The healing touch

By Syed Saadat |From the Newspaper Dawn

A FAMOUS doctor runs a clinic set up in a house in a posh sector of Islamabad. She even carries out surgical procedures on her patients there.

The treatment area is on the first floor and since there are no elevators in the building, patients, usually pregnant women, are made to go through the ordeal of climbing highly uncomfortable stairs to the first floor. This is not the only thing; after surgery, patients are brought down to the ground floor by guards at the gate who lift the chair carrying the patient and climb down the same set of stairs.

It is akin to a tragic scene from a film when a newborn needs oxygen and everybody runs helter-skelter searching for a cylinder; the receptionist finds one somewhere and dusts it with the cloth used for dusting tables at the reception area. The doctor I am referring to is no ordinary soul. She practises in England half the year and her charges are exorbitant.

Exploitative businessmen in the garb of health service providers are no different from the notorious bhatta mafia as both of them ask for considerable amounts to ensure one stays healthy. Under the 18th Amendment, health has become a provincial subject and to ensure better coordination the government has recently formed the Ministry of National Health Services, Regulations and Coordination, but its scope and charter of duties remains sketchy.

The focus seems to be on projects like the Federal Drugs Surveillance Laboratory and the National Maternal, Neonatal and Child Health Programme, which is good, but the regulation of private hospitals is an area nobody seems to be interested in.

A regulatory body should be established under the ambit of this ministry which works with each provincial health ministry to aggressively take up the following three issues which do not require great spending, but strong will.

First and foremost is the lack of infrastructure at private health facilities. These clinics and hospitals are using humans like guinea pigs to carry out procedures without any proper facilities. During my cursory research for this piece I personally visited several private clinics in the Rawalpindi-Islamabad area and found more than 50pc to be lacking in basic facilities like oxygen cylinders, instrument sterilisation etc.

A regulatory body needs to ensure that the minimum requirements are fulfilled before it allows a clinic, where major medical procedures are to be carried out, to operate.

However, care should be taken so that the sole purpose and function of such a regulatory body does not become that of a permit-issuing entity after collecting hefty fees, or less hefty bribes, like so many other regulatory bodies in the country. The purpose should be improvement of standards and not revenue generation.

Secondly, hardly anyone points out the skewed service charges of business ventures that are mostly owned by doctors and investors who earn their money abroad and come to Pakistan to augment their income. They do so because here health laws are so lenient that they can get away with medical murder without anybody even noticing.

There is no proportion in the treatment cost and the charges. What a regulatory body needs to do is to link the charges and cost. There should be a list of standard costs for most procedures. Barring very complicated cases, most medical procedures can be covered in such a list.

The list should take into account the fact that these ventures earn reasonable profits. Also, the hospitals should be categorised based on their infrastructure, quality of human resources, contribution to research, training of employees, compensation of employees etc and charges should be in proportion to that rating.

Linked to the above, another important factor is the exploitative treatment of employees of such medical institutions. So many private hospitals, in order to evade taxes, do not offer a written contract to employees, no medical cover is provided to even the doctors working there and no annual vacations are granted. The pay is meagre and working hours are inhumane.

Health is not just another sector; it is a matter of life and death. Just as the aviation authorities have rules that limit consecutive duty hours for pilots and associated staff, the health sector requires similar measures otherwise deaths can occur. The problem with such deaths is that they do not make the headlines and the problem with us is that we take notice of only the deaths that do.

Lastly, a regulatory body must carry out annual technical audits to assess the hospitals in various categories and recommendations must be made in light of the performance of hospitals (both public and private) in the annual technical audit.

With the same party ruling in the centre and in Punjab, the largest province in terms of population, such a system of checks and balances is not a dream but can be very much a possibility. Other provinces would follow suit.

Allocating huge funds or building government hospitals is appreciable. But a bit of lateral thinking and forthright spirit is also needed to heal the health sector of Pakistan.

