely enough, but because it was indeed doing everything according to IMF agenda. All through the 1990s, opinion makers like the Financial Times hailed Argentina as the ‘star pupil’ of the IMF. The GDP rose by 60% over the decade, and foreign investment poured in. However, this glorious facade hid a crumbling edifice. The wealth flowing into Argentina during the 1990s was a combination of speculative finance and one-off sales: the phone company, the oil company, the post, rails, and airline. Between 1989 and 1999, national debt rose by $80bn and un-employment soared from 6.5% in 1989 to 20% in 2000.

Today 57% of Argentina’s population lives below the poverty line.

Just before the default and right afterwards as well, mainstream economics machinery pounced on the country for plunging itself into international isolation, a sin beyond redemption according to the gods of globalization. The real fear underlying this hysteria was that Argentina might set a bad example for other countries caught in the debt spiral. Other indebted countries could also default and use default on multilateral debt as a bargaining chip with creditors.

The fall of Argentina

Arguably the most developed country in Latin America, Argentina had an adult literacy rate of 91% in the 1960s. It has also been, historically, a highly politicized and unionized country. During World War II the country reaped huge gains from commerce with allied and Axis powers. Peron, a left leaning politician became president soon afterwards. His politics was laden with nationalist and anti-imperialist demagogy, and although his achievements in office did not match up to the rhetoric, his rule did result in significant gains for the working and middle class in Argentina. Popular demands not completely satisfied, unrest in the country continued. Ultimately a military coup in 1976 led to a fierce clamp down. This was a period of immense brutality in which at least 30,000 activists, students, teachers and workers ‘disappeared’. Argentina’s dictators, instead of being shunned by ‘democratic’ institutions like the IMF, in fact received massive doses of loans and advice on how to re-organize the economy. The generals were rewarded handsomely for their policies. In 1976 and 1977 Argentina received more than $2bn in foreign loans, more than the country had received in all of the preceding six years combined. After the disastrous war in Falklands, it became unsustainable for global finance to support a military dictatorship. The reins of power were handed over to a ruling clique that continued the implementation of IMF dictated policies. The country’s external debt had increased from $8 billion to $43 billion under the generals. Therefore, while they were no longer in power, their legacy ensured that the hold of international finance remained firm on Argentinean policy making. President Menem, a Peronist, where the insinuated affiliation to a popular regime in the past is just a cover, rather like Bhutto and his daughter in Pakistan, only implemented IMF policies with increased vehemence.

Menem brought in a former banker Cavallo to manage the finances of the country. Cavallo followed the directions of the IMF to the letter. Argentina privatized state enterprises (which are now facing bankruptcy), raised interest rates to ward off inflation, cut public sector salaries by 35 percent, and then fired 40 percent of its public employees. Under President Menem’s rule, class discrepancy increased dramatically. Cavallo, with IMF approval, also imposed fixed parity between dollar and peso, which was to strangle exports. The country entered a recession in late 1990s. Tens of thousands of firms went bankrupt leading to mass unemployment. By the time a centre-left president, Fernando de la Rua, was elected in October 1999, democracy was a charade in this neoliberal show state, ruled by an extremely corrupt government. In March 2001, the parliament gave Cavallo special powers and in July a zero deficit law was passed. Among other measures, civil service salaries and some pensions were further reduced by 13%; and the draft budget for 2002 proposed to cut spending by 18.6%, $9.2bn less than in 2001. With all these changes, the country was IMF's prize disciple, with 90% of its banks and 40% of its industry in the hands of international capital. By this time, Argentina's external debt stood at $132bn in 2001 and the $40bn that the state collected from privatisation had ‘disappeared’. U

Unemployment had risen to 20%, the number of people in extreme poverty from 200,000 to 5 million, those in poverty from 1m to 14m, and illiteracy from 2% to 12%. Purchasing power had almost halved in the five years leading to 2001. The straw that broke the back of the middle class The final blow was the government’s decision in December 2001 to limit all bank withdrawals to $250 per week in a country where most salaries are deposited and credit cards carry 30% interest rates. Under increasing international pressure to service the external debt, the government’s move was supposedly intended "to stem the hemorrhage of capital". The average Argentinean was not to take out more than $250 a week in cash, although more than $136bn had been taken out of the country by the big national and international speculators, the ruling elite. This move hurt the newly impoverished middle class the most.

