Pakistan’s Concern: How to Get Back to Basics

If you think Pakistan is facing threat from Al Qaeda- Taliban brand of terrorism alone you are simply mistaken. The well being of the country founded by constitutionalist Md Ali Jinnah is threatened by several health disorders. Polio particularly has become an epidemic in the ungoverned tribal belt of the country that borders Afghanistan. Interestingly, tribal chiefs and militants hold sway over the area, which has been kept out of normal administrative diktats by successive governments in Islamabad.

Pakistan’s nuclear rival in South Asia, India is in no better shape. Along with Pakistan, it figures in the group of four nations where polio still exists. The other two nations are Afghanistan and Nigeria. Because of its democratic structures and vibrant media, India is able to come to grips with epidemic. It made the fight against polio a community campaign. Public icons like Amitabh Bachchan, Sachin Tendulkar and Aishwarya Rai and have lent their weight; they keep popping up on the silver screen and small screen at regular intervals with the message – ‘Just give one drop – Saves your child from Polio’. Non -official agencies, school teachers and opinion leaders have closed ranks with the health department to make India polio free sooner than later.

What a contrast this is with the situation that obtains in Pakistan’s terrorist havens of Federally Administered Tribal Area (FATA) and the North West Frontier Province (NWFP). Workers of domestic and foreign NGOs are scared of entering the area most of the time. When they overcome fear of the gun and manage to enter the interior, they come up against a wall of ignorance and superstition. For parents vaccination against polio is something that should be shunned. The local belief, nurtured by militants and mullahs alike, is that polio drops cause impotency and infertility, and that vaccination is ‘un-Islamic’. According to reports, which could not be verified, the situation is no different in some pockets of Balochistan and even Sindh.

No surprise, therefore, Pakistan is witnessing a rise in the number of polio cases. By early October, as many as 70 cases were reported, according to the World Health Organization (WHO), and nearly half of these were registered in just two months – August and September. NWFP and adjoining tribal belt reported thirty of these cases. Peshawar, the gateway to the region, itself registered 12 cases.

These statistics may not reflect the true picture. Pakistan doesn’t have a well oiled health machinery to hold a mirror to its countryside. But whatever statistics that are available should be cause for concern. Because IRIN (Integrated Regional Information Networks)- the humanitarian news and analysis service of the United Nations Office for the Coordination of Humanitarian Affairs – points out that 32 polio cases were detected in 2007 and 40 in 2006. Yes, Pakistan has come a long way since 1994- the year the polio programme was launched after detecting over 1000 cases. It is no consolation.


In the prevailing milieu, it is difficult to expect a turn around in the grim situation. The government in Islamabad is pre-occupied with its own survival and also with the fight against terrorism besides the economic Tsunami that has engulfed the country.

Isambard Wilkinson reports in The Telegraph (UK) that Pakistan forex reserves are dwindling, and by the second week of October, the country has only $ 3 billion – enough to buy about 30-days of imports like oil and food. Nine months ago, Pakistan had $16 billion. High oil prices have combined with endemic corruption and mismanagement to inflict huge damage on the economy.

Pak rupee has lost 23 per cent against the dollar since the start of the year, and was hovering close to an all-time low of 80.30 per dollar last week. Yet, the authorities

insist that Pakistan’s economic fundamentals are holding steady though these have been weakened in recent days.

Credit rating agencies like Standard & Poor’s are unenthused; they are asking questions over Pakistan’s ability to repay about $3 bn of debt which will be due in February next. This is clear from CCC + grade assigned to Pakistan’s sovereign debt; it stands only a few notches above the default level. Put differently, Pakistan’s creditworthiness rating is the second worst, superior only to that of the Seychelles.

The Wall Street Journal says that Pakistan’s economic travails are ‘at least in part, a crisis of confidence’ in President Asif Ali Zardari. As the husband of Benazir Bhutto, he was known as Mr. Ten percent. A wily he is and can outsmart rivals in the political ping-pong, as Nawaz Sharif, a former prime minister, realised the hard way. He however lacks a constituency and administrative acumen.

