After the troika meeting

MUCH has been written about the Musharraf visit to the United States and the UK and much has been said about the book which the tour was designed to promote. It was perhaps inevitable that laudatory or critical comment on the book tended to overshadow the substance of the discussions that the president had with his American counterpart, separately as well as at a trilateral dinner that included Afghanistan’s Hamid Karzai.

At another time I will probably put in my tuppence worth on the merits of the book, on the effect the disclosures in the book, and in Musharraf’s media appearances had on the credibility of the president and other Pakistani spokespersons, and the advisability of such an extended book tour. For the moment, suffice it to say that even though the president received a standing ovation at the prestigious Council of Foreign Relations — dubbed sarcastically as “Musharraf’s fan club” by a Wall Street Journal columnist — and even though this set the trend for most of his public appearances, his words and views were not accepted by serious analysts and policymakers as accurately reflecting the true version of past events or the current situation in South Asia.

I will also not dwell on the undoubted success of the meeting with Prime Minister Manmohan Singh in Havana or on his other bilateral meetings or on the speech at the UN — or even on the mudslinging in which the president, with total lack of restraint, and President Karzai, with somewhat greater diplomatic finesse, indulged in the deluge of public appearances and official statements. I will focus instead on the discussions and the agreements reached by the Bush-Musharraf-Karzai triumvirate on the pursuit of the global war on terrorism, the elimination or at least reduction of the Taliban threat in Afghanistan and the elimination or reduction of extremism in Pakistan.

What are the prospects for the implementation of these agreements given the current situation on the ground? The number of suicide bombings and roadside booby-trap blasts in Afghanistan has soared by 600 per cent in nine months, rising from 11 in 2005 to 67 by September 28, 2006. It is feared that this is not merely a textbook emulation of the Iraqi insurgency’s tactics but a reflection of the ties that have been created through an Al-Qaeda intermediary between the trainers of the Iraqi suicide bombers and the Taliban leadership wherever it is based.

UN officials in Afghanistan may maintain that there is no evidence of such a nexus and that suicide-bomber tactics may have been picked up by the Taliban from extremist web sites, but there are reports that Afghans have received training in Iraq and that Arab trainers have been to Afghanistan. Taliban leader Mullah Dadullah has claimed that he has, in addition to 12,000 fighters, some 500 suicide bombers who are eager to seek martyrdom.

The leaked National Intelligence Estimate has emphasised the “centrality” of the US invasion of Iraq, and the insurgency that has followed, as the leading inspiration for new Islamic extremist networks and cells that are united by little more than an anti-western agenda. In Afghanistan I have no doubt that the three-fold effect of the war in Iraq was the diverting of American attention and resources, the consequent resurgence of the Taliban and the development of ties between Sunni extremists in Iraq and the Taliban.

The one silver lining seems to be that the Taliban realise that suicide bombings in which the victims are civilians alienate the local population. In areas like Helmand, they have distributed pamphlets attributing the suicide attacks to “foreign Taliban”. The Afghans of course maintain that “foreign” means not Arabs but Pakistanis emerging from the madressahs that continue to dot the landscape in the border region and elsewhere in Pakistan.

Four weeks after the conclusion of the Pakistan government’s deal with the tribal leaders in Waziristan, a peace of sorts has continued to hold in the tribal areas. On the other side of the border, American military spokesmen have claimed that the number of Taliban attacks in the eastern provinces bordering Waziristan has tripled since the agreement.

In Miramshah, a local man was executed by militants who left behind a note describing the man as a spy for America and warning the locals against such informants. The Taliban opened an office in Miramshah and asked people to report the whereabouts of masked men who were disturbing the peace so that the Taliban could take care of them. The office has now been closed but the Taliban, while overtly promising to honour the agreement reached with the government by tribal leaders, clearly believe that they should be responsible for the security of the region.

The UNHCR has announced that this year’s programme for repatriating Afghan refugees from Pakistan has come to an end with 130,000 refugees having travelled home instead of the planned 400,000. The next UN-assisted repatriation will have to wait upon the conclusion of a new tripartite agreement and will not commence until March 2007. Some 2.5 million refugees continue to be on Pakistani soil. There is no indication that the Pakistan government is urging the UNHCR to do more to lift this burden.