Small and medium sized businesses could not access their accounts to meet business transactions. Millions among the salaried middle class struggled to buy basics of food. The strains of this hollowed out economy ultimately led not just the working class, but this increasingly impoverished middle class to turn out into the streets.

This so-called Argentinazo was a spontaneous outpouring of the people and not organized by any of the main political parties. People just left their homes to gather in the capital banging pots and pants, or to block highways refusing to go the government to negotiate, asking instead for the government to come to them. This started on Dec 19, 2001. Within the next 12 days, the country went through five presidents and defaulted on $95bn of its debt, the largest default in history.

IMF’s Star Pupil

Anoop Singh, IMF Director of Special Operations, heading the delegation to Argentina declared in April 2002, “In our view, failures in fiscal policy constitute the root cause of the current crisis.” However, a review of Argentina’s economic data shows that in fact the crisis could not have been caused by the fiscal policy. Inherent in IMF’s declaration is the view that the government should not have increased public spending, which is exactly what Argentina had done. Not only had public spending not increased, it had actually been cut between 1993-2002. The only increase in government spending had been on interest payments on loans. In reality, the crisis was rooted in many of the policies that the Argentinean government had followed on the recommendation of the IMF including pegging the peso to the US dollar, which made Argentinean exports un-competitive, and lifting barriers to capital flow. This meant that Argentina was extremely vulnerable to any interest rate increases in the US. The exogenous shocks of US Federal Reserve’s decisions to raise short-term rates in February 1994 from 3% to 6%, and the Mexican, and Brazilian financial crisis from 1995-1999, all had a devastating impact on the economy of Argentina.

The IMF contends that policy decisions are made by the governments of client countries and are not its responsibility. This argument completely ignores the fact that the IMF actively pressurizes governments into policy directions through threats of loan recalls etc. We can see clearly in the pattern of negotiations between the IMF and Argentina’s government since 2002 that the IMF does and did refuse to allocate new loans, or even provide instalments of previously agreed loans, unless Argentina agreed to damaging new policies, which included re writing its laws to interpret the constitution. The power that IMF exerts stems not just from the loans that it can dole out but also because of its close relationship with the US Treasury department and its role as the head of a creditors cartel than can deny any developing country, access to sources of credit. It is assumed that if the IMF is willing to invest in a country other private investors will also follow suit. F

Finally, the sister organization World Bank is the carrot attached to IMF’s stick. The World Bank withheld previously approved $700 million in loans for social programs from Argentina until it agreed to IMF’s new conditionalities after the default. Many economists have argued that Argentina had a good chance of stabilizing its economy without assistance from the IMF. The country had in 2002, a sizeable balance of credit due to massive shrinkage in imports. The devaluation of peso had made their exports more competitive and the country could invest its surplus in public works to reduce unemployment. Once the economy has started to recover, foreign investment will flow in since investors no longer need to fear a break down. In fact, this is precisely what the US government itself has undertaken in recent recessionary times. However, to make this a reality, the government would need to stem the flow of capital outflow, which would mean some kind of currency control. This is in direct conflict with the IMF’s dogma, which places financial deregulation at a high priority. This means in fact, that the so-called assistance from IMF, given its terms and conditions, is likely to slow or even negate the recovery that Argentina is capable of.

