PAKISTAN 2020 | A Vision for Building a Better Future

8/6/2019 PAKISTAN 2020 | A Vision for Building a Better Future

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PAKISTAN 2020

A Vision for Building a Better Future

ASIA SOCIETY PAKISTAN 2020 STUDY GROUP REPORT

BY HASSAN ABBAS


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PAKISTAN 2020A Vs F Bg a

B F

Hassan abbas

My 2011

ASIA SOCIETYPAKISTAN 2020 STudY GrOuP rEPOrT

AsiaSociety.og/Pakistan2020


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I the word of the legedry poet, Fiz ahmed Fiz, whoecetery i beig celebrted i 2011:

We shall see / certainly we, too, will see /

that day that has been promised us

When these high mountains

Of tyranny and oppression / turn to uff

And evaporate

And we oppressed

Beneath our feet will have

this earth shiver, shake and beat

And heads of rulers will be struck

With crackling lightening and

thunders roar.

When from this Gods earths (Kaaba)

All falseness (icons) will be removed

Then we, of clean heartscondemned by zealots those keepers of faith,

We, will be invited to that altar to sit and Govern

When crowns will be thrown offand over turned will be thrones

We shall see / certainly we, too, will see

that day that has been promised us

Then Gods name will remain (Allah will remain)

Who is invisible and visible too

Who is the seer and is seen

Then will rise one cheerI am God!

Who I am too

And so are you

Then the masses (Khalq e Kuda) people of God will rule.

Who I am too

and so are you

Hm dekhenge

(trltio y Miz nqvi)


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Poject diecto

Hassan Abbas, Bernard Schwartz Fellow, Asia Society; Quaid-i-Azam Proessor, South Asia

Institute, Columbia University

Poject Manage

Robert W. Hsu, Assistant Director, Global Policy Programs, Asia Society

Membes

Samina Ahmed, South Asia Project Director, International Crisis Group

Graham Allison, Douglas Dillon Proessor o Government and Director, Beler Center or Science

and International Aairs, Harvard University

Peter Bergen, Journalist; Director, National Security Studies Program, New America Foundation

Christopher Candland, Associate Proessor o Political Science and Co-Director, South Asia

Studies Program, Wellesley College

Stephen Cohen, Senior Fellow or Foreign Policy Studies, 21st Century Deense Initiative,

Brookings Institution

Suzanne DiMaggio, Vice President, Global Policy Programs, Asia Society

Asad Durrani, Lieutenant General (Ret.), Pakistan Military, and Former Director General o

Inter-Services Intelligence; Former Pakistan Ambassador to Germany and Saudi Arabia

C. Christine Fair, Assistant Proessor, Center or Peace and Security Studies, Edmund A. Walsh

School o Foreign Service, Georgetown University

Asher Hasan, Founder and CEO, Naya Jeevan

Andrew Hess, Proessor o Diplomacy and Director, Program or Southwest Asia and IslamicCivilization, Fletcher School o Law and Diplomacy, uts University

Pervez Hoodbhoy, Chairman and Proessor, Department o Physics, Quaid-i-Azam University

Mir Ibrahim, Founder and CEO, Geo V

Pasa 2020 S Gp


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Asma Jahangir, President, Supreme Court Bar Association o Pakistan

Jehangir Karamat, General (Ret.) and Former Chie o Pakistan Army; CEO, Spearhead ResearchInstitute

William Milam, Senior Policy Scholar, Woodrow Wilson International Center or Scholars; FormerU.S. Ambassador to Pakistan

Adil Najam, Director, Frederick S. Pardee Center or the Study o the Longer-Range Future,Boston University

Nigar Nazar, Cartoonist; CEO, Gogi Studios Ltd.

John D. Negroponte, Vice Chairman, McLarty Associates; Former U.S. Deputy Secretary o State

Sania Nishtar, Founder and President, Heartle

Amir Rana, Director, Pakistan Institute or Peace Studies

Ahmed Rashid, Journalist and Author; Former Correspondent, Far Eastern Economic Review

Eric Rosenbach, Faculty Aliate, Beler Center or Science and International Aairs, Harvard

University

Babar Sattar, Founding Partner, AJURIS Advocates and Corporate Consultants

Ayesha Siddiqa, Political Analyst; Author,Military Inc.: Inside Pakistans Military Economy

Shirin Tahir-Kheli, Former Senior Advisor or Womens Empowerment, U.S. Department o State,

and Senior Director or Democracy, Human Rights, and International Operations, U.S. NationalSecurity Council

Frank Wisner, Foreign Aairs Advisor, Patton Boggs, LLC; Former U.S. Ambassador to India and

U.S. Undersecretary o Deense or Policy

Moeed Yusuf, South Asia Advisor, Center or Conict Prevention and Analysis, United States

Institute o Peace

Mariam Abou Zahab, Lecturer, Institut National des Langues et Civilisations Orientales

Mosharraf Zaidi, Columnist, Te News; Policy Analyst

Nasim Zehra, Director, Current Aairs, and Host, Policy Matters, Dunya V


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Foreword |7

Given ever-increasing concerns about Pakistans stability and its impact on the region and beyond, it

is not surprising that there has been a urry o studies on Pakistan in recent months and years. TeAsia Society Pakistan 2020 Study Group seeks to contribute to the thinking about Pakistans uture

by oering three unique and mutually reinorcing dimensions. First, this Study Group is the rst in

recent years to include a signicant number o leading experts rom Pakistan andthe United States,

representing a range o sectors in both countries. Second, rather than viewing Pakistan exclusively

through a security lens, the Study Group set out to examine the crises in Pakistan in a broader and

more comprehensive context. A myopic ocus on security challenges is problematic, as economic

challenges, perennial political tussles, and resource scarcity problems in Pakistan are o equal, i notgreater, concern to the uture o the country. Finally, rather than dwelling on what is going wrong

and resorting to quick xes, the Study Group ocused on generating pragmatic and durable policy

recommendations aimed at improving Pakistans uture prospects with a long-term vision.

Tis report, however, is not meant to represent a consensus among all the members o the Pakistan

2020 Study Group. It presents the ndings and conclusions reached by the project director and thereports principal author, Hassan Abbas, through consultations with Study Group members. While

individual members may disagree with some parts o the report, the Group broadly supports theoverall set o recommendations.

Tis report went to print as the news o Osama bin Ladens death suraced. As the United States and

Pakistan ace an extremely dicult moment in their bilateral relationship, our hope is that the recom-

mendations provided here will help policy makers in both countries and in the broader international

community to ormulate the best and most eective decisions to set Pakistan on a progressive path

by 2020. Moreover, the ideas or reorm contained in this report are directed at civil society actors inPakistan, who in recent years have started to play an increasingly important role.

On behal o the Asia Society, I would like to thank the members o the Pakistan 2020 Study Group or

dedicating their experience and expertise to this enterprise. I am especially indebted to Hassan Abbas

or ably directing the project and or bringing his deep knowledge o Pakistan to bear in penning this

report. My thanks go as well to Suzanne DiMaggio, Vice President o Global Policy Programs at the

Asia Society, or skillully overseeing all aspects o this initiative, and project manager Robert W. Hsuor supporting the many moving pieces rom the initial stages to the nal product. Special thanks are

due to Shahan Muti or his help in writing this report, imothy Orr or coordinating meetings with

Study Group members, and Yasser Kureshi, Kinza Hasan, and Cynthia Lee or providing research

assistance.

During the course o this project, valuable insights were gained rom interviews with senior Pakistani

government ocials, including ariq Pervez, ormer Director General o the National Counterterrorism

Authority; ariq Khosa, ormer Director General o the Federal Investigation Authority; KhawajaMohammad Asi, Member o the National Assembly o Pakistan; Ambassador Nazar Abbas; Amjad

Bhatti, Advisor in the Ministry o Inormation, Islamabad; and Owais Ahmed Ghani, ormer Governor

o Khyber Pukhtunkhwa Province. I grateully acknowledge their valuable insights. Useul eedback


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8|PAkiStAn 2020: A ViSion For BuildinG A Better Future

or the report was also gained rom interviews with students at Government College University in

Lahore, Pakistan and the School o International and Public Aairs at Columbia University in New

York. I also wish to thank the Lotte Group or generously supporting this eort.

Finally, this eort began under the keen eye and passionate commitment o Asia Societys ormer

Chairman, the late Richard C. Holbrooke. Asia Society dedicates this report, and our ongoing work

and programming on South Asia, in his memory, with deep gratitude or his legacy in international

relations and his service in this region in particular.

Vishakha N. Desai

President, Asia Society


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i n recent years, Pakistan has stumbled rom one crisis to another. A number o political andsocioeconomic challenges threaten to urther destabilize a country that already is reeling rominsurgencies along its northwestern border. Pakistans newest democratic government is struggling to

maintain control over parts o its territory where militant religious groups are intent on challenging

its authority and legitimacy. Te countrys conict with India over Kashmir, now in its seventh de-

cade, appears as intractable as ever, and the war in neighboring Aghanistan has deepened instabilitythroughout Pakistan. Te transition rom a near-decade-long rule under a military dictatorship is

slow and complicated, as rampant corruption and politicization o the bureaucracy present huge

obstacles to the state-building process.