Civil service reforms needed

By Syed Saadat |From the Newspaper Dawn

GEORGE Bernard Shaw said, “I am afraid we must make the world honest before we can honestly say to our children that honesty is the best policy.” The same can be said in light of last week’s elections.

Civil servants are of the essence in terms of fair elections. In an article published in this space last week, the very experienced former civil servant Kunwar Idris said that “woefully, the standards both of personal ethics and commitment to a code of conduct among officials have been steadily declining because the principle of merit has been progressively abandoned in their recruitment, placement and promotion”.

I would like to take the argument to the next level and propose an out-of-the-box solution to inculcate institutional integrity in the civil service. But before that, a brief history of the politicisation of Pakistan’s civil service.

From 1947 to 1971 the civilian bureaucracy was largely independent and the politicians had hardly any influence. The constitutions of 1956, 1962 and the interim constitution of 1972 provided safeguards for civil servants against dismissals, demotions or compulsory retirements on political or nepotistic grounds. The bureaucracy, particularly the elite Civil Service of Pakistan, maintained its integrity and institutional autonomy by virtue of reasonable control over the selection, training and posting of its members.

The downfall of Ayub Khan and the rise of Zulfikar Ali Bhutto, however, gave the political class an opportunity to assert its power. Once the eastern half of the country seceded, the military and the civil bureaucracy were left severely discredited. The former managed to hold its own owing to the nature of the institution, but the structure of the civil bureaucracy was turned upside down.

Bhutto decided to redress the power imbalance between the elected and unelected institutions of the state by withdrawing constitutional protections for civil servants in the 1973 Constitution. The seeds of political influence in the functioning of the permanent executive of the country were sown and political manipulation became a norm.

The civil bureaucracy became even more complacent when, instead of rebuilding the system, subsequent military regimes eroded it further through measures such as large-scale inductions from the military and showed a general distrust for civil servants. Over time, bureaucrats lost the plot altogether and became the most obedient servants of the rulers or rulers-in-waiting instead of the state; they became puppets in the hands of the rulers, military and political.

Can the problem now be reversed? The best bet under the present circumstances would be to provide the civil service with a nucleus — a godfather, so to speak — that each pillar pivotal to the governance of the state of Pakistan already has.

The Pakistan Army as an institution always has a patron in the form of the army chief. The office of the chief justice of the Supreme Court of Pakistan has seen a meteoric rise in stature and this ascent has been institutional rather than on an individual level.

The political executive and legislature is on track and towering leaders will emerge in due course. The media, by virtue of matchless influence in forming public opinion, is its own godfather. This leaves the civil service as practically the only institution that lacks direction and strength of purpose. The only way to provide the requisite strength to this pillar of state is by allowing for a ‘chief’ of the civil service. The incumbent to such office would be appointed for a fixed term protected by the Constitution, neither extendable nor terminable.

The establishment division of the cabinet secretariat might claim to be performing a similar function already, but events such as someone as senior as the establishment secretary being made ‘officer on special deputation’ overnight or succumbing to political pressures to allow illegal inductions in the civil service leave little merit to that claim.

With a chief of the civil services, nobody — not even the sitting prime minister or one in waiting — would be able to influence him for administrative matters such as appointments, transfers, postings and recruitments. This would provide unflinching resolve for civil servants in taking decisions without pressure.

But there’s many a slip ’twixt the cup and the lip, one being the requirement of a constitutional amendment for the setting-up of such an office. All the political parties promised change in the build-up to the elections; the question is, once in the driver’s seat will they remain committed to real change or settle on a cosmetic one? Also, can an opposition that promises to be real push through some real change?

Such measures, being far from public focus, might not bring new votes and would actually block the way of bogus ones. Yet they would be the vanguard of the real change people so richly deserve for showing their faith in democracy by coming out to vote. The suggested change in the structure of the civil service is akin to keeping an endangered species in protective custody until it’s strong enough to survive in the wild: there’s no doubt that the ‘most obedient servant of the state’ is an endangered species.