His financial chief Shaukat Tareen has made a round of Washington on a mission to persuade international agencies and expatriate Pakistanis to pump in $10 bn ‘to rescue Pakistan from bankruptcy’. Overseas Pakistanis estimated at around three million sent a record $6.45 billion home in the year ended June 30. Most of them live in the US, UK, Saudi Arabia and United Arab Emirates.

Frankly, Pakistan is facing a ‘threat to basic survival’ to borrow the expression used by the World Bank while on the plight of millions living in miserable poverty-stricken conditions stand. The Bank said poverty alleviation programmes in Pakistan have done little to improve the lot of poor. “They (the poor of Pakistan) lack social safety nets that could help cushion the impact (of high rate of inflation and food prices).”

Sharing this concern, the sedate Karachi daily, The Dawn (Oct 14, 2008) said “Already Pakistan has abysmal statistics for education and falls in the category of nations with a large number of malnourished people. Add to this a high population growth rate and we have a recipe for disaster in the years to come if present economic trends continue.”

Pakistan has been witnessing an alarming rise in the number of suicides; instances of couples selling children to combat destitution are increasing. And there is a marked increase in social frustrations which affect family life and threaten to undermine age-old values like caring for old parents at home.

Summing up the mood in the country, The Dawn observed: “As people are forced to live with stagnant incomes in an era of ever-rising prices, their frustrations can only grow and tell upon the family unit in a variety of negative ways. The picture for the future is not only sombre; it is downright frightening as one envisions a large body of unemployed, uneducated youth with nothing to look forward to in life.”

Terrorists and their masters are quite pleased with the prevailing socio-economic situation in Pakistan. And they have no dearth of recruits. Because, many prospective young suicide bombers are carried away by the assurance that their families would be looked after financially once they have succeeded in their mission.

So, as the country stands at cross roads in its six-decade long history, odds are stacked against health and wealth programmes. Says Nima Abid, WHO’s polio team leader in Pakistan: “There are many factors that are beyond the control of the polio programme, including the security situation in NWFP/FATA and southern Afghanistan. Recently we have seen cases in Swat. The vaccinators have not been able to go to some of these areas to immunise children for nearly a year due to the security situation.”

There are several other hurdles as well. Besides a sense of insecurity, these are very few women workers, poor service delivery, low public demand for immunisation, lack of independent monitoring, very variable routine immunisation coverage, pockets of refusals in a few key districts, rapid turnover of district health officials. Other contributory factors are poor sanitation and high population density which lead to a high prevalence of diarrhoeal disease and enteroinfections.

In areas like Swat, Bajaur, Mohmand and Killa, where Pakistani and foreign mostly Uzbek and Afghan militants hold the sway, the immunisation drive confronts ‘refusal’ for vaccination. “”Refusal is a significant problem….. (But) overall less than 1 percent of the targeted children are missed because of refusals,” according to health workers. An independent study of ‘refusals’ also highlighted that management and service delivery issues are also an ‘issue’.

Probably, Pakistan should take a leaf out of Indian experience in controlling polio. As observed at the outset, India is able to come to grips with polio epidemic because all stake holders are brought on the deck. In fact, every phase of nation-wide polio drops programme ushers in a carnival atmosphere to the delight of children; it is a good photo-ops for leaders who have to nurture their constituencies if they want a second term in an elected office. So, leaders big and small vie with another in administering polio drops and ensure their photo splashed in the next day’s dailies.

In a manner of speaking, more democracy and not less democracy is the anti-dote to all the ills- afflicting Pakistan. That may be tall wish in the prevailing situation. What can be done straight away, however, is strict monitoring of all anti-poverty and health programmes particularly the polio drive besides observing a prudent fiscal policy.