On the contrary, there is evidence that refugees continue to pour into the country and that the Pakistan government does little to check this influx. It is estimated that some thirty to forty thousand persons cross the border at Chaman every day with no documents beyond the red Rs100 note that they proffer to willing immigration officials. The border is more fantasy than reality at Chaman, as is the case at most other so-called official crossing points on the 1,400-mile long border.

Un-contradicted reports in the press indicate that the Karzai government’s ministry of tribal affairs has resumed the practice of past Afghan regimes of paying a subsidy to tribal leaders on Pakistan’s side of the border, particularly in the Waziristan area. One can assume that the Pakistan government is doing likewise on the Afghan side.

This year Afghanistan will harvest some 6,100 tons of opium, much of it in the provinces bordering Pakistan. The Americans and the Nato forces contend that this opium is grown with Taliban encouragement and is financing the Taliban war effort. My own view is that the major encouragement is provided by Afghan officials and warlords sitting in the Afghan Wolesi Jirga who use the money to pay their private militias and to build garishly opulent houses on dubiously acquired government land in Kabul and other cities. Lists are apparently available of the warlords and officials involved, but the Karzai administration is not able to dismiss or apprehend them despite pressure form the UN.

We in Pakistan should note that the European market will, at most, take the equivalent of 1,700 tons of opium, converted into heroin in laboratories which have sprung up once again on both sides of the border. The rest will be consumed by addicts in Afghanistan, Pakistan and Iran, countries where the number of addicts and users is growing. It should also be noted that Nato forces will not seek to eliminate opium cultivation and will leave this task to the Afghan forces, which have yet to prove their mettle though there is now talk of enormous improvements having been brought about in their training programmes and of the provision of suitable weaponry and transport.

Nato forces in southern Afghanistan claim to have killed some 800 militants in the pitched battles that they have fought against large Taliban formations. They concede that, as a result, they have been able to do little reconstruction work and have further alienated the local population which has suffered the most from these battles and the consequent “collateral damage”. Nato has not been able to get the commitments of additional troops that local commanders have sought after facing unexpectedly tough resistance. They have, according to press reports, taken the wise step of reaching an agreement with the Taliban on vacating areas in Helmand province, provided the Taliban do likewise, and leaving administration to the local populace.

In eastern Afghanistan, American forces have killed some 300 Taliban in the latest operation but have also managed to start work on some 120 construction projects — government offices, schools hospitals and roads — for which $43 million has been allocated. What will actually happen on the ground is open to question. The Americans too may have to start looking at compromise solutions such as the British are accepting in the south if their reconstruction is to proceed and provide some relief to the suffering locals.

Agreement has been reached on Nato being given operational control of all of Afghanistan by March 2007. Twelve thousand of the roughly 20,000 American troops now in Afghanistan will come under Nato command while the balance will continue, under American command, to search for and eliminate Al Qaeda and Taliban. While plans for a partial American withdrawal from Afghanistan appear to have been shelved for the time being, it is likely that a brigade — some 3,000 troops — will be withdrawn once Nato takes command in southern Afghanistan. When this happens, the durability of America’s commitment to Afghan stability will be called into question, wrongly I feel, by Afghan leaders and the public. It will be seen as a victory by the Taliban and their supporters in Pakistan and elsewhere.

While there is no doubt that the Taliban are deriving some revenues from the opium trade, there is also no doubt that they are receiving foreign funding and foreign fighters. They are said to pay their volunteers $100 per month as against the $70 that an Afghan soldier gets. The Americans, despite their best efforts, have not been able to stem the flow of such funds or the influx of non-Afghan recruits to the Taliban cause.

Pakistan continues to publicly express concern about the growing Indian influence in Afghanistan. Islamabad claims to have evidence that Indian officials posted in Afghanistan are using this vantage point to foment trouble in Pakistani Balochistan and to promote anti-Pakistan sentiment in the country.