Irregular inductions

 By Syed Saadat |From the Newspaper Dawn

RECENTLY, the Federal Public Service Commission (FPSC), that is responsible for conducting the Central Superior Services (CSS) exam which candidates have to clear to qualify for the civil services of Pakistan, found itself caught in a scandal.

Some CSS aspirants from Faisalabad had bribed the postal staff to make changes to the answer sheets of the exam as they were being couriered to the FPSC head office.

The aspirants involved could not be identified but thankfully the scheme was foiled. But even if their plan had worked they would have achieved at best a government job in BPS 17, which pays so little that I am sure the amount they paid in the bribe would not be covered for the next five years at least.

All in all, these individuals need to learn from the flawless plan of the lot mentioned in the following paragraphs.

Among his last official activities, the former prime minister Raja Pervez Ashraf approved a summary pertaining to the induction of 284 people from corporations, autonomous bodies and provincial departments to the Office Management Group (OMG) of the Federal Civil Service, a group meant to be filled primarily by candidates who are selected by the FPSC via the CSS exam.

This direct induction means that the appointees will bypass all exams and recruitment procedures, land permanent jobs in the federal government and make a mockery out of merit.

The summary for their induction was moved on March 16, 2013 and approved on March 18, 2013. What prompted such quick action was the fact that the beneficiaries were apparently handpicked for being close to the political class which seems to have taken Otto von Bismarck’s words, “politics is the art of the possible”, a bit too literally.

Out of these 284 people, 130 would be inducted in BPS 18, a level which someone selected on merit after passing the CSS exam with flying colours achieves after at least five years of service. This means that these 130 persons would always stay ahead of those inducted on merit — seniority is the most important criterion for promotion to the next grade.

The move was attributed to the shortage of 200 odd section officers in the Federal Secretariat owing to two periods of decade-long gaps in recruitment to the OMG via the CSS exam. This shortage would have been plugged to some extent when 41 officers selected on merit by the FPSC and currently under training joined the ranks.

The remaining 160 positions could easily have been filled in two years at the most by selecting candidates on merit through the CSS exam. The heavens would not have fallen if regular recruitments were made in this time period for the sake of upholding merit.

However, if the shortage of officers demands that positions be filled with immediate effect, the rules allow officers from other service groups of CSS cadre like the railways, commerce and trade, postal services, etc to be posted on deputation thus ensuring meritocracy.

Compromising on merit for plugging shortages is a mindless move. But we suppose that for the politicians, compromising on merit for the sake of securing votes or favouring cronies is very wise.

So much so that the tale of the tortoise and the hare is currently playing itself out between two class fellows. One of them passed the CSS exam, the other failed it thrice — the maximum number of times a candidate can take the exam. The one who passed is still serving in BPS 17 and the one who failed is now waiting to be inducted in BPS 18 in the same group.

Moral of the story: one should never lose hope in politicians.

Now that the political government has completed its term will all these wrongs be undone? I believe the answer is in the negative. We have seen enough of such anomalies being brushed under the carpet.

One can drive around flouting the law in non-custom-paid luxury vehicles for years while those with respect for the law spend their hard-earned money on cars that are not even safe, let alone luxurious. Then one fine morning an amnesty scheme is announced endorsing the actions of those who broke the law.

Accountability laws appear to come with a cutoff date and those who embezzle public money before that date are allowed to walk away unquestioned — so the earlier you start the better.

This example applies to these irregular inductions to the civil service; even if the next government expels the usurpers from service by which time they have already accrued considerable advances. The government after that restores them with all the perks and wages paid in arrears.

Evidence suggests the man behind this move was a former minister for religious affairs.

The bottom line is that the rule of law and respect for the law are a distant dream in a system where the unlawful becomes lawful in a matter of minutes.

The pensioner’s plight

 By Syed Saadat | From the Newspaper Dawn

GIVEN the way teachers and pensioners are treated in Pakistan, it is not a good idea to be either — worse still is being a teacher first and a pensioner later.

