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MPDR Seminar: Improving Planning and Policy

22 Feb  2107: Seminar at MoPD&R on how we can improve planning and policy making in context of Health & Nutrition.  The seminar was based on the Outcomes and Conclusions of the Brainstorming Session on Policy Priorities for Health & Nutrition held at PIDE Friday 17th Feb 2017. An Executive Summary and outline of points made at the seminar is listed below. Somewhat more detailed minutes of the Brainstorming Session are also given below. SHORTLINK for this page: bit.do/azmpdr1

A Brainstorming Session on policy priorities for “Health & Nutrition” was held at PIDE on 17th Feb 2017, with the goal of identify the major issues that we urgently need to address in this sector. Participants from Planning, PIDE, PPAF, SUN Network and Shifa Medical College attended the meeting (List attached below). An executive summary of actionable items arising from this discussion, and subsequent seminar on the same topic, is presented below for necessary action.

  1. The body of the planning process is sound, but the spirit of serving the people is missing. This is as essential as petrol to run a car. We need to encourage the development of this spirit among bureaucrats, who should see themselves as “public servants” in the true meaning of the word. A seminar on this topic was delivered by Dr. Asad Zaman, VC PIDE, at the Planning Commission on 21st February as a model of the effort that needs to be made in this direction.

ACTION PLAN: Member Communications + Our own Communication Strategy Person should brainstorm on initiatives that need to be taken, to promote the spirit of public service everywhere in general, and in PIDE and Planning Commission in particular.

  1. There is a strong tendency to ignore and criticize existing on ground projects as failures, and start fresh projects without studying the ground realities, and the causes of success and failure of earlier projects. Buildings cannot be constructed if everyone abandons previous structures, and starts putting bricks down on a new location. This tendency needs to be combatted in the following ways.
    1. Quite often, there are successful planning interventions, but we do not learn from them, and replicate them at large scale. Just being able to transplant best practices would achieve marvels in developments – we do not need to borrow models from outer space.
    2. Quite often, failures are just one small step away from success, and they are abandoned or neglected. Large amounts of effort need to go into an evaluation of existing projects, with the goal of tweaking them to improve their performance.
    3. We need to do a thorough job of evaluating existing projects, ensuring completions of PC-IV and PC-V for at least the larger projects. This is essential to learn from experience. As it is, we keep repeating the same mistakes

ACTION PLAN:  A systematic failure is the expectation (never fulfilled) that those executing the project will themselves evaluate the project. This creates the wrong incentives and ensures the perpetuation of current state of affairs where no projects are evaluated, and no lessons learnt from experience. In the future, simultaneously with the approval of the PC-1, an independent body of auditors and evaluators should be hired to report on the performance, and to produce the PC-IV and PC-V. They should be paid directly by the Planning Commission out of funds reserved in the PC-1 for this purpose. For major ongoing projects, we need to implement this right now: fund an independent audit group to (a) suggest how we can improve efficiency of the project and (b) create the PC-IV evaluation forms, with the idea of documenting the experience, so that we can learn from it. Again, it would be of great importance to involve the stakeholders in this evaluation – those involved in service delivery as well as those who are recipients of the service being provided. PIDE is prepared to facilitate this process. Money for evaluation should be built into the project PC-1 and should be released directly to the auditors, instead of asking project executors to hire auditors, or to do self-evaluations. A SEPARATE TASK FORCE should identify major success stories in projects, and devise strategies to replicate best practices across the board.

  1. A major problem identified was lack of ownership of the projects, and a very paternalistic attitude, a leftover remnant of the colonial bureaucratic tradition. Instead of letting communities take the lead in identifying their own problems and finding means to solve them, we wish to do it on their behalf, which results in lack of ownership. We should strive to ensure that the PC-1 projects are planned and initiated by the communities being served, and provide them help with this process.

ACTION PLAN: Current PC-1s have provision for ensuring that community being served has some input into the project but this is not taken seriously in evaluation of PC-1s. We need to insist on community participation in the preparation of PC-1s. In addition, some change of rules is required to enable and empower communities to originate their own PC-1s for projects with the assistance of relevant ministries.

  1. Behavioral psychologists have identified a major source of irrational human behavior: our tendency to find free offers irresistible. Whenever foreign donors come in with strange projects, we don’t look gift horses in the mouth, and agree to do whatever they suggest on the false assumption this is a free gift. Millions are wasted, and certain types of debt traps are created because we too eagerly accept gifts without close examination.

ACTION PLAN: A sophisticated evaluation of all projects with foreign donors using independent auditors is required to ensure that we don’t allow donors to test experimental medicines and treatments on our children. This can be done along the same lines as in the previous actions plan.

Brief: Minutes of the Brainstorming Session on “Issues Related to Health & Nutrition”

held at PIDE, on February 17, 2017.