Although Pakistans vibrant civil society, relatively open media, and the rise o an independent higher

judiciary provide some glimmers o hope, poor economic and development indicators coupled with

worrying demographic trends pose serious challenges to the well-being o millions o Pakistanis.

Energy shortages have worsened in recent years, and the destruction caused by the oods o 2010

has exacerbated the countrys many strains. In short, how Pakistan manages these challenges in the

coming years will have great consequences or its uture prospects.

While recent reorm eorts in the higher judiciary and constitutional amendments to strengthen

democratic institutions and expand provincial autonomy signal a positive trajectory or the country,

sustaining democratic governance is complicated by radicalization and violence perpetrated by an

intolerant and extremist minority in the country. errorist attacks on respected and cherished Su

shrines throughout Pakistan and high-prole assassinationsincluding the January 2011 killing

o Salman aseer, the governor o Punjab, and the assassination o Shahbaz Bhatti, Pakistans only

Christian cabinet minister, in March 2011illustrate the lengths to which religious extremists inPakistan will go to silence opposition voices in the country. And rather than condemning these acts o

vigilante justice as un-Islamic, the governments slow and timid response to the violence has allowed

voices o intolerance to gather strength.

Preventing Pakistan rom urther deterioration will require a sustained, long-term commitment rom

the government o Pakistan, the United States, and other international stakeholders to promote genu-

ine reorm in the coming decade. Tis commitment must be enshrined in a comprehensive package

o policies aimed at promoting sustainable constitutional democracy, credible and eective rule o lawand law enorcement, a signicant expansion and improvement o the education and health sectors,

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exeCutiVe SummAry |11

their leaders, limit the areas where candidates can contest an election to their home constituen-

cies, and establish a transparent mechanism by which unding can be provided to low-income

candidates.

rle of Law an the JiciayTe weaknesses o Pakistans judicial system not only pose a serious challenge to access to justice, butalso hinder the ght against terrorist groups. In the most basic sense, the rule o law in Pakistan must

aim to protect the rights o citizens rom arbitrary and abusive use o government power. A unctioning

judiciary is a undamental element o any societys rule o law. Expanding reorm eorts rom higher

to lower judicial levels o the system will be critical or Pakistan in the coming years. Te ollowing

measures should be carried out to strengthen the rule o law in Pakistan over the coming decade:

e2002BangalorePrinciplesofJudicialConductwhichstipulatethat,inadditiontoinde-

pendence, the values o impartiality, integrity, propriety, competence, diligence, and equal treat-

ment o all beore the courts are essential to proper judicial conductmust be ollowed.

Respectingtheseparationofpowersenshrinedintheconstitution,aswellasplacingreasonable

limits on the Supreme Courts use osuo moto powers, will contribute greatly to the enhancement

o the rule o law in Pakistan.

Securityforjudges,especiallyforthoseinlowercourtshearingsensitivecasessuchasthosecon-

cerning blasphemy and terrorism, must be enhanced.

eUnitedNationsConventionontheEliminationofAllFormsofDiscriminationAgainst

Women needs to be ratied without delay.

eNationalJudicialPolicyshouldbeimplemented,withanemphasisonprovisionscallingfor

oversight, disciplining corrupt and inecient judicial ocers, setting a timeline and establishingspecial benches or prioritizing cases that can be ast-tracked, and unding courtroom construc-

tion and the hiring o judicial ocers and administrative sta.

IntheFederallyAdministeredTribalAreas,thePakistangovernmentandSupremeCourtmust

establish as a matter o priority a unctioning judicial system with civil and criminal courts and a

reormed legal code to replace the outdated and irrelevant Frontier Crimes Regulation.

Hman developmentPoor governance and weak institutions have eroded the Pakistani publics condence in the govern-

ments capacity to address their everyday needs. Pakistan currently ranks 125th (out o 169 countries)

on the United Nations Development Programmes Human Development Index. Te governmentis investing little in socioeconomic development, which also is hindering the growth potential oPakistans economy and depriving people o opportunities to live a satisying lie.

Ecation

Given the dire crisis in education in Pakistan today, the country will not achieve universal primary edu-

cation by 2015, as set orth in the United Nations Millennium Development Goals. Te ocus should


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be on getting as close to the goal as possible by 2015, with a renewed commitment to achieve universal

primary education by 2020. As a rst step, Pakistan must immediately raise its public expenditures on

education rom less than 1.5% to at least 4% o gross domestic product, and by 2020, the expenditures

should be set to at least 6%. Without making this minimal commitment, a reversal o the worrying

trends in the education sector is unlikely to occur. An immediate increase in public expenditures on

education to at least 4% o gross domestic product should target the ollowing priority areas:

Devisingandimplementinganaccountableandpredictablesystemofteacherrecruitment,

hiring, payment, retention, and training, as well as promotion based on merit, achievement, and

outcomes will greatly improve the quality o education and teacher perormance in Pakistan.

eintroductionofcurriculumreformfocusingonalife-skills-basedapproachtoeducationwill

promote real-world applications o creative thinking and analytical reasoning.

Developingarobustcentralregulatorysystemwillcontributetothemaintenanceofstandards

and the collection o timely data on service delivery, operations, inrastructure availability, scal

fows, learning achievements, teacher perormance, and school outcomes in the education sector.

Adynamicsetofinstitutionalizedrelationshipsshouldbeestablishedbetweenthecentralregula-

tory mechanism and the autonomous and independent subnational government units responsible

or service delivery.

Separatingthehighereducationfunctioncompletelyfromtheprimaryeducationfunction

and enacting legislation to provide specialized management and authority over higher education

institutions will ensure greater regulatory control.

Madrasareformcanbeachievedthroughstrategiesforcurricularimprovement.Publicschool

curricula should be devised, designed, and monitored by provincial governments and combine

religious and secular education.

egovernmentofPakistancanfulllitseducationreformplansifforeigndonorsandinter-

national agencies ocus their aid eorts on establishing a single coherent approach to providing

signicant budget support in this sector.

Health

Pakistan is in need o deep-rooted reorm in its health care system, which must include systems o gov-

ernance outside the public health sector that aect the perormance o health systems. While universal

access to basic public health acilities is an ambitious goal that many Pakistanis desire, investments

now must begin to build a strong inrastructure by 2020 to make this goal attainable. Immediate

action in the ollowing priority areas should begin to address health needs in Pakistan:

Proactivestepstoimprovehealthgovernancewillbegreatlyenhancedbythedevelopmentofa

national consensus on a health reorm agenda.

Inadditiontodevolvingservicedeliveryresponsibilitiesfromthefederalleveltotheprovincial

and district levels, capacity building at the provincial level will allow or the planning, evaluation,


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and implementation o alternative service delivery and nancing mechanisms. Key national

unctions or health should be retained by the ederal structure.

Collecting,analyzing,andswiftlyscalingupsuccessfulbestpracticesfromexistingexamplesof

public service delivery reengineering at the primary health care and hospital levels will contributegreatly to health sector improvement in Pakistan.

Separatingpolicy-making,implementation,andregulatoryfunctionsinthehealthsector,aswell

as adopting market-harnessing regulatory approaches, will lead to an improvement in service

delivery.

Concretestepsforincreasingpublicnancinginhealthmustbeginalongsidemeasuresto

improve utilization and limit pilerage. Strengthening essential services, enhancing social

protection or the inormally employed, and pooling insurance or the unemployed are priority

areas or any increase in revenues in the health sector.

Aninnovativesystemofprivatepublic,employer-andsponsor-subsidized,andpooledgrouphealth insurance can be introduced nationwide, especially or low-income groups.

Investmentsmustbemadetoleveragethefullpotentialofhealthinformationtechnologyin

mobile health systems, with the aim o improving transparency in procurements, increasing

philanthropic subsidies, enhancing quality assurance, and promoting access to medical education.

echnology such as telemedicine can help bridge the gap between rural and urban access to

quality health care.

Collecting,analyzing,anddisseminatinghealthinformationforshapingpolicyandplanning

at the decision-making level can be achieved through the development o an apex institutional

arrangement.

Byadoptingmarket-harnessingregulatoryapproaches,therstpointofcontactinprimary

health care will be broadened while enabling equitable access and the purchase o health care or

many Pakistanis.

Strengtheninggovernmentoversightandregulationsinprivatesectorhealthcaredeliverywill

prevent and check problems such as malpractice and acilitate publicprivate collaborations in

health delivery.

Enegy InfastctePakistan aces chronic inrastructure challenges when it comes to energy sources. In addition to

nurturing social and political instability, Pakistans poor energy inrastructure imposes enormouseconomic costs in the orm o unemployment and loss o revenue. An uninterrupted supply o energy

to uel the nations economy should be the highest priority or Pakistans economic managers. o

meet its current and uture energy demands, the government o Pakistan should invest a minimum

o $5 billion in energy production by 2020. Additionally, the ollowing measures in the energy sector

should be implemented:


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Pakistanmustenhanceitscapacitytocultivatemorepowerfromrenewableenergysources,particularly by improving its ability to harness wind energy along its southern coast and by

making use o solar power.