Had it not been for her, I would have not been able to write this; and had it not been for many like her, no reader would have been able to read this. After a career spanning well over three decades, my former teacher retired early last year in BPS 20 from her position as the principal of a college run in the federal capital by the federal government.

It would be no exaggeration to say that if ever anybody truly deserved the emoluments the government bestows on its employees on retirement, it would be her.

However, more than a year has passed but she is still waiting for her retirement benefits. This may be unfortunate, but it’s definitely not unexpected, for hers is not the only case that has been mishandled. The woes of pensioners, if they do not happen to be from the privileged class — which sadly does not include teachers — know no limits in Pakistan.

It is convenient to criticise the bureaucratic elite for slack systems and the media often takes that route. Yet a closer look reveals that the problem does not essentially lie with people higher up the bureaucratic hierarchy; it lies in the lower ranks. Employee unions and the trend of taking away bureaucrats’ discretionary powers have resulted in “look busy, do nothing” governance.

In most departments, a junior to middle-level officer is nothing more than a paper tiger. The maximum action that an officer can take against indiscipline on part of the lowest-ranked government employee is issue a warning or conduct a fruitless inquiry. Resultantly, even pragmatic officers lose motivation and a sense of ownership of their duties over time.

The department that deals with pensions and retirement benefits is section G8 of the Accountant General Pakistan Revenues (AGPR). The section is run by clerks under the supervision of officers that are helpless at the hands of the clever tactics by these clerks. They entwine officers and stakeholders in such a web of procedures and forms that getting a just claim through becomes a hugely arduous task.

The teacher to whom I am referring is a very meticulous individual, which is why the application she submitted to the AGPR was so thorough that even the staff at the AGPR could not come up with any objections — despite their best efforts. Therefore, she was told to come in a fortnight to get her claim.

A couple of weeks later, she was told to her utter surprise that no progress had been made in her case as the file that contained her documents had been lost and couldn’t be found. Such was the audacity of the clerk in charge that he told her rather disrespectfully that if she wanted to get her case processed, she must get duplicate copies of all the documents and submit them again.

Going from one office to another and getting duplicate copies of decades’ old records is an uphill task for even a young man, let alone a 61-year-old woman. Gutsy as my teacher is, she did even that and provided the department with the relevant file. After a few more rounds of objections and rejections the new dossier of documents was accepted.

To cut a long story short, it has now been 15 months since her retirement but she has neither received her pension nor a penny from her retirement benefits. More unfortunate is the fact that she is not an exception; this is the plight of a large number of pensioners who refuse to grease palms or pull strings.

Lastly, something that made me feel very uncivilised and selfish, and prompted me to write on the issue: her reply when I advised her to meet a very senior officer in AGPR who I know personally to get her case processed. She said, “Thanks for your help but I do not want selective justice. Also, I don’t think he would be able to do anything as most of these men are clueless about their duties.”

Then, she left me speechless by quoting the following verses from the poet Daagh, very apt considering her rich taste in literature (having taught the subject for decades), and befitting of the attitudes of our public servants: “Jin ko apni khabar nahin ab tak, Woh meray dil ka raaz kya janein; Jo guzartay hain Dagh per sadmay, Woh yeh banda nawaz kya janein.” (Those who are clueless about even their own self would obviously be oblivious to my secrets. Privileged as they are, they would obviously be oblivious of my sufferings.) Perhaps, in the end, it is relevant to mention that AGPR employees were on strike until an audit and accounts allowance at 20 per cent of basic pay with effect from March 1, 2013, was announced by the prime minister recently. Given inflation, this increase was justified; but I hope for a time when public servants will start taking performance as seriously as they take perks.

A purposeless civil service

By Syed Saadat | From the Newspaper Dawn

HORSE-RIDING was a mandatory part of the training imparted to ICS officers of the pre-Partition era. The reason was less chivalrous and more practical as horses were a viable mode of transport and administrative officers would need the skill ever so often to visit their jurisdiction.