Many but not all Pakistanis realise that unless the Taliban are eliminated, extremism is bound to grow in Pakistan and that it will be impossible to prevent the spread of Talibanisation from the tribal areas to the settled districts. ‘Enlightened moderation’ will then be seen as no more than a joke. The government’s resolve is perceived as being weak with the fiascos of the blasphemy law amendment, the extra column in the passport and, most recently, the amendment of the Hudood laws being cited as examples of the government’s surrender of positions of principle in the face of pressure from the religious parties.

It is against this backdrop that I will analyse, in the next part of this article, the agreements reached in Washington, and in particular the decision to hold Loya Jirgas. These councils could make effective the compromise agreement with the tribals in Waziristan as well as the understanding that the British have reached in Helmand and which may be replicated by the Americans in Khost and Paktika.

Our profit-driven drug industry

AT the inauguration of the Hanifa Suleman Dawood Centre of Oncology, the director of SIUT, Dr Adib Rizvi, promised to launch a movement against the spiralling prices of drugs. His concern at what can be described as the anti-social strategies of pharmaceutical manufacturers is quite valid.

The Sindh Institute of Urology and Transplantation in Karachi, prescribing to the maxim ‘health is the birthright of every man’, provides free medical treatment to every patient who enters its portal.

Since the bulk of SIUT’s budget comes from public donations and it is always looking around for funds, it has to be extra mindful of its spending. It is, therefore, worrying for it that 38 per cent of its budget goes towards financing the cost of medicines alone. This trend is nothing unusual. The Pakistan Association of Mental Health, which runs a free clinic for indigent patients and provides drugs free of charge to quite a substantial number of patients, spends 25 per cent of its budget on medicines. It may be noted that PAMH’s formulary includes only the lower-priced items.

This phenomenon of high drug prices, which amounts to the pharmaceutical industry capitalising on the distress of an ill person in desperate need of medicines, is nothing new for Pakistan. The country never went in for the manufacture of basic drugs and has always depended on the pharmaceutical multinationals importing their products at transfer prices. When combined with the corruption in the health sector, especially in the regulatory bodies that fix prices, give licences and inspect the quality of the drugs produced and marketed, the fortunes of the manufacturers have never flourished as much as they have today in Pakistan.

The Drug Regulatory Authority that has been on the cards for over two years has yet to see the light of day. The process might be expedited somewhat now that the prime minister has given his approval for the DRA Act which will be introduced in the National Assembly. But how the DRA will perform will be known only after it starts functioning.

Seen against the backdrop of the world pharmaceutical industry that had a hefty turnover of $550 billion in 2004 and has been growing at the rate of seven per cent per annum, the drug manufacturers — both indigenous and multinational — have fared well. Considering that this is a third world country with nearly a third of the population living below the poverty level and the public sector gradually disengaging from the health delivery system, can Pakistan afford to turn a blind eye to the waywardness of the drug manufacturers?

The pharmaceutical industry differs from other manufacturers in a basic way. The decision to use any of its products is not made primarily by the user. It is basically the health practitioner who makes the choice. That would explain why manufacturers cannot advertise their products in the media. Their advertising is directed only at the health professionals. In a way it has made the manufacturers’ job a tougher one. They have to employ an army of medical representatives to carry their samples to the physicians and persuade them to give their drugs a try. They cannot take the easier way out and place an advertisement in the newspaper or on television. The Drug Act 1976 does not allow it for sound reasons. How can a patient who is a layperson decide which medicine is best to treat his condition?

Hence the drugs manufacturers can only advertise in medical journals/papers that are read by doctors and surgeons. They have now found the easy way out. They try to buy over the health professionals in a bid to influence them into prescribing their brands of medicines to create a seller’s market for the pharmaceutical company. Many of the marketing tactics the manufacturers have employed have been unethical and unscrupulous.

A leading Pakistani psychiatrist, Dr Murad Moosa Khan, writes about a multinational pharmaceutical company that launched a drug for dementia in Pakistan and flew 70 Pakistani doctors to Bangkok for a three-night all-expenses-paid trip estimating to have cost the sponsor seven million rupees. Other promotional practices include sponsoring attendance at conferences, underwriting symposia, free drug samples and expensive gifts such as cars, air conditioners, laptops, etc. for writing 200 prescriptions for a medicine.

The manufacturers easily recover the cost of their marketing strategy by jacking up the price of their drugs. In Pakistan, since minimal basic manufacturing is done, multinationals import their own products and by employing the technique of transfer pricing keep the prices pitched high.