Alongwithproperupkeepandmaintenanceofexistinghydropowerdams,moredamsareneededto meet current and uture energy requirements in Pakistan. Tis can be achieved by directing

investments toward the construction o a very small number o large dams (Kalabagh dam is one

project that has been stalled) or a larger number o small reservoirs. At the same time, these plans

must be integrated into a broader strategy to improve water resources management throughout

the country. Additionally, Pakistan can dispel the impression that big dam projects will benet

only larger provinces by exploring ways to reach a consensus among all the provinces on its water

inrastructure and providing provinces with legally binding guarantees.

EnergyeciencyinPakistancanbeimprovedifgovernment-ownedpowergeneration

inrastructure is reurbished technologically and power inrastructure is upgraded with a modern

ecient grid.

ForeigndonorscanplayakeyroleinbuildingPakistansenergycapacitybyprovidingexpert

advice to the public and private sectors in Pakistan on energy development and management.

Te United States, in particular, should explore investing in a large energy inrastructure projectin Pakistan, which will not only deepen strategic ties with Pakistan but also create goodwill in the

country.

The Floos of 2010Te massive oods in Pakistan during the summer o 2010 set back all development indicators in the

country. Te enormity o the humanitarian crisis caused by the oods requires concerted planning

and a seamless transition to the rehabilitation and reconstruction phase. Securing resources or thepost-relie phase continues to be a challenge, but every eort should be made in the next two to

three years to ensure that reconstruction in Pakistan proceeds eectively. Te ollowing steps shouldbe taken to ensure that Pakistan ully recovers rom the ood and is adequately prepared or uture

disasters:

Pakistansvulnerabilitytodisasterscanbeaddressedbyimmediatelyimplementingsoundbuild-ing regulations, starting land rehabilitation, de-silting canals and waterways, and constructing

dikes.

IntegratingclimatechangescenariosintothePakistangovernmentsannualdevelopmentplanswill help develop a well-coordinated strategy to address the impacts o global climate change in

the country while ensuring progress toward meeting the Millennium Development Goals targetsor poverty reduction.

Regionalaswellasglobalsupportforreconstructioninood-hitareasiscritical.Toimproveits

credibility and potentially attract more unds or reconstruction, Pakistan must be ully transpar-

ent about the use o international unds.


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Baluchistan, where reports o abductions o political activists by security orces are common,must end.

Arobustwitnessprotectionprogramthatalsoprotectsinvestigators,prosecutors,andjudges

particularly in major criminal and terrorism casescan be created through amendments in theCriminal Procedure Code.

Rigidandimpartialenforcementofthelawwillhelpameliorateethnicstrifeandsectariankill-

ings in cities, especially in Karachi. Tis strategy will require revising the curriculum in publicschools, as well as in madrasa networks, in ways that encourage pluralism and deter any dissemi-

nation o intolerance.

CurricularimprovementinPakistanalongscienticlinescanbemodeledonsimilareortsinIn-donesia and other countries. In this context, progressive religious scholars who challenge violent

extremists must be provided ull security as well as state support or their independent research

work and publications.

Internalsecuritycanbeachievediftheinternationalcommunitydirectlytargetsitsassistance

toward helping Pakistan in this area. Hal o U.S. unding allocated or counterterrorism and

counterinsurgency support in Pakistan, or example, can be directed toward supporting scientic

investigations and enhancing orensic capabilities in law enorcement. Additionally, the rules o

engagement o coalition orces and policies on drone attacks should be reassessed.

relations with Inia an NeighbosPakistans development is almost impossible without regional cooperation, and China and India play

a very important role in this context. An optimistic scenario in the next 10 years would be orPakistans economy to grow at a rate o approximately 5% annually, which would provide a cushion so

that the country could begin investing in long-term human capacity development. However, withouta sustainable peace deal with India that includes an amicable resolution o the Kashmir dispute, this

is unlikely to happen. Tere is a growing realization in India that a ailed Pakistan is not in its best

interest. Peace in South Asia is attainable i Pakistan, its neighbors, and international stakeholders

ocus on the ollowing measures:

PakistanmustsetagoalofincreasingannualdirectbilateraltradewithIndiatomorethan$5

billion by 2020, as increased economic interactions will expand the space or peace constituencies

in both states. As a rst step, India should unilaterally lower nontari barriers to trade with

Pakistan. In turn, Pakistan can accord India most-avored-nation trade status.

Reformingthevisaissuanceprocesswillhelpsupportandstrengthenpeople-to-peoplecontactrom both countries, as will urther encouraging contacts between civil society groups and

student exchange programs in both countries.

EnhancingenergycooperationbetweenIndiaandPakistanisapotentialavenueofdialogue

between the two countries. Cooperative energy projects, such as joint natural gas pipelines,

joint electricity-generation projects, and the development o a common grid system, will go a


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long way toward demonstrating that the people o both countries can benet rom improved

relations.

egovernmentsofPakistanandIndiashouldplaceamoratoriumontheexpansionoftheir

nuclear weapons programs. Pakistans military leaders must realize that more nuclear weaponswill neither improve the countrys nuclear deterrence capabilities nor help in its ght against

terrorism. Furthermore, Pakistan must ensure the saety and security o its nuclear materials.

ByreposturingmilitarilyandbecominglessPakistanfocused,IndiacanhelpeasePakistans

insecurity. War doctrines such as Cold Start should be reviewed and Pakistans apprehensions

about Indian intererence in Baluchistan need to be addressed. At the same time, Pakistan must

dismantle all armed groups ocused on Kashmir.

Pakistan,India,Afghanistan,andotherexternalpowersmustrecognizethatterrorismisbyno

means a state-specic problem; the entire region will have to conront it together. Cooperation

between civilian law enorcement agencies in South Asia should be institutionalized.

eUnitedStatescannotpromoteanamicableresolutionofthedierencesanddisputesbetween

India and Pakistan by supporting one side or the other; it must remain objective. In the case o

Aghanistan, a more proactive role or the United States must include bringing all the regional

stakeholders to the table, ideally under a United Nations umbrella and with the aim o endingthe IndiaPakistan rivalry and proxy war in Aghanistan.

Pakistan aces enormous challenges in the years ahead. But the people o Pakistan have shown a

remarkable resilience in addressing some o these challenges, and there is a high potential or reorm

and development in the country. Progressive and constructive policy shits, as suggested here, are

what truly matter in the long term. Moreover, internal and regional actors will dene and drivePakistans path toward reorm, and the international community, especially important allies such as

the United States, must play a supportive role.


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For much o the past six decades, the Pakistani military has been the dominant player in nationalpolicy making, especially in ormulating oreign policy in the region. Ater the all o GeneralPervez Musharra s military regime in 2008, the army restrained itsel rom interering in government

ormation in the center and in the our provinces. However, one o the most important challenges

acing Pakistan is the militarys dominance o the countrys scal priorities and strategic calculus.

Te military consumes the lions share o state resources and continues to ocus on its ear o Indian

regional hegemony. In this context, one o the biggest challenges or the democratic government is tobuild, consolidate, and strengthen civilian-led democratic institutions.

Te promise o bold political reorms in the

Federally Administered ribal Areas (FAA),

reconciliation eorts with secessionist groups in

Baluchistan Province, economic reorms in the

shape o a newly negotiated National FinanceCommission award involving all provinces

and the ederal government, as well as a major constitutional amendment to enhance provincial

autonomy in critical areas are positive steps toward comprehensive political reorm. Yet it remainsto be seen whether these decisions will be implemented to the satisaction o all local stakeholders.

In this context, corruption in the bureaucracy and political arena is a serious obstacle to democratic

reorm in Pakistan.

Te militarys inuence in the political arena remains pervasive, albeit inconspicuous. It continues to play

an important and inuential role in the countrys internal security policy while retaining its vast business

interests in the country. Financially, the Pakistani military is one o the most opaque in the world. Te

relationship between the civilian government and the military is reminiscent o earlier governments,

many o which eventually ell into conict with the military. Te current government led by the Pakistan

Peoples Party initially made bold gestures to exert its supremacy over the military, although some o

those steps were not well thought-out. For instance, an attempt to bring Pakistans premier intelligenceservices, Inter-Services Intelligence, under civilian control ailed, as this was done in an unduly hurriedand conused manner, causing the army to react and orcing the government to retreat.

Te civilian political orces clearly are not nearly as powerul or united enough to bring about a

sea change in the civil-military power dynamic in Pakistan in the short term. Many in the country

view the prime ministers decision to extend General Ashaq Kayanis tenure as chie o the army or

Cv-ma ras a

dcac

The militarys inuence in the

polcal aena emans pevasve,

albe nconspcuous.


