Each year, the UN observes international days to create awareness on ‘issues of concern’. The issue of self-determination for the Kashmiri in prison and creation of Palestinian State as per UN resolution is never an international day. The avowed aim of observing such days is to ‘mobilize political will and resources to address global problems and to celebrate and reinforce the achievements of humanity.
The people who generally participate in such days and are in the media limelight generally hail from the elite stratum of society (photoshoots, Facebook and Twitter displays, sumptuous dinners).
One reason why the laity stays aloof is the conviction that the elitist marches and rallies would evolve no concrete program to ameliorate a lot of the common man. For instance, coronary patients can’t be cured simply through brisk walks and riding bikes in vanishing forests, roads being dangerous. Education is a complex issue and it can’t be improved without stimulating unmotivated teachers and correcting pays and fee structure.
Short of funds, we should put our fragmented unbridled hospitals under one civil-military supervisory board, and distribute load reasonably.
Universal Health Coverage Day
We would observe this day on 12th December. I, for one, wonder how dishing out health certificates, as doles selectively, would get us closer to universal healthcare. The USA is a rich country even it discouraged doles. Even the oil tycoons doling out money to the needy were mocked.
Universal Medicare requires careful reallocation of resources. If India and Pakistan remain at daggers drawn, it would be well nigh impossible to move chunks away from defence to welfare. So, it may require even international cooperation and a bit of détente.
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Inspired by successful role models
The familiar medical system of wealthy countries is the Bismarck model (multi-payer health-insurance model), the Beveridge model, the National Health Insurance Model, the out-of-pocket model, and the US model.
The government should pick up the good points of the medical systems of wealthy and poor countries alike. The Bismarck model is being followed in Belgium, France, Germany, Japan, and Switzerland.
Generally, healthcare providers in this model are private entities. The government neither owns nor employs most physicians. Private companies also provide health insurance, not by governments.
Governments strictly regulate costs and other aspects of healthcare (no arbitrary fees and fleecing). The US outspends its peer nations on health. Yet it has no universal-health insurance, nor universal health coverage.
We would observe this day on 12th December. I, for one, wonder how dishing out health certificates, as doles selectively, would get us closer to universal healthcare. The USA is a rich country even it discouraged doles. Even the oil tycoons doling out money to the needy were mocked.
No healthcare system in the world is perfect
India is submerged in a dole system like us. It spends around four percent of its Gross Domestic Product on health. In Thailand, the out-of-pocket medical expense has fallen to 12 percent, as compared to 40percent to 60percent in wealthy countries. The proportion of children dying in the first five years of life has dropped to less than 1.2 percent. Thailand saved money by shutting down or consolidating selected good-for-nothing lackadaisical hospitals (like ours) that had large government budgets.
Short of funds, we should put our fragmented unbridled hospitals under one civil-military supervisory board, and distribute load reasonably. The facilities at Pakistan Institute of Medical Sciences should be improved, also increasing the number of ventilators.
The politically expedient burden of residents of Rawalpindi/Islamabad on Federal Government Services Hospital should be taken off. The hospital is now good for nothing. It is of little use; it is laudable that our government is alive to woefully reserve inadequate medical facilities for the common man. No healthcare system, not even the US ‘system’, in the world is perfect. Yet, each, by and large, delivers the goods. What about ours?
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Following the footsteps of Thailand
Thailand took opposition and other stakeholders aboard. As such, the plan remained intact despite changes in governments. Thailand’s per capita income, health expenditures, and tax base are comparable to India. Yet, it achieved universal healthcare in 2002.
It spends around four percent of its Gross Domestic Product on health. In Thailand, the out-of-pocket medical expense has fallen to 12 percent, as compared to 40percent to 60 percent in wealthy countries. The proportion of children dying in the first five years of life fell to less than 1.2pc. Thailand saved money by shutting down or consolidating selected good-for-nothing lackadaisical hospitals (like ours) that had large government budgets.
The Federal Government Services Hospital (FGSH) is now good for nothing for the civil servants for which it was built. Many of its doctors are nicely available at Ali Medical provided you can pay.
Each year, the UN observes international days to create awareness on ‘issues of concern’. The issue of self-determination for the Kashmiri in prison and creation of Palestinian State as per UN resolution is never an international day.
The ‘civilian officers paid out of defense services’, including the retirees disentitled from in-service medical treatment, should be impaneled to the military (CMH/MH) and other hospitals (like Shifa International or Aga Khan’s) for secondary and tertiary treatment to reduce FGSH patient load.
In case of financial crunch, such officers may be called upon to contribute to an insurance-based system contributed to by the parent departments and the officer/retiree.