Life After the Default:

More significant than Argentina’s decision to repudiate the IMF, to whose fold its hapless politicians are moving again, and its ability to get some debt written off, are the changes going on in the society that are likely to have a much longer lasting influence. As middle class Argentineans lost their purchasing power and their illusions about growth in an economy at the mercy of international capital, the search for alternatives intensified. Argentineans have started re-organizing from the smallest scale. "Asambleas barriales" or neighbourhood meetings take place as frequently as every two days or every week, not just in working class areas but also in the middle class localities. These meetings discuss anything from how to run the collective kitchen, to what the effect of years of de-politicisation has been. Most significantly a generation of young activists has been politicised almost by necessity. A vibrant underground barter economy is also flourishing in neighbourhood markets where people are allocated credits for goods and services they can provide. The paucity of resources available to these millions in poverty is alleviated by their creativity and spirit of solidarity.

The movement of the unemployed workers called “piquesteros” is gaining momentum. Workers have taken over several businesses that went bankrupt during the current crisis and are managing them themselves. Often the items produced are bartered for other goods or services. They are finding larger and larger networks to barter with. In 2002, around 150 factories have been taken over by their workers and turned into cooperatives or collectives. These include tractor plants, supermarkets, printing houses, aluminium factories and pizza parlours. Decisions about company policy are made in open assemblies, and profits are split equally among the workers. In recent months, the "fabricas tomadas" ("taken factories") have begun to network among themselves and are beginning to plan an informal "solidarity economy". For instance, garment workers from an occupied factory, sew sheets for an occupied health clinic; a supermarket in Rosario, turned into a workers' cooperative, sells pasta from an occupied pasta factory.

Most neighbourhood assemblies and the various small-scale political groups decided not to participate in the elections that concluded on May 18, 2003 with the appointment of Nestor Kirchner, a relatively unknown governor with links to previous regime, as President. It is important to realize that unless the Asambleas barriales and the piquesteros do not form a cohesive front at the political level their potential for radical change will remain limited. The government has increased the violent crushing of the piquesteros recently.

The relevance of Argentina’s experience

Argentinean (or Pakistani) citizens are not unique in having military/civilian dictatorships imposed upon them, which are then sustained by massive doses of international loans. Around the world, this recursive relationship between dictators and global capital serves the purpose of enslaving people through increased indebtedness while forcing them to open up their markets for increasing the profits of large multinationals through threats of loan recalls etc. The insecurity of dictators and their need to silence all opposition is a well-calculated advantage in this relationship to international capital. An added advantage is that once the dictators have been deposed, the people of that country remain indebted as the loans were taken in their name, regardless of the fact that beyond lining the pockets of the ruling junta these loans served little developmental purpose.

As the IMF imposes devastating demands for privatisation of public resources that will increase social polarization, our government only responds with pleas for patience. The IMF pushes through sale of Habib Bank Limited, and the only resistance the Pakistani government can offer is that the process cannot be completed within the deadline specified by IMF, June 30. At the same time we are told that the government is set to increase the budget for ‘law and order’. The increased violence in our society is a direct result of the incredible polarisation that has gone on as schools, hospitals, two square meals and the prospect of employment have moved out of the reach of an increasing number of Pakistanis. The service that our public hospitals and schools provide in spite of a pitiful budget allocation, barely 5% for health and education combined, is remarkable (51% of our budget is used to service loans). We can only imagine how much better the system could be with adequate funding.

Throwing more people in jails, and more policemen on the streets is likely to only increase the magnitude of the problem. As Delia Garcilazo de Ríos, whose son was killed by prison guards, claims, "Police repression and low salary are forms of having social control. When the people ask for things in a blockade or in a march and there's a kid who breaks a window, we are violent. But I ask what's more violent, a youth dying of starvation, a kid being shot from behind, or if we break a window? A window is a material thing, you can fix it, life you can't ever get back."


In Pakistan, the word 'NGO' has become a controversial one. For the common man, it represents a foreignfunded organization (read West) where good looking, educated men and women work together in huge offices and drive expensive vehicles. Such people are often referred as the 'mummy-daddy-group' or the 'burger-family'. Lay people make fun of them in their private sittings - thus gaining pleasure and inspiration both at once. Is there any truth to the theory that NGOs have always been confused about their identity in society? NGOs undoubtedly face resistance from many corners of society for their alleged weak points.