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CiVil-militAry relAtionS And demoCrACy |19

another three years as an indication that the military chie retains his prominent place in governmentand in relations with the United States. Tis unprecedented step possibly was meant to ease tensionsbetween civilian and military leaders, which began in 2009. Te WikiLeaks disclosures on this subjectsubstantiated strong rumors about this civil-military tension.1

In regional policy making, the Pakistani armys General Headquarters is still oremost in deciding andimplementing security and geostrategic policy or the country, especially in regard to its neighborsIndia, Aghanistan, and, to some extent, Iran. op Western civilian leaders, especially rom Washington,D.C., and the European Union, continue to meet with top military commanders in Pakistan in one-on-one meetings, apparently without the involvement o ocials in Pakistans Ministry o Deense.Tis serves to strengthen the role o the Pakistani military in the policy-making arena.

All o this eclipses the act that the military now must contend with a newly empowered judiciarythat has risen in Pakistan through a popular street movement. Historically, all military takeovers o

government were sanctioned or at least rubber-stamped by a compliant judiciary. oday, however,the Supreme Court, which is led by a powerul chie justice who rose to power on the promise tobury the doctrine o necessity that had been used in the past to justiy military takeovers, is unlikelyto sanction a military takeover o the government in Pakistan. Te increasingly popular televisionnews media also has made clear its position that military rule is not the way orward. While a hand-ul o ultranationalist newspaper columnists continue to suggest that the militarys role in politics isneeded, the overall prospects or a military takeover in Pakistan are quite remote under the prevailingcircumstances.

Vision 2020 Objectives and Recommendations: Expecting the military to completely withdrawrom civilian politics within a couple o years o civilian rule is unrealistic. ransition rom military

to civilian rule takes timeas is evident rom previous occasions in Pakistans history, and is shownby experts who have analyzed the urkish and Indonesian experiences. Over the next decade, it ishoped that civilian orces will be able to unction in a way that will strengthen democratic institutionsand that the military will realize the damaging impact it has had in the country through its directinvolvement in governance. Pakistans armed orces are well resourced and largely well organized andcan contribute eectively to national building, provided they remain within their constitutionallyprescribed domain. Te ollowing course o action should be pursued to strengthen democratic rulein Pakistan:

Astrictadherencetotermappointmentsforarmedforcespersonnelbythecivilianleadership

will support the proessionalization o the Pakistani military. Retired or serving generals should

not be appointed to lead civilian institutions.

MakingtheexpendituresofthePakistanimilitarymoretransparentiscriticalandwillrequire

enacting parliamentary legislation through a legislative process similar to those ollowed by many

governments worldwide.

1 ahfq Kyi Mulled Topplig aif ali Zrdri Who Hd nmed succeor: WikiLek, Daily News and Analysis, Decemer 1, 2010


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CiviliansupremacyinthePakistaniarmycanbeestablishedthroughthedevelopmentofinternal

mechanisms, or example, by emphasizing the importance o democracy in military academies,

making the Pakistani militarys budget transparent, and involving civilian leaders rom Pakistans

Ministry o Deense in strategic decision-making processes.

einterestsoftheUnitedStatesandotherimportantalliesofPakistanwillbebetterservedby

giving priority to strengthening relations with the democratic leadership and institutions o the

country.

AchievingstabilityinPakistanandstrengtheningdemocratictraditionsinthecomingdecadewill

require all major Pakistani political parties to be internally democratic and transparent. Strength-

ening democratic traditions will require taking the ollowing steps:

Every political party must hold regular elections or all leadership positions in the party and

enact term limits or oceholders.

No candidate should be allowed to contest an election in any constituency, except in theconstituency where the candidate and his or her amily normally reside.

All parties must establish central and provincial party unds to enable low-income party

workers to contest elections. Allocations must be made through a transparent mechanism.


22/61

Pakistans judicial system has a checkered history. Corruption and ineciency, as well asdeerence to military rule and extraconstitutional interventions, have dened the Pakistanijudiciarys reputation with its citizens.2 Access to justice always has been a problem, particularly in the

countrys peripheral regions. However, in recent years, the judiciary has gained popularity and stature

by deying authoritarianism and by taking on a populist agenda o social justice. In this regard, the

lawyers movement o 20072009, which led to the restoration o the chie justice o the Supreme

Court o Pakistan, Itikhar Muhammad Chaudhry, and helped bring an end to military rule, hasplayed the most signicant role.

Te overall judicial system in Pakistan, however,

aces grave problems, including ineciency, a

judicial backlog, high levels o corruption in

lower courts, lack o training, and insucientaccess to justice in most parts o the country.

In peripheral regions o the country, there is an

absence o any real judicial system. For instance,

1.1 million cases were pending with the countryslower courts as o May 2010, while 150,000 cases remain pending in the High Courts. Te Supreme

Courts backlog o cases in July 2010 was about 17,500. 3 Tis staggering backlog causes signicant

delays. According to a report by the International Crisis Group (ICG), it can take anywhere rom 10to 20 years beore a nal judgment is given in civil cases. A major reason or this backlog is the very

limited resources available to the judicial sector and understang. In 2008, a judicial ocer in Punjab

Province, on average, had to deal with a case list o 1,668 cases a day. Te ICG report calculated that

in Sindh alone, 250 more judges were needed to manage the backlog.4

Insucient government investment in the judicial sector has resulted in corruption and ineciencywithin both the courts and the police, particularly in criminal cases. As a result o inadequate pay

and resources, the criminal justice system is characterized by limited investigation and prosecutioncapacities and long gaps between the ling o charges and trial dates, during which evidence oten

r f la a Jca

in ecen yeas, he judcay

has ganed populay and saue

by defyng auhoaansm and

by akng on a populs agenda of

socal jusce.

2 For hitoricl perpective, ee Itertiol br aocitio, a Log Mrch to Jutice: a Report o Judicil Idepedece d Itegrity i Pkit,Hum Right Ititute Report, septemer 20093 see Kmr Hider, Court Ce bcklog, suffer Commo Pkiti, Dawn, July 21, 2010, for dt o lower d higher court well thesupreme Court4 Itertiol Crii Group, Reformig the Judiciry i Pkit, ai Report o 160, Octoer 16, 2008; ee lo secretrit of the Lw d Jutice

Commiio of Pkit, ntiol Judicil Policy: 2009, http://wwwidhhighcourtgovpk/jp2009/jp2009pdf (cceed Ferury 7, 2011)


23/61


disappears. Criminal cases can take more than ve years to process, except when tried by special

courts such as accountability courts, where cases oten are politically motivated. As a result, Pakistan

has a critically low arrest and conviction rate.

Prisoners on trial oten are not brought to the court on trial dates because o simple deciencies such

as the unavailability o transportation. Prison personnel also seek bribes rom prisoners to ensure ac-cess to a judge. Fearing indenite detention, many detainees are orced to plead guilty to obtain lesser

sentences, or they might bribe police ocials to avoid going through the courts. Te huge backlog

o cases provides opportunities or corruption within the subordinate judiciary, as many judges seek

bribes to x an early hearing. Women are especially disadvantaged in this environment.

Access to justice is even worse in the peripheral regions o the country. For instance, the lack o accessto justice and public rustration over the existing legal system in Swat Valley in Khyber Pukhtunkhwa

Province contributed to an increase in support or the ehrik-e-Niazi-Shariat-e-Mohammadis brand o

brutal but decisive law.5 Ater the brie takeover o Swat by local militants in 2009 and the establishment oa parallel judicial system, the civilian government realized the need or improvement in judicial services.

In FAA, the national judicial system essentially

does not exist because o the outdated and re-pressive colonial laws o the Frontier Crimes

Regulation, which still is enorced. Moreover, the

all-powerul Political Agent makes all judicial

decisions, including arrests and punishments that

cannot be appealed in any court. Te absence o

a real judicial system and the diminishing impor-

tance o tribal leadership, along with the increasing isolation o FAA rom the rest o the country,

have helped bring FAA under the control o religious extremists and militants.

Lately, concern has been growing over the conrontational tone between the judiciary and the executive,

as the judiciary has been seen as encroaching on the powers o the executive and legislature. Meanwhile,

the political leadership is being criticized or ailing to implement judicial decisions. Moreover, the

newly empowered and active Supreme Court has been criticized or not building the capacity and

inuence o district courts, which are the ace o justice or many ordinary Pakistani citizens.

Clearly, the judicial system is in urgent need o drastic reorm, and has been or many years now. In

2009, the newly reinstated chie justice announced the National Judicial Policy, which was intendedto transorm the judiciary into a cleaner, more ecient, and more accessible system.6 A host o reorm

measures were planned, some o which have been initiated. For example, to prevent the politicization

o the judiciary, judges are prohibited rom taking executive oces, and special courts were brought

under the control o the judiciary rather than the executive. Furthermore, placing undue stress on

in FAtA, he naonal judcal

sysem essenally does no exs

because of he oudaed and

epessve colonal las of he

Fone Cmes regulaon.

5 Judicil Reform i swt, Dawn, Mrch 25, 20106 For the full text, ee secretrit of the Lw d Jutice Commiio of Pkit, ntiol Judicil Policy: 2009


24/61

rule oF lAw And the JudiCiAry |23

disposing o court cases rapidly should not compromise procedures or ensuring justice. Tere must

be a distinction between timely as opposed to hasty delivery o justice.