For one thing, our healthcare system, like our education and law-and-order systems, is on autopilot mode.
Anti-Corruption Day
This day was observed on 9th December. Corruption is a hydra-headed monster. It entangles not only politics but also almost every other realm of life. The enforcement laws are either too stringent or too lax. Those indulging in financial corruption know the inbuilt loopholes.
The economically advanced countries pay lip service to calls for eliminating corruption. It is the advanced countries where offenders stash their money. Have a look at Britain; you would find there the world’s most corrupt tycoons living in comfort.
The UNO needs to study manifestations of corruption in different fields of life and recommend measure to curb it.
In a society like ours where there is no healthcare or free education, people are prone to indulge in corruption. They want to save a penny for a rainy day. Even young doctors find it alluring to try their luck at superior civil services. Authority and corruption go hand in hand.
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People join politics not to serve the common man but to serve themselves and their kith and kin. Lord Acton has rightly said, “power corrupts and absolute power tends to corrupt absolutely”.
The international financial institutions are not interested in everyday corruption in Pakistan. They are focused on money transactions that may lead to terrorism in their countries. One worrisome aspect is hand-to-hand transactions facilitating stashing money abroad.
Illicit money abroad
According to international media, the money belonging to Pakistanis in Swiss banks far exceeds that of Indians’ (excluding dormant accounts of about $300 million). It is speculated that Pakistan could retire its entire debt (and even build some dams) if this money is repatriated.
From 2013 to 2016, then finance minister Ishaq Dar (now a fugitive under extradition) held negotiations with Switzerland regarding hidden bank accounts, double taxation and granting Switzerland the most-favored-nation status. It is eerie that the upshot of the negotiations was that only accounts from January 2018 onwards could be investigated. Dar himself is nowadays a declared absconder at law.
He preferred to flee to Britain instead of proving his honesty before Pakistani courts. He cut a sorry figure when the BBC asked him some awkward questions about his assets and that of his family.
In a society like ours where there is no healthcare or free education, people are prone to indulge in corruption. They want to save a penny for a rainy day.
Pakistan became a priority region for counter-terrorist financing, due to the presence of al-Qaeda and other terrorist groups, porous Pak-Afghan border, and cash-based economy that often operates through informal mechanisms, such as hawala (hand-to-hand delivery).
Despite freezing of over US$ 10 million of al-Qaeda assets, Washington remained rueful. International attitude to India and Pakistan’s efforts smacked of blow-hot-blow-cold (‘US slams India, praises Pak on terror!’Indian Express, July 15, 2005,). In yesteryears, India was the bête noire. Now, the focus is on Pakistan.
Learning from India
To check the flight of money abroad and get ‘foreign’ money repatriated, Pakistan could learn from India.
Financial offenders are highly qualified people, educated in foreign universities. For instance, Nirav Modi is an accomplished Real Estate lawyer. He developed a specialization in acquisitions and disposals of corporate vehicles and underlying real estate assets. He is an expert in private mergers, acquisitions and disposals in the children’s nurseries, dental practices and other sectors. Even super-sleuths in India could not get back Rs. 11400 crore chipped off from Indian-Punjab Bank.
The fraudsters abroad remained immune to the Enactment of Economic Offenders Bill, extradition request under and mutual legal assistance, and so on. A fugitive offender may seek political asylum if he is not entitled to ‘indefinite leave’ to stay in a foreign country.
India focused on Mehul Choksy, Nirav Mallya, alleged bookie Sanjeev Chawla, and Tiger Hanif. Notwithstanding the extradition treaty with the UK since 1993, it could get back only one offender.
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Observing International Days is useless unless accompanied with follow-up action by stakeholders.
Unlike India, Pakistan’s enforcement bureaucracy lacks the competence to deal with shrewd money launderers. A plethora of cases against the previous government bureaucrats has their enthusiasm for taking bold steps. Pakistan’s bureaucracy acts hands in glove with politicians. Tax circulars and tax-amnesty schemes are invented to whiten black money. Interestingly, even three-time Prime Minister Nawaz Sharif like so many other politicians has no declared business. They plead their sons or foreign princes gold-fingered them
Even offenders in India did not cough up a penny. Incentive schemes look better than legal mousetraps.
Mr. Amjed Jaaved has been writing free-lance for over five decades. He has served federal and provincial governments of Pakistan for 39 years. His contributions stand published in the leading dailies and magazines at home and abroad (Nepal. Bangladesh, et. al.). He is author of eight e-books including The Myth of Accession. He knows many languages including French and Arabic. The views expressed in this article are the author’s own and do not necessarily reflect the editorial policy of Global Village Space.