In the post 9/11 era, the NGO-phenomenon has undergone big changes. Many NGOs are being showered with unaccountable sums of money, some are banned and others have had their accounts frozen. Although the scenario is not yet clear since the dust of terrorism is not settling down, let us analyze the phenomenon. Sociologists have defined a non-governmental organization (NGO) as "an independent, flexible, democratic, secular, non-profit people's organization working for assisting in the empowerment of economically socially and socially marginalized groups." According to the World Bank an NGO is a "private organization that pursues activities to relieve suffering, promote the interests of the poor, protect the environment, provide basic social services, or undertake community development." In wider usage, the term NGO can be applied to any non-profit, value-based organization, which depends, in whole or in part, on charitable donations and voluntary services. NGOs range from large charities such as IUCN, CARE, Oxfam, World Vision, Islamic Relief and the Aga Khan Development Network to community based small and self-help groups.

They also include research institutes, mosques, churches, temples, professional associations and lobby groups etc. NGOs are operating in almost all countries of the world. A good proportion of NGOs are based in the US and Europe. Besides these, Far Eastern and Middle Eastern based and home-grown NGOs are also present. They mostly work in Africa, Asia and Latin America, but are also operating in Europe and North America with a different methodology. Many of the NGOs have relationships with inter-governmental organizations such as the United Nations, the World Bank, IMF, the Asian Development Bank, the European Union, International Labour Organization, the World Trade Organization and International Committee of the Red Cross.

The majority of NGOs work primarily on three issues: environmentally sustainable development; human rights and women in development. They have been classified into many categories which are involved in advocacy and lobbying, policy issues and debates, emergency relief, rehabilitation and implementation of development projects/programmes. They also work in the fields of children/youth, communications, conflict resolution, disarmament, disaster relief, drug abuse, education, environment, ethics/values, family, health/nutrition, human resources, law, natural resources, peace, security, religion, trade, finance, transport, population welfare, refugees, science and technology.

With the process of globalization and free market economy, societies around the world have changed a lot over the years and NGOs are being encouraged as packets of change. Governments and international organizations consult them in matters of public interest. A major part of development aid is channeled through NGOs, which has made a significant impact on the social, economic and political activity of a country or a region involved, particularly in the developing world. Consequently, NGOs have become influential in world affairs. The pros and cons of NGOs have been discussed since the very beginning - not only amongst people but also in the corridors of power. The nature and quality of NGOs varies greatly and it is extremely difficult to make generalizations about the sector as a whole.

Generally NGOs have strong grassroots links and field-based development expertise. They have the ability to innovate and adapt to society through their process-oriented approach to development. Participatory methodology, long-term commitment, emphasis on sustainability and cost-effectiveness are the main features of NGOs. These organizations have the ability to experiment freely with innovative approaches and, if necessary, to take risks. They are flexible in adapting to local situations and responding to local needs. Therefore, NGOs are able to develop integrated and sectoral projects. They enjoy a good understanding with people and can render micro-assistance to their needs. They have the ability to communicate at all levels, from the neighbourhood to the top levels of governments. They are able to recruit both experts and highly motivated staff with fewer restrictions than the government.

As is true of other social organizations NGOs have flaws too, which are often pointed out from the public and are highlighted in the media for the benefit of the public. The most commonly identified weaknesses of NGOs include: non-representative ness, paternalistic attitude, limited financial and management expertise, limited institutional capacity, low levels of self-sustainability, isolation and lack of inter-organizational communication and coordination, small-scale interventions and lack of understanding of the broader social or economic circumstances.

Since the mid-1970s, the NGO sector has experienced a rapid growth, not only in the developed countries but in developing ones as well. In Pakistan, NGOs mushroomed in the early 1980s. It was a tumultuous period for the country. The cold war between the US and the Soviet Union was at its peak after the latter's invasion of Afghanistan.