Vision 2020 Objectives and Recommendations: In the most basic sense, the rule o law is a system

that aims to protect the rights o citizens rom arbitrary and abusive use o government power. A unc-

tioning judiciary is a undamental element o any societys rule o law, and expanding reorm eortsrom higher to lower judicial levels o the system will be critical or Pakistan in the coming years. Te

provision o justice in a timely manner will go a long way toward stabilizing Pakistan and, indirectly,

strengthening democracy in the country. In recent years, disenranchised segments o the population

at times have adopted vigilante tactics to mete out justice, which has created a space or extremists

and criminals to assert themselves. Curbing this trend also will check the rise o militant groups in

the country. Te ollowing measures should be carried out in the next decade i improvements in the

rule o law are to be established in Pakistan:

e2002BangalorePrinciplesofJudicialConductwhichstipulatethat,inadditiontoinde-

pendence, the values o impartiality, integrity, propriety, competence, diligence, and equal treat-ment o all beore the courts are essential to proper judicial conductmust be ollowed.7

Respectingtheseparationofpowersenshrinedintheconstitution,aswellasplacingreasonable

limits on the Supreme Courts use osuo moto powers, will contribute greatly to the enhancement

o the rule o law in Pakistan.

Anincreaseinfundingfortheexpansionofcourtsandforagreaternumberofjudgesatalltiers

is needed, and the judicial arms nancial autonomy must be greatly enhanced over the next

decade.

Securityforjudges,especiallyforthoseinlowercourtshearingsensitivecasessuchasthose

concerning blasphemy and terrorism, must be enhanced.

eUnitedNationsConventionontheEliminationofAllFormsofDiscriminationAgainst

Women needs to be ratied without delay. Moreover, police and judicial training must include

sensitization to issues aecting women and minorities.

eNationalJudicialPolicyshouldbeimplemented,especiallyprovisionsthat:

Call or disciplinary action against corrupt and inecient judicial ocers implemented

through the mechanisms outlined in the National Judicial Policy;

Require superior judges to carry out vigorous oversight and conduct surprise checks o lower

courts;

Prohibit judicial ocers rom being posted in a home district or in a particular district beyondthree years, which would prevent judges rom developing close ties, biases, and corrupt rela-

tions within a district; and

7 For the complete text of the 2002 bglore Priciple of Judicil Coduct, ee http://wwwuodcorg/pdf/crime/corruptio/judicil_group/bglore_priciplepdf (cceed april 23, 2011)


25/61


Set a timeline and constitute special benches at the Supreme and High Courts to begin pri-

oritizing cases that can be ast-tracked. Funding or inrastructure, such as the construction o

courtrooms, and or the hiring o more judicial ocers and administrative sta also should be

increased. At the same time, salaries or court sta must be raised and made equal in the our

provinces.

IntheFederallyAdministeredTribalAreas,thePakistangovernmentandSupremeCourtmust

establish as a matter o priority a unctioning judicial system with civil and criminal courts

and a reormed legal code to replace the outdated and irrelevant Frontier Crimes Regulation.

Additionally, legislation is needed to address the role o jirgas and other orms o traditionaljustice and to regulate their use and relationship to the ormal justice system. Extending the

Political Parties Act to FAA will ensure that political parties there can participate in elections so

that these areas can be brought into the mainstream.


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EcationPakistan currently ranks 125th (out o 169 countries) on the United Nations DevelopmentProgrammes Human Development Index, and the government is investing little in socioeconomic

development, which also is hindering the growth potential o the Pakistans economy and depriving

people o opportunities to live a satisying lie. Poverty and illiteracy rates are among the highest in

the region: almost one-quarter o the population lives on less than $1.25 per day, and more than hal

o all Pakistani adults are illiterate. A 2010 review conducted by the Pakistan Education ask Force,

which was ormed by the Pakistani government, highlighted the severe challenges in the countrys

education system. According to the ask Forces report, government expenditures on education as ashare o gross domestic product are estimated to be less than 1.5%. As a result, approximately 1 in 10

o the worlds children not in primary school live in Pakistan, making the country second in the global

ranking o out-o-school children. (See Figure 1). Moreover, 4.2 million girls are out o primary school

compared with 3.1 million boys, highlighting the gender disparity in education in Pakistan, and 30%

Pakistanis have received less than two years o education.

Poor acilities also contribute to Pakistans edu-

cation crisis. Only 36% o public schools are insatisactory condition, with many schools lack-

ing basic acilities. For example, approximately

two-thirds o Pakistans schools have adequate

water and sanitation acilities, while only 39%

have electricity. Blackboards, textbooks, and desks are oten in short supply.8 Te ask Force makesa strong case or education reorm and ocially acknowledging the countrys crisis is a positive

sign.

Pakistans educational system is a battleground or competing political and ideological claims. Even

worse, Pakistans ailing education system potentially has opened the doors or the radicalization o

many young people who lack the skills necessary to participate in Pakistans modern economy. In

2007, the total number o school-aged children (519 years o age) in Pakistan was approximately 60

million, but only 37 million were enrolled in school. O the total number o children enrolled, more

than 21 million studied in public-sector or government schools, and 12 million studied in private-

ha dvp

Appa 1 10 f s c pasc v Pasa.

8 For dt d lyi, ee the Pkit Eductio Tk Force pulictio t http://eductioemergecycompk/pulictio/ (cceed april 23,2011); ee lo Uited ntio Developmet Progrmme, The Rural Wealth of Nations: Pathways to Human Development (new York: UnDP, 2010)


27/61


sector schools. Mosque schools and madrasas accounted or approximately 1.6 million, or about 5%,

o total enrollment.9 Such religious schools operate privately, and, peculiarly, their curricula remain

unregulated by the government.

Poor recruitment, promotion, and retention policies or teachers make matters worse. Increasingly,

teachers are recruited as contract employees on a political basis, but within a ew years, they are

made permanent employees o the government, either at the provincial level or at the ederal level.In most cases, these promotions are awarded without any clear criteria or merit system. As a result,

any increased budgetary burdens on the education sector are not complemented by an enhancement

in the quality o education. Students who attend public schools are at a severe disadvantage when

they enter the job market compared to their peers who attend expensive, elite private schools, where

the curriculum is up to date, teachers are well paid, and English is taught. One study estimates that

wealthy Pakistani citizens typically receive seven more years o education than the poorest. Curriculum

development in Pakistan also suers rom serious problems. Historical misstatements and religiousbias in textbooks continue to exist, and despite eorts by scholars and education specialists to x these

problems, the results have been mixed at best.10

8

7

6

5

4

3

2

1

0

India *Pakistan Bangladesh Philippines Cambodia Malaysia * Korea, Rep.

Female

Male

Total

*Data for 2007

Fige 1: Chilen Ot of Pimay School (millions), 2008

9 Tleemi Chowk, Pkit Eductio sttitic: 20072008, prepred y acdemy of Eductiol Plig d Mgemet, ntiol EductioMgemet Iformtio sytem, Pkit Miitry of Eductio, 2009, http://wwwmoegovpk/Pkit%20Eductio%20sttitic%2007-08pdf(cceed april 23, 2011)10 see, eg, a H nyyr d ahmd slim, ed, The Subtle Subversion: The State of Curricula and Textbooks in Pakistan (Ilmd: sutileDevelopmet Policy Ititute, 2003), http://wwwdpiorg/wht_ew/reporto/stte%20of%20Curr&Textbookpdf (cceed april 23, 2011); dbel Rz Jmil, Curriculum Reform i Pkit: a Gl Hlf Full or Hlf Empty? pper preeted t the semir o school Curriculum Policie

d Prctice i south ai Coutrie, new Delhi, augut 1012, 2009, http://wwwitcecorg/documet/ep09/nCERT%20Pkit%20pper%20bRJpdf (cceed Ferury 7, 2011)

source: World bk, World Developmet Idictor, http://dtkworldkorg (cceed april 11, 2011)


28/61

humAn deVeloPment |27

Vision 2020 Objectives and Recommendations: Given the dire crisis in education in Pakistan today, the

country will not achieve universal universal primary education by 2015, as set orth in the United Nations

Millennium Development Goals. However, the ocus now should be on getting as close to the goal as

possible by 2015, with a renewed commitment to achieve universal primary education in the next 10

years. As a rst step, Pakistan must immediately raise its public expenditures on education rom less than

1.5% to at least 4% o gross domestic product, and

by 2020, the expenditures should be set to at least

6%. Without making this minimal commitment,a reversal o the worrying trends in the education

sector is unlikely to occur. Tis immediate increase

o public expenditures in education to at least 4%

o gross domestic product should target the ollow-

ing priority areas over the next decade:

Devisingandimplementinganaccountableandpredictablesystemofteacherrecruitment,

hiring, payment, retention, and training, as well as promotion based on merit, achievement, and

outcomes will greatly improve the quality o education and teacher perormance in Pakistan. As

part o this system, teacher employment, pay, benets, and pensions should be de-linked rom

the basic pay scale regime, which currently guarantees permanent employment and providesvirtually no accountability.

