Who shapes health policies?

By Zubeida Mustafa

IN a country where policies are formulated in an ad hoc fashion and are designed to promote the interests of a vested class rather than of the people as a whole, it is creditable that there are researchers trying to inject some rationality into the decision-making process.

That is how I see the move by the Research and Development Solutions, an organisation working on collecting information, analysing it and sharing it with concerned parties. ResDev’s focus is on health, specifically maternal and reproductive health and immunisation. Above all, the research is done professionally under the director Dr Adnan Khan.

And who would deny that our health policy making leaves a lot to be desired? With a measly 0.7pc of GDP being assigned for the health sector in the official budget, Pakistanis end up incurring the heaviest out-of-pocket expenditure on health in South Asia. It does leave one wondering as to how policies are made.

ResDev’s latest research promises to be an innovative one and might prove to be very revealing as well. We will certainly learn how governments make policies. With a daunting title Maternal-Child Health Decision Making Processes and Outcomes in the Public Sector: From Theory to Action: How Does it Work, the study will seek to analyse the factors and the actors that determine health policies and their outcome.

ResDev (Credit: resdev.org)
ResDev (Credit: resdev.org)
Before beginning work on this study, Dr Adnan Khan decided to hold consultations with various stakeholders to decide on the parameters of the research and the people who should be approached. At the Karachi consultation, there was a diverse group that was collected ranging from NGOs, health and population department representatives, medical practitioners, politicians and media persons.

The discussions provided food for thought and one hopes that the research outcome will help reduce the disconnect between policymaking and implementation which has proved to be the bane of Pakistan’s efforts in development. Some influences have been widely recognised: donors have their own agendas and they seek to influence the policies and their outcome.

Research is said to be transformative yet it is not always geared towards advocacy and strategies are not always defined. In fact many policymakers have complained that they do not understand the jargon used by the researchers. Since ResDev has promised an analysis of the existing policies as well, this survey will be of great public interest.

The researchers are quite comprehensive in their approach and plan to include stakeholders across the spectrum to collect information and analyse the policymaking process. This is important considering that our policymaking processes do not strictly follow the regulatory framework that has been formulated.

The researchers at ResDev appear to be fully aware of it and that is why they speak repeatedly about the role of the political economy in decision-making.

What emerged clearly is the competitive relationship between the population department and the health department with each accusing the other of neglecting its duties and thus undermining the other’s work. It reminded me of what UN special adviser Dr Nafis Sadik has been saying for decades now that not keeping population planning under the health umbrella was one of the structural disasters enacted by Pakistan’s planners in the early years. Although last week there was some talk of mergers of programmes taking place, these were more of an administrative nature.

Three key players were not identified as participants in the research. They include the practising clinicians (not health administrators) as suggested by a gynaecologist who was present at the meeting, besides the public and the pharmaceutical sector.

It is something so typical of Pakistan that those taking a policy to the end beneficiaries, the people, are never consulted. For instance, teachers’ opinions are not taken when framing education policies. Similarly, it would be a good idea to talk to the public to determine how the government functionaries are performing and their relationship with the public. Also missing from the research survey is the pharmaceutical sector which is known to play a not very virtuous role in health policies.

Another dimension that needs very careful monitoring and verification if the research has to be authentic is that of data collection. Along with our poor records, the public is also notorious for its amnesia when it comes to dates, numbers and basic facts. We are a nation that lives in some kind of timelessness. Surveys can be a nightmare. One hopes ResDev will address this aspect and brief its researchers well. Departments that are quite cavalier about maintaining records should be thoroughly grilled if discrepancies are discovered.

The final question that will be asked is: will the policymakers take note of the research findings and recommendations? We know the fate of the best policies so diligently framed. Many would still remember the White Paper on Education drawn up by Javed Hasan Aly after a backbreaking exercise when he travelled all over the country with his team to determine what will work for our people. Even before he had finished his work he was “advised” not to question the official policy and produce results conforming to what the government — in those days Musharraf’s — believed was best for the country.

Yet such independent research is important and should be carried out irrespective of what cynics say. It will be instructive to learn how governments make policies in the social sector. If nothing comes out of it, ResDev can at least rightly claim, “We tried.”

Source: Dawn

2 thoughts on “Who shapes health policies?

  1. The only thing surprising is that the phenomenon of government interferance in honest research is regarded as something new. It is not new or considered inappropriate by the governments of all shapes and hews in Pakistan. Even when the government invite a foreign team to advise and is paid for the service they employ thier own civil service to make sure that nothing untowards comes out of the exercise. Shame but true. It reflects on the integrity of the political leadership.
    The surveys, research, and finding legitimate information is and has been the way it is as pointed out. The first step in resolving the problem is to make Pakistan National Broadcasting instrument free of the government control. I do not mean the privately owned and privately controlled outlets. The only thing about the ownership is that such bodies must be registered. The government funded or more approprietly tax payer funded " PTV and local radio" should be a 'Satuatery Body ' and not under the political control so that the true journalism may develop in the country and inform the populace of the unvarnished truth.
    Then it will be possible to let the surveys and research do their part in the development of the country.
    Then it will correctly focus on the priorities of the country.
    For example, the country will know that our priorities will not be distorted by the powerful players in the smoke filled back rooms where shady deals or done. The UK government declared their priorities yesterday. Health is top the priority for expenditure which will not suffer the ostarity cuts, education comes next in the priority list followed by foreign aid, then are listed the areas that will have reduced expenditure the Defence is there to reduce its expenditure. That shows the priorities of a nation that has world wide commitments and needs to earn its living from trade. On the other hand look at our priorities , it paints a shameful picture. Defence takes the lions share , is wasteful of resources allocated to because it is not subject to proper scrutiny by honest aditing.
    Our nation needs health and education as its top priorty not the defence. It should be replace by thoughtful foreign policy to steer the safe way out of the troubled waters.

  2. Your article is quite informative. It would have added to its usefulness if you had added one or two lines about the importance of alternative medicine as well.

    Dr. Ahmad Fakir Muhammad

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