An elitist system

State Bank Governor Dr Ishrat Hussain made some interesting observations at the launching in Islamabad recently, of a report on "Human Development in South Asia, 2004 - the Health Challenge" at the Mahbubul Haq Human Development Centre. He termed the country's health delivery system as elitist, pointing out that rationing of access to the service is done according to the patients' status.
He also wondered aloud as to why the country has failed to show progress on social indicators despite unanimity among political parties and other stakeholders on the issue of human development. The explanation lies in his assertion that the system caters only to the needs of the elite, and also in the fact that the democratic process has remained in a constant state of flux.
The people are powerless to demand their rights whether these are related to health care, education or some other necessities of life. Over the years, health care and education, the two basic requirements of human development, have lingered at the tail end of successive governments' list of priorities. Which is obvious from the fact that budgetary allocations to these sectors have been dismally low: about 2 percent of the GDP for both put together.
In its report on the condition of education released a year ago, the State Bank itself had lamented that only 1.7 percent of the GDP was being spent on this sector - the lowest percentage for the whole of South Asia. As a matter of fact, it had remained below one percent until a few years back. The health sector gets even less money.
In her comments on the health challenges report, Mehbubul Haq Centre's President, Dr Khadija Haq, said that Pakistan's public health expenditure is lower than that of most other developing countries, and has registered no visible improvement in the last three decades. So, when only a small amount of money goes into this sector, it is plain that the facilities it offers are going to be limited. And when things are limited, the powerful tend to benefit from them the most. Patients from underprivileged backgrounds can hope to have a better access to health care facilities only if these are increased sizeably.
As to Dr Hussain's question why the political parties have failed to improve social indicators despite a consensus on the subject, it is not difficult to imagine their response. At least the two main parties, the PPP-P and PML-N, which alternated in power between 1988 and 1999, would want to cite the fact that they did not get to complete their respective terms in power. And hence they did not have enough time to implement their plans and policies for human development or other projects for progress.
Aside from the role of political parties, it needs to be mentioned, the people too have a role to play in the improvement of their condition. That they can do if elections are held regularly, allowing them the chance to demand a better deal from the rulers.
Those who fail to deliver can be held accountable at the next elections. Needless to say, an essential feature of a truly functioning democracy is accountability of the rulers at the hands of the ruled.
Unfortunately, for much of the time in this country's checkered history, the people have been denied that right. It should not be surprising therefore for anyone if the level of human development here is as low as it is.