Teachingprofessionalsshouldbeseparatedfromschoolmanagementandadministrationand

rom the education sector administration and management system. Without specialization, thebest teachers stop teaching mid-career and enter the bureaucracy as managers, which is both

highly inecient and ineective. Pakistan also must invest in more teacher training acilities.

eintroductionofcurriculumreformfocusingonalife-skills-basedapproachtoeducation,asopposed to rote memorization o esoteric inormation that has little or no vocational relevance,

will promote real-world applications o creative thinking and analytical reasoning

Developingarobustcentralregulatorysystemwillcontributetothemaintenanceofstandards

and the collection o timely data that can be made available to the general public on servicedelivery, operations, inrastructure availability, scal fows, learning achievements, teacher

perormance, and school outcomes in the education sector.

Adynamicsetofinstitutionalizedrelationshipsshouldbeestablishedbetweenthecentralregula-tory mechanism and the autonomous and independent subnational government units respon-

sible or service delivery. Greater eciency will also be achieved by reducing the size and scope o

the ederal Ministry o Education and divesting ederal schools to the jurisdictions in which they

exist. Whenever possible, ederal employees should be transerred to the province o their choice.

Asystemofincentivesisneededtobringteacherstounderservedlocationsandtopreventthe

concentration o teaching talent in the big cities. Legislation providing ree transportation or

women teachers to schools within their districts that require emale teachers also will strengthen

education in underserved areas.

As a rst step, Pakistan must

a as s pbcps ca fss a 1.5% a as 4%f gss sc pc.


29/61


Anovelsystemofpartnershipsintheeducationsectorisneededtoinvolvethepublicandprivate

sectors and nongovernmental organizations. Tese partnerships will promote the active sharing

o knowledge, as well as the sharing o human capital and resources through peer-to-peer student

exchange programs, which will promote social cohesion and bridge the quality gap in educationacross the socioeconomic divide. Te private sector is especially important in this regard, as it will

help stimulate scientic and technological exchanges and create new opportunities or improving

Pakistans education system.

Separatingthehighereducationfunctionallcollegeanduniversity-leveleducationbeyond12

years o schoolingcompletely rom the primary education unction, and enacting legislation to

provide specialized management and authority over higher education institutions, ideally central-

ized within Pakistans Higher Education Commission or by province, will ensure greater regula-

tory control.

Madrasareformcanbeachievedthroughstrategiesforcurricularimprovementandappropriate

changes in public school curriculum. In this regard, a school curriculumdevised, designed, andmonitored by provincial governmentsthat combines religious and secular education, as sug-

gested by both religious scholars and educationists, will oer some advantages.

egovernmentofPakistancanfulllitseducationreformplansifforeigndonorsandinter-

national agencies ocus their aid eorts on establishing a single coherent approach to providing

signicant budget support in this sector. Tis aid must be conditioned on the Pakistani govern-

ments achievement o unding benchmarks (e.g., education expenditures as a percentage o the

countrys gross domestic product).

Health

Pakistan has a mixed health system. Te public inrastructure comprises three tiers o service deliveryunder the Ministry o Health. Public nancing covers only one-quarter o the population, and medical

impoverishment as a result o catastrophic health expenditures is very common. Low remuneration

in the public system leads health providers to hold dual jobs and oten contributes to absenteeism

and a propensity to reer public patients to their private practices. As a result, public acilities are

woeully underresourced, suer rom poor maintenance and administrative ineciency, and routinely

underperorm. Te situation is urther complicated by corruption in procurements and preerentialtreatment in sta deployment, which engineers the health system to provide benets to a select ew.

In such an environment o poor public health service provision, market mechanisms have arisen to

meet the ever-growing demand o a burgeoning population. Te extensive market system is made up

o a diverse range o nonstate actors, including hospital trusts, nongovernmental organizations, social

enterprises, and or-prot health insurance companies. Private-sector service provision is predominant,

but the lack o regulatory oversight o private acilities has resulted in poor standardization o qualityo care. Malpractice is also a common occurrence.

While Pakistan has excelled at producing graduates o both public and private medical colleges and

universities, a large number o these graduates opt to study abroad or postgraduate medical training


30/61


and live abroad (primarily in the United States and the United Kingdom) because o a perceived lacko nancial incentives and quality o lie in Pakistan. Tis has created a massive medical brain drain,

which is urther complicated by low nancial remuneration or general physicians in Pakistan, urban

saturation, and an urbanrural mismatch in human and inrastructural resources.

Overall, the health system in Pakistan perorms poorly with respect to six key perormance assessment

yardsticks: access in rural and peri-urban areas, airness in nancing, preventive health awareness, health

improvement, ormal training o ancillary health workers (e.g., nurses, paramedics, occupational therapytechnicians), and equity in outcomes and responsiveness. Te determinants o poor perormance are

rooted in the interplay o what has been described as a triad o determinantsinadequate state und-

ing, an unregulated role o the private sector, and lack o transparency in governance.11 aken together,

these actors greatly compromise the quality and equity objectives o public health care delivery. Deep-

rooted reorm is needed with actions at several levels to address this systemic distortion.12

More importantly, Pakistans poor health care system has had a proound impact on human develop-ment in the country. Rates o inant mortality in Pakistan are high at 70 per 1,000 births, compared to

a regional rate o 55 and a global rate o 43. (See Figure 2). More than one-third o the deaths among

children under the age o ve in Pakistan are caused by treatable illnesses such as pneumonia and

diarrhea, and 60% o child deaths in Pakistan are the result o water- and sanitation-related diseases.

In the FAA alone, 135 out o 1,000 children die rom curable illnesses every year. Approximately

260 in 100,000 women die rom childbirth,

compared with 25 per 100,000 in Organisationor Economic Co-operation and Development

countries.13 At the same time, reproductive health

services in Pakistan are lacking and the ertility

rate in the country is 3.9 children per woman.Te doubling o the population in a little more

than a generation will not be sustainable.

Government investment in the health sector is low, and more than 75% o health nancing is out

o pocket. Primary research indicates that monthly expenditures on routine, primary, and secondary

care are as high as 20% per capita income in major urban centers.14 Te silver lining is that public-

sector expenditures on health as part o overall public expenditures have increased recently, and the

government has started to give greater priority and allocate relatively more resources to the health

sector.15

11 For detil, ee si nihtr, The Mixed Helth sytem sydrome, Bulletin of the World Health Organization 88 (2008): 7475, http://wwwwhoit/ulleti/volume/88/1/09-067868/e/ (cceed april 23, 2011)12 si nihtr, Choked Pipes: Reforming Pakistans Health System (Oxford Uiverity Pre, 2010) acceed t http://wwwiihtrifo/choked-pipephp13 World bk Dtk, http://dtkworldkorg/ddp/homedo?queryId=189 (geerted april 11, 2011)14 see ny Jeev t http://wwwjfkorg for dt15 For exmple, the Pkit govermet expediture o helth icreed from 06% of it gro dometic product i 2005 to 16% i 2006 For helthstatistics, see World Health Organization, Pakistan Health Prole, August 13, 2010, http://www.who.int/gho/countries/pak.pdf (accessed February 7, 2011);

d idem, Pkit, i Country Cooperation Strategy at a Glance, april 2008, http://wwwwhoit/coutryfocu/coopertio_trtegy/ccrief_pk_epdf(cceed Ferury 7, 2011) see lo Uited ntio Developmet Progrmme, The Rural Wealth of Nations; d Us agecy for ItertiolDevelopmet, MCH Progrm Decriptio: Pkit, July 2008, http://pdfuidgov/pdf_doc/PDaCn952pdf (cceed Ferury 7, 2011)

m a - f as ag c

the age of ve in Pakistan arecas b aab sss.


31/61


Fige 2: Matenal an Infant Motality rates in Pakistan, 2008

Since 1950, Pakistan has received $58 billion in oreign aid or the health and population sectors,

but the country has little to show or it. One reason may be that many Pakistani ocials associated

with oreign aid programs have beneted privately and personally rom the programs that they were

supposed to supervise and implement in the public interest.16

Vision 2020 Objectives and Recommendations: Pakistan is in need o deep-rooted reorm in its health

care system, which must include systems o governance outside the public health sector that aect healthsystems perormance. While universal access to basic public health acilities is an ambitious goal that

many Pakistanis desire, investments now must begin to build a strong inrastructure by 2020 so that this

goal is attainable. A social protection system or health should bring improvements in the existing system,

rather than reinventing the wheel. Much can be achieved by reorganizing existing nancing arrange-

ments to increase access to quality private health care or large, low-income, and vulnerable populationsthat currently are at the mercy o a dysunctional public health care system. Immediate action in the

ollowing priority areas should begin to ensure that all Pakistani citizens health needs are provided or:

Proactivestepstoimprovehealthgovernancewillbegreatlyenhancedbythedevelopmentofanational consensus on a health reorm agenda.