The subject session was held on February 17, 2017, at 11:00 am, in the Office of the Vice Chancellor, PIDE, Islamabad. Dr. Asad Zaman, VC PIDE chaired the meeting. Session participants were from the Planning Commission of Pakistan, PPAF, SUN academia and research network in Pakistan, Shifa medical college and PIDE.  The following attended the meeting:

  1. Dr. Asad Zaman                                         Chairperson (VC, PIDE)
  2. Iffat Zaman                                                  Shifa medical college, Islamabad
  3. Dr. Durre Nayyab                                        PIDE
  4. Dr. Atiya Yasmeen Javed                            PIDE
  5. Adeeba Ishaq                                               PIDE
  6. Muhammad Nasir                                        PIDE
  7. Mahmood Khalid                                         PIDE
  8. Dr. Irshad Danish                                         SUN academia & research network Pakistan
  9. Zafar-ul-Hassan                                           Planning Commission of Pakistan
  10. Dr. Mubarik Ali                                           Planning Commission of Pakistan
  11. Syed Tanwir Hussain Bukhari                     Planning Commission of Pakistan
  12. Dr. Asma Haider                                          Planning Commission of Pakistan
  13. Muhammad Fazal                                        PPAF
  14. Dr. Seema Raza                                           PPAF

The meeting started with the recitation from the Holy Quran.  In his opening remarks, the Vice Chancellor, PIDE welcomed the participants of the meeting. After brief introduction of participants, Dr. Asad Zaman (VC, PIDE) explained that the objective of this session is to identify top priority issues of health and population in Pakistan. Three areas i.e. IMR, MMR and Malnutrition were focused in discussion.

Following issues were discussed;

  • Many countries are economically poor compared to Pakistan but have less Infant mortality rate. Pakistan’s score (107) is poor on world hunger index. High rates of malnutrition, stunting in Pakistan. Lack of immunity among children causing malnourishment that results in high infant mortality rate. Health issues arising because of poor hygiene practices, unavailability of safe drinking water and inappropriate sanitation facilities. In certain cases, Pakistan has adopted world’s successful health practices but still it is failing to make remarkable improvement in malnutrition statistics. Hence, innovative/creative adaptation of world’s best health practices is missing resulting in failure of health sector interventions. Absorption of vaccination delayed or failed because of malnutrition. Behavioral problems in food consumption also causing malnutrition in Pakistan i.e. even the rich are not food insecure but are facing nutritional deficiencies. Feeding practices specifically among children are not optimal or healthy (exclusive breastfeeding causing health issues, complementary feeding is required to lower IMR. A study conducted by PIDE on determinants of malnutrition suggest that maternal factors are crucial for IMR). Awareness and health dimensions of poverty should be addressed in poverty research. It’s not only food security that causes malnutrition. Right social norms needs to be promoted e.g. in food choices and food manufacturing both taste and nutrition value must be considered. Ethnic/geographical diversities are mostly ignored in studies identifying causes of malnutrition. Poverty is not only cause of malnutrition. It is often over emphasized. Integrated/compound programs required for malnutrition solution. Health issues are causing more damage to GDP compared to energy shortage issues.
  • Immunization practices/behaviors must be improved from community point of view. We need to think about “No missed child concept” and how to execute it into our own communities? NHC department tertiary healthcare are important but Primary healthcare level needs attention. Primary healthcare investment can be more productive than tertiary healthcare investment. Preventive healthcare more important compared to curative healthcare. Promote prenatal care as it has serious consequences for malnutrition, stunting and IMR (Fetal origin hypothesis). Also awareness about mental health and its connection with domestic violence must be created. Community resource person programs can be very effective here.
  • Lot of Foreign Aid available in health sector but effective indigenous strategies lack to channelize aid to address curative health issues. How to increase effectiveness of different health and schooling interventions or what are effective interventions in social sector? (Researchable areas). One suggestion is that Medical anthropologist must be part of design and implementation of health and population interventions. Post program evaluation or impact evaluation of interventions/ongoing programs is required to rectify interventions’ failure reasons. Also we need to go beyond increase in GDP only and emphasize social indicators importance in growth studies.
  • Sector specific PC-I should be designed and they must be demand driven. Indeed if societies get necessary awareness they can make their own PC-I. Ethics standards must be defined for PC-I. Budgetary allocations for process and execution are minor in PC-I compared to other heads in ongoing practice.

Dr. Asad Zaman concluded the session with following three points;

  1. PC-I should be originated from owners (community) and not from 3rd party (consultants)
  2. Planning commission should prioritize projects (both completed and ongoing) and get them audited from external auditors.
  3. Foreign donors’ projects must be validated by planning commission of Pakistan as external evaluators.