Pakistan was hosting the world's largest number of refugees - 35 million Afghans. Thus, despite ambiguity and suspicions, a mushroom growth of NGOs with different motives took place in the country. It is widely believed that there are 70,000 plus NGOs present today. Most of them are believed to be fake; some allegedly have vested interests and others are said to be not sound technically. Only a few NGOs are practical and have the analytical skills and detailed local knowledge of the complex social, economic and political processes of the country.

These NGOs changed traditional social life and gave rise to a new breed of people - especially in the rural areas. In a society where once a scholar or a teacher was admired and respected, there has been a change and those with high wages, big vehicles and lavish lifestyles have become role models. The once invisible line between the "haves and have nots" have now become prominent. The influential have hijacked some NGOs and made them a source of income. There are allegations that there are many NGOs which exist on paper only. Some politicians and civil and military bureaucrats are allegedly involved with the NGO business. Some of them have taken NGOs directly under their wings. They grant definite favours to certain NGOs when in power and get executive posts when retired. For the last few years there is this new trend that serving bureaucrats are taking long leave from their government jobs and joining top NGOs with lucrative packages.

Such NGOs come under the government's influence directly and thus are no longer non-government organizations in spirit. Some intellectuals claim that after joining NGOs their fellow intellectuals became moneymaking machines. They also say that NGOs were used against democracy and in an engineered way Pakistan was depoliticized - never let democracy flourish in the country. In the 1980s, General Ziaul Haq had given representation to the NGO lot in his cabinet and General Pervez Musharraf did the same after coming to power. NGO people have never been happy with elected governments and have always been under direct attack. The fundamental question for the NGOs is how to move from the current position as unhappy agents of a foreign aid system, to vehicles for international cooperation in the emerging global arena.

Looking at the rapidly changing world today, it seems as though the NGO phenomenon is in a state of inertia - whatever it has done or achieved in its prime time over the last few years is now a thing of the past, nothing special has happened nor is expected to. For many NGOs it has become a big challenge to continue or maintain their past works/achievements; thus they are facing a lot of threats. Maintenance and consistency of projects and donations are the main problems for NGOs today. Meanwhile there are some multinational companies which have taken the work of NGOs directly into their hands.

For example, some oil exploration companies operating in Sindh and Balochistan are also doing community development work and initiating social welfare in their areas of operation. They have opened schools, training centres, health centres, assistance with irrigation, installation of hand pumps, and construction of water canals and supply of portable water to the public on a daily basis. There are companies which are donating a certain amount of their income to charities. This seems a new and growing market strategy of the process of globalization, and may be an effort to cool down the growing anti-globalization movement.

NGOs are in a deep crisis administratively as well. The visionary pioneers and experienced lot are out, or no more remain active as projects are being terminated and down/right sizing of employees is creating chaos in society. The social, psychological and economic impact of NGOs is very complicated. Despite the bleak situation in this new century there is plenty of excitement regarding new possibilities. There is a need to think and act globally. It is difficult to say how NGOs will re-shape themselves. After the tragic events of 9/11, a change in the activities of NGOs and in the behaviour of the donor agencies is being observed. The donors have somewhat assumed that their funds in developing countries were misused in the past at different levels, and they don't want a repeat of the same pattern.

Nowadays the West and developed countries are more interested in the economic strength of their own societies. So a shift of direction has become obvious. In future the well-established or self-sufficient NGOs may be able to continue their development works and social reforms. Others may go out of sight and out of mind soon (the intelligent ones are tailoring themselves according to the changed world). Many donor agencies are taking the work of NGOs directly into their own ands and at the same time some NGOs have started successful businesses. What will be the role of NGOs in the changed world?

Governments, non-governmental organizations, communities and the private sector have to redefine theirrole in the new world.


2- Journals of Pakistan Medical Association

4- A Paper on Health Sector in Pakistan by SPDC.

5- US Central Intelligence Agency.

6- World Health Organization.

7- Asian Development Bank.

8- World Bank.

9- International Monetary Fund.


DATE: April 1, 2004

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