Inadditiontodevolvingservicedeliveryresponsibilitiesfromthefederalleveltotheprovincialand district levels, capacity building at the provincial level will allow or the planning, evaluation,and implementation o alternative service delivery and nancing mechanisms. Key national

unctions or health should be retained by the ederal structure.17

300

250

200

150

100

50

0South AsiaPakistan OECD World

Maternal Mortality (per 100,000)

Infant Mortality (per 1,000)

source: World bk, World Developmet Idictor, http://dtkworldkorg (cceed april 11, 2011)

16 Khlid H, Pkit Helth, Popultio sector Hve Regreed, Daily Times, July 11, 200817 For more detil, ee si nihtr, scrppig a Miitry of Helth, The Lancet, o 9775 (377), My 5, 2011; d idem, Ce of the VihigMiitry, The News, December 25, 2010, http://www.heartle.org/pdf/92_The_vanishing_ministry.pdf (accessed April 23, 2011).


32/61


Clarifyingtheroleofdistrict-levelhealthsystemswillstrengthenlocalaccountabilityand

ownership alongside local community social responsibility.

Collecting,analyzing,andswiftlyscalingupsuccessfulbestpracticesfromexistingexamplesof

public service delivery reengineering at the primary health care and hospital levels will contributegreatly to health sector improvement in Pakistan.

Separatingpolicy-making,implementation,andregulatoryfunctionsinthehealthsector,aswell

as adopting market-harnessing regulatory approaches, will lead to an improvement in service

delivery.

Concretestepsforincreasingpublicnancinginhealthmustbeginalongsidemeasuresto

improve utilization and limit pilerage. Strengthening essential services, broadening the base o

social protection or the inormally employed sector, and maximizing pooling through insurance

or the ormally employed are priority areas or any increase in revenues in the health sector.

Aninnovativesystemofprivatepublicandemployer-andsponsor-basedsubsidies,alongwith large cooperative pooled insurance or low-income populations, can be provided through

aordable access to private health care networks.

Investmentsmustbemadetoleveragethefullpotentialofhealthinformationtechnology

in mobile health systems. Tis will have a positive, catalytic eect on a range o health care

challenges, including improving transparency in procurements, enabling health care conancing

through philanthropic subsidies, enhancing quality assurance through electronic medicalrecords, and promoting easy access to continuous medical education. Additionally, innovations

in telemedicine, such as the introduction o point-o-service diagnostics in rural primary care

settings with skilled paramedics, can dramatically bridge the gap between rural and urban access

to quality health care.

Collecting,analyzing,anddisseminatinghealthinformationforshapingpolicyandplanning

at the decision-making level can be achieved through the development o an apex institutional

arrangement.

Byadoptingmarket-harnessingregulatoryapproaches,therstpointofcontactinprimary

health care will be broadened while enabling equitable access and the purchasing o health care

or many Pakistanis.

Apriorityshouldbeplacedonhealthsystemsresearchbymakinglinkageswiththerightagencies

both within and outside the health sector. Linkages with agencies outside the health sector must

consider the social determinants and the intersectoral scope o health.

Strengtheninggovernmentoversightandregulationsinprivatesectorhealthcaredeliverywill

prevent and check problems such as malpractice and will acilitate publicprivate collaborations

in health delivery.


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Pakistan aces chronic inrastructure challenges when it comes to energy sources. Te countrysenergy woes are clear or everyone to seemost o all or Pakistanis o every class and region, who have experienced long periods o load shedding or power outages across the country over

the past ew years. In addition to nurturing social and political instability, Pakistans poor energy

inrastructure imposes enormous economic costs in the orm o unemployment and loss o revenue.

As Charles Ebinger and Kashi Hasnie aptly remarked, Even i the aliban and its Pakistani allies

were to disappear tomorrow, Pakistan in the absence o a plan to deal with its energy crisis will remain

in darknessliterally and guratively.18

Pakistan ranks 38th in the world in terms o

energy use, but current per capita energy con-

sumption is low (14 million British thermal

units against 90 million British thermal units or

Malaysia, or example), at only one-th o the

world average.19 According to the government

o Pakistan, the mix o primary energy supply in

20042005 was gas (50.3%), oil (29.8%), hydro(11.0%), coal (7.6%), and nuclear (1.2%), with

current installed electricity-generation capacity at 19,400 megawatts. (See Figure 3). Pakistan depends

heavily (50%) on its reserves o natural gas or industry, power generation, and commercial and

household use. Tese reserves will start declining within the next decade i no new major discoveries

are made.20

Te current energy shortall in the country is estimated to be between 4,000 and 5,000 megawatts.

Pakistans proven coal reserves are the worlds sixth largest, and the government plans to increase the

share o coal in the overall energy mix rom 7% to 18% by 2018a necessary policy choice rom

an energy standpoint, though it is not without negative environmental implications. Ocial gures

rom Pakistan warn that demand or energy will be 22% more than the projected supply in 2015,

eg ifasc

i a g scaand polcal nsably, Paksans

p g fascpss s cc

coss n he fom of unemploymen

a ss f v.

18 Chrle K Eiger d Khif Hie, Powerle Pkit, Dawn, My 17, 201019 a meured y coumptio of petroleum, turl g, col, electricity, d reewle ource i britih therml uit see Eergy Iformtioagecy, Itertiol Eergy sttitic, http://wwweigov/cfpp/ipdproject/IEDIdex3cfm (cceed Ferury 7, 2011)20Govermet of Pkit, Eergy for Growth, i Pakistan in the 21st Century: Vision 2030 (Ilmbd: Plig Commiio, 2007), http://wwwpl-igcommiiogovpk/viio2030/Pk21tcetury/Chpter%20Wie/Ch%209,%20Eergy%20for%20Growth,%2081-90pdf (cceed april 23, 2011)


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enerGy inFrAStruCture |33

with energy shortalls reaching 64% by 2030.21 Tis is a sure recipe or increased unemployment,

economic stagnation, ewer growth opportunities, and turmoil on the streets.

Dam construction and the building o the countrys hydropower capacity also are raught with di-

culties. Water scarcity in Pakistan is already severe, and poor water resources management remainsan ongoing problem. For example, much o the countrys irrigation system, which dates to thecolonial era and is a ew hundred years old, is in desperate need o modernization, and meeting

current and uture water demands continues to be a serious challenge. In larger towns and cities,

water scarcity has led to the unregulated mining o groundwater, which is a highly unsustainable

practice. Because o these competing demands or water, increasing hydropower capacity to meet the

countrys energy needs remains a challenge. Moreover, any plans or the construction o new dams

or reservoirs are subject to long delays because o water disputes between the provinces and ethnic

politics surrounding it.

Pakistans ailure to meet its current energy needs is largely the result o poor planning, but other

actors also have contributed to the prevailing crisis. Heavy line losses o electricity are common as a

result o old and deective energy grids (e.g., transmission lines and power distribution centers), and

approximately one-third o these losses result rom thet. Moreover, Pakistans potential sustainable

and renewable energy resourceshydro, wind, and solar powerremain largely untapped.22

21 Pkit lrget exitig dm t Trel produce le th tht see noor-ul-Hq, ed, Energy Crisis in Pakistan, (Ilmd: Ilmd Policy

Research Institute, 2008), http://ipripak.org/factles/ff99.pdf (accessed February 7, 2011); and ibid.22 Eiger d Hie, Powerle Pkit

Gas

50%

Oil

30%

Hydro

11%

Coal

8%Nuclear

1%

Fige 3: Mix of Pimay Enegy Spply, 20042005

source: Govermet of Pkit, Plig Commiio


35/61


Vision 2020 Objectives and Recommendations: An uninterrupted supply o energy to uel the

nations economy should be the highest priority or the countrys economic managers. o meet its

current and uture energy demands, the government should invest a minimum o $5 billion dollars in

energy production over the next decade. Tis is a very achievable target, and the investment could end

load shedding or power outages. Resorting to ad hoc measures to deal with Pakistans energy needs,

such as opting or rental power plants, must end, and deep-rooted structural problems in the energysector should be tackled head-on. Te ollowing measures in the energy sector should be implemented

over the next decade:

Pakistanmustenhanceitscapacitytocultivatemorepowerfromrenewableenergysources,par-

ticularly by improving its ability to harness wind energy along its southern coast and by making

use o solar power. One reason that countries such as Malaysia, China, and India can meet their

energy demands is that they have a better mix o nonrenewable and renewable energy sources.

Alongwithproperupkeepandmaintenanceofexistinghydropowerdams,moredamsareneeded

to meet current and uture energy requirements in Pakistan. Tis can be achieved by directinginvestments toward the construction o a very small number o large dams (Kalabagh dam is one

project that has been stalled) or a larger number o small reservoirs. At the same time, these plans

must be integrated into a broader strategy to improve water resources management throughout

the country. Additionally, Pakistan can dispel the impression that big dam projects will benet

only larger provinces by exploring ways to reach a consensus among all the provinces on its waterinrastructure and providing provinces with legally binding guarantees.

EnergyeciencyinPakistancanbeimprovedifgovernment-ownedpowergeneration

inrastructure is reurbished technologically and power inrastructure is upgraded with a modernecient grid.