Horse-riding continues to be part of the training of the officers of the Pakistan Administrative Service, the erstwhile District Management Group, even today. Since horse-riding instils self-confidence and improves physical fitness one can argue that this is something which still has at least some farfetched purpose, unlike the countless practices and policies of our civil services that continue to prevail despite having no purpose at all.

It would not go down very well with many of my juniors, seniors and peers, if I say that the ‘elite’ civil service of Pakistan is in fact the ‘obsolete’ civil service of Pakistan.
The morale of the aspirants taking the Central Superior Service (CSS) exam, the gateway to the ‘elite’ civil service of Pakistan, will be badly hit as well and they might end up blaming me for their subsequent failure.

Whatever the reaction, it would not change the fact that from pay scales to promotion criterion, office buildings to office environment, the superiority complex of seniors to the sycophancy of juniors, every single facet of the elite civil service of Pakistan is obsolete.

On a recent trip to Singapore I had the privilege to shadow a young but senior Singaporean bureaucrat. Chee Seng is on a three-year secondment as executive vice-president with a big oil company and will rejoin the government-run Energy Market Authority of Singapore on completion of the period.

Fortunately or unfortunately, Chee Seng invited me to a dinner along with some of his colleagues. The lady sitting on my right having graduated from the London School of Economics on a state scholarship was working in the Ministry of Finance and the young gentleman on my left had graduated from Stanford University and was serving in the Ministry of Trade and Industry. While waiting for dinner to be served, I could not resist the temptation of asking the question that had been rearing its head since the start of my interaction with Chee Seng and his very qualified colleagues. What on earth were they doing in the government sector with such profiles and talent? They were unanimous in stating that it was the place where their talents were put to the greatest use and where they were most appropriately rewarded.

The Singapore civil service is one of the most efficient and least corrupt in the world with some of the highest paid civil servants. This high-wage structure was introduced in the early to mid-1990s and civil service salaries are pegged to those of the private sector.

The Singapore government introduced civil service reforms in the 1990s and a couple of decades down the road these have proven their effectiveness. Public Service for the 21st Century (PS21) was the flagship reform programme. It met two objectives and these are also what we need most to make our obsolete civil service more goal-oriented.

Firstly, civil servants must be motivated into nurturing an attitude of service excellence in meeting the needs of the public with high standards of quality, courtesy and responsiveness. This can be achieved by better perks, ruthless performance audit and breaking the “iron rice bowl” (translation of a Chinese term used to refer to an occupation with guaranteed steady income and benefits).

Office files moving from the desk of one babu to another must be taken over by emails and record registers should be taken over by servers and databases. Many might find it hard to believe that even in this day and age, a single police station anywhere in Pakistan maintains as many as 27 registers related to documentation and still we ask the reason for our police being unable to tackle crime.

Singaporean mandarins are actually very young when compared to Pakistani civil servants who are at a similar level in the hierarchy. Peter Ong, who heads Singapore’s civil service, is 50 years old and has been in senior positions (equivalent to that of a grade 22 secretary in Pakistan) since 2002 when he was merely 40.

On the contrary, in Pakistan a recent change in the promotion criterion of civil servants ensures that an officer must have completed at least three years in BPS 20 to qualify for promotion to BPS 21. To be honest, this would serve no purpose except for blunting the talents of our bureaucrats even further.

Secondly, the Singapore civil service is not closed to hiring talented individuals from outside the service structure. In fact, unlike the case in Pakistan, this practice is not despised by the bureaucrats. Pakistani bureaucrats despise technocrats because the appointment of a technocrat to a bureaucratic position means that the babus are left without their share in the big game.

In Singapore civil service the line differentiating technocrats from bureaucrats has been smudged by transforming bureaucrats into technocrats by providing them with training opportunities and keeping them motivated by a just system of reward and appreciation.

Lastly, as someone once said, insanity is doing the same thing over and over again but expecting different results. Need I say more?