ForeigndonorscanplayakeyroleinbuildingPakistansenergycapacitybyprovidingexpert

advice to the public and private sectors in Pakistan on energy development and management.Te United States, in particular, should explore investing in a large energy inrastructure project

in Pakistan, which will not only deepen strategic ties with Pakistan but also create goodwill in the

country.


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the massive oods in Pakistan during the summer o 2010 set back all development indica-tors in the country, and the resulting gures are staggering. According to the U.S. Agency orInternational Development, approximately 2,000 people died as a result o the oods, and almost 2million homes were destroyed or damaged.23 Te United Nations estimates that the ood injured

or aected approximately 18 million people in Pakistan, a gure that exceeds the total number oindividuals aected by the 2004 Indian Ocean tsunami, the 2005 Kashmir earthquake, and the 2010

Haiti earthquake combined. At the peak o the ood, approximately one-th o Pakistans total landarea was reported to be underwater.24(See Figure 4).

Pakistans economy has been seriously harmed by extensive damage to the countrys inrastructure,

which is estimated to be around $4 billion.25 Additionally, Pakistans crop production has beenimpacted heavily, and the damage to the countrys sugar, rice, and wheat crops is estimated to be ap-

proximately $2.9 billion. In all, 17 million acres o Pakistans most ertile crop lands were submerged,and massive amounts o grain were washed away by the oods. Farmers were unable to meet the all

deadline or planting new seeds in 2010, which means a major loss o ood production in 2011 andpotential long-term ood shortages. Te damage to the agriculture sector includes more than 700,000

acres o lost cotton crops, 200,000 acres o sugarcane, and 200,000 acres o rice, in addition to theloss o more than 500,000 tons o stocked wheata primary ood item in Pakistan. Additionally,

more than 6 million heads o livestock (including poultry) were killed. According to an assessmentconducted by the Asian Development Bank and the World Bank, the total direct economic impact o

the 2010 ood is approximately $10 billion.26

Te foods also damaged an estimated 2,433 miles o highway and 3,508 miles o railway, with cost estimates

or this damage valued at $158 million and $131 million, respectively. Te countrys power inrastructure

also took a severe blow rom the foods, with 10,000 transmission lines and transormers, eeders, and

t Fs of 2010

23 Pkit Flood, Fct sheet o 9, Us agecy for Itertiol Developmet, Jury 10, 2011, http://wwwuidgov/pk/dowlod/d/012111-UsaID-DCHaPkitFloodFctsheet9-FY2011pdf (cceed april 23, 2011)24 See United Nations Ofce for the Coordination of Humanitarian Affairs, Pakistan Floods Relief and Early Recovery Response Plan, November 5, 2010,

http://ocholieuorg/humitrippel/webpgep?MeuID=14351&Pge=1903 (cceed april 23, 2011); ee lo C Chritie Fir, Wht

Pkit Did Right, Foreign Policy, Jury 18, 2011; d Urget Cry for Help Deth Toll Rie from Pkit Floodig, CNN, augut 16, 201025 Michel J Hick d Mrk L burto, Prelimiry Dmge Etimte for Pkiti Flood Evet, 2010, Ceter for buie d Ecoomic Re-

erch, bll stte Uiverity, augut 2010, http://ceriweuedu/reerch/PkitFloodpdf (cceed april 23, 2011)26 see Pkit Flood 2010 Dmge d need aemet, World bk, novemer 15, 2010, http://itereourceworldkorg/PaKIsTanEXTn/Reource/Dnayd-worldkPreettiopdf (cceed april 23, 2011); Uited ntio Food d agriculture Orgiztio, Pkit Iitil

Flood Emergecy Repoe Pl 2010, augut 10, 2010, http://wwwfoorg/emergecie/tce-ppfud/tce-ppel/ppel/emergecy-detil0/e/item/44701/icode/?uidf=19653 (cceed april 23, 2011); sugr, Whet, Rice Worth $29 billio Ruied y Pkit Flood, Bloomberg, augut12, 2010; Pkit Flood Cued $97 billio i Dmge: aDb/World bk, Reuters, Octoer 14, 2010; Fir, Wht Pkit Did Right; d

2010 Pkit Flood, New York Times, novemer 16, 2010


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powerhouses destroyed in food-hit areas. Floodwater inundated the Jinnah hydropower plant and 150

powerhouses in Gilgit. Te food damage caused an additional power shortall o 3,000 megawatts.27

Te inability o centralized institutions in Pakistan to respond immediately to the oods reects the

weakness o governance in Pakistan. Tis weakness was revealed ully by poor governance along theIndus River, especially the ailure to implement construction regulations around the river and its

canals. Financing disaster management is also a great challenge to the country. Te severe shortage

o paramedics to respond to emergencies and the water and sanitation crisis that emerged in the

atermath o the oods, or example, exposed a deciency in local social service inrastructure that isleading to a slow recovery process. Overall, the state o social services in Pakistan remains abysmal.

Rehabilitation eorts since the ood have been slow as well, and many victims still are living in camps

and cannot return to their homes.28

B a l u c h i s t a n

Pu n j a b

K h y b e r-Pa k h t u n k h w a

G i l g i t -B a l t i s t a n

A z a d J a m m u Ka s h m i r

F A TA

A r a b i a n S e a

Islamabad

National boundary

Line of controlLine of control

Provincial boundary

Maximum flood extent

Severely affected districts

Moderately affected districts

SOURCES: OCHA, NDMA, UNOSAT

0

0 100

100

200 300 km

300 mi

Karachi

Larkana

Bahawalpur

MultanQuetta

ParachinarPeshawar

Lahore

Sialkot

Gilgit

S i n d h

Rawalpindi

Faisalabad

Hyderabad

Fige 4: Aeas Affecte by the 2010 Floos

27 See United Nations Ofce for the Coordination of Humanitarian Affairs, Pakistan Floods Relief and Early Recovery Response Plan, August 2010July

2011, http://ftuochorg/pgeloderpx?pge=emerg-emergecyDetil&ppelID=905 (cceed april 23, 2011); d Power shortfll Rie to3,135 Megwtt, The Statesman, augut 13, 201028 See Waqar Bhatti, UN Ofcial Laments Post-Flood Conditions in Sindh, The News, Ferury 9, 2011

adpted from Relief We mp, http://reliefweit/txoomy/term/182 (cceed april 11, 2011)


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the FloodS oF 2010 |37

Moreover, competition or unding between the Pakistani state agencies and the United Nations

system are apparent, and unding tensions between the ederal and provincial governments also have

come to light. However, it is noteworthy that most o the rehabilitation work was managed by the

Pakistani military, which switly moved its orces and equipment into the ooded regions to evacuate

people and distribute supplies in the immediate atermath o the oods. Rapid support rom the

United States helped Pakistan in the initial weeksand months ater the massive oods, but support

rom Pakistans riends in the region, as well as

rom the Middle East, was slow and inadequate.

Indeed, the United States is the largest donor o

unding or ood relie eorts in Pakistan.29

Vision 2020 Objectives and Recommendations:Improving Pakistans lagging social and economicdevelopment indicators should be a top priority. Te enormity o the humanitarian crisis caused by

the oods requires concerted planning and a seamless transition to the rehabilitation and reconstruc-tion phase. Securing resources or the postrelie phase continues to be a challenge, but every eort

should be made in the next two to three years to ensure that reconstruction in Pakistan proceeds

eectively. Te ollowing steps need to be taken to ensure that Pakistan ully recovers rom the ood

over the next decade and is adequately prepared or uture disasters.

Pakistansvulnerabilitytodisasterscanbeaddressedbyimmediatelyimplementingsoundbuilding

regulations, starting land rehabilitation, de-silting canals and waterways, and constructing dikes.

IntegratingclimatechangescenariosintothePakistangovernmentsannualdevelopmentplans

will help develop a well-coordinated strategy to address the impacts o global climate change in

the country while ensuring progress toward meeting the Millennium Development Goals targets

or poverty reduction. Tis will require billions o dollars in medium-term investments in climate

change mitigation and adaptation measures. Mechanisms such as the Climate Investment Funds,or example, support low-carbon and climate-resilient development through scaled-up nancing.

Regionalaswellasglobalsupportforreconstructioninood-hitareasiscritical.Donorfatigue

in recent years resulted in slow nancial support or Pakistan initially, but this can be oset bysustained support or reconstruction. o improve its credibility and potentially attract more unds

or reconstruction, Pakistan must be ully transparent about the utilization o international unds.

Stabilizingandimprovingaccesstosteady,aordable,andnutritiousfoodsuppliesinPakistanis essential, especially or the 6 million people most aected by the foods. Te Pakistan gov-

ernment must continue to ensure adequate supplies o nutritious ood to inants, women, andyoung children in food-hit areas. Areas that are experiencing high levels o ood insecurity and

economic and social underdevelopment also have been associated with growing insurgencies.30

29 K al Krotdt, Pervze a sheikh, d bruce Vugh, Floodig i Pkit: Overview d Iue for Cogre, Cogreiol Reerch service,Report o R41424, novemer 18, 2010, http://wwwforg/gp/cr/row/R41424pdf (cceed april 23, 2011)30 Kier begli

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PAKISTAN 2020 | A Vision for Building a Better Future