Another grave problem the country faces — and that too is linked to the price issue — is in respect of the quality of drugs. It is estimated that 50 to 70 per cent of the medicines in the market are spurious or fake. They are referred to as “dou number” (#2) and cost less. They do not cure a patient as effectively as the genuine ones are supposed to.

Given all these malpractices in which a number of physicians and manufacturers are involved, and the wrong policies adopted in the drug sector, it is not surprising that medicines are so expensive in this country. In neighbouring India the same drugs are much cheaper than what they are here. The following prices are eye-opening.

Ranitadine for acidity costs Rs2 per tablet in India as compared to Rs10 in Pakistan. Ciprofloxacin for pneumonia is Rs1.5 per tablet in India and is Rs20 in Pakistan. Alfazosin for hypertension is Rs10 per tablet in India and is Rs100 in Pakistan. Injection Amphotericin B, an antibiotic, costs Rs150 in India and is Rs300 in Pakistan. Bicalutamide, used for treating prostate cancer, is Rs35 per tablet in India compared to Rs450 per tablet in Pakistan. Lipitor, for lowering cholesterol, costs Rs8 in India and Rs60 in Pakistan.

In the absence of basic manufacturing, Pakistan is at the mercy of the drug multinationals. As a result, even after the patent of a drug has expired, not many companies other than the original manufacturers feasibly manufacture generic drugs at a lower price. India has done this successfully and thus brought down its drug prices. If the SIUT’s campaign is to succeed, Pakistan will have to promote the manufacture of generic drugs and at the same time defeat the ulterior motives of the multinationals who would not want the generic drugs to sell. It is here that the medical profession should refuse to be bought over by the drug manufacturers. Can one be hopeful? After all Z.A. Bhutto’s health policy that introduced the generic scheme failed to popularise it.

Under Trips (Agreement on Trade-Related Aspects of Intellectual Property Rights) of the WTO, a patented medicine cannot be manufactured by another company until the patent expires. But Trips contains a clause which allows their generic manufacture in case of an emergency. That is how South African manufacturers could get away without being penalised for making anti-retrovirals, used in the treatment of Aids. Why are Pakistani drug manufacturers not more inclined towards social justice? Why are profit motives allowed to determine their policies?

Meaningful justice

THE five years that I spent in the Wafaqi Mohtasib’s Secretariat from 1983 to 1988 were the happiest of my long service career, and therefore an appropriate culmination.

They were different from my youthful days in Punjab Information in the early fifties which were naturally marked by an absence of responsibility. Government job rarely provides an official an opportunity to be satisfied that he has given his money’s worth in the shape of work, but these five years with the Ombudsman were unique in that respect. I felt like a missionary (as did all my colleagues) and we believed that we were contributing to the good of those who came to us for redress of injustices done to them.

This feeling comes naturally if one performs his duties in the Mohtasib’s office honestly. Add to this the pioneering spirit of Sardar Muhammad Iqbal (who had retired as Chief Justice of the Lahore High Court) as the first ombudsman in Pakistan. Words cannot do justice to describe his devotion to the spirit of ombudsmanship, his style of work, his compassion for the wronged and his stern attitude to the senior-most federal officers long accustomed to having their own autocratic way in dealing with the public.

I was primarily in charge of publicity, but Sardar Sahib also allotted me two ministries, to investigate complaints against them. He was a most cultured person but a hard taskmaster as far as work was concerned and, as he proudly claimed, “You can set your watches by the time of my officers’ arrival in office.” He himself was punctual to a dot, but there was no time fixed for leaving office. It seemed that we were the only part of the government following the exhortation of the Quaid-i-Azam, “Work, work, and work...”

The work situation in respect of publicity was also unique and couldn’t have been easier. You see, PR men in Pakistan’s political administration have a terrible time. The poor chaps are required to publicise what is not there at all. Their bosses expect them to fill up the newspapers with reports of non-existent achievements and meaningless statements. Wirh Sardar Iqbal (and perhaps with any other Mohtasib) the number and nature of cases decided in favour of complainants, and against government agencies, were so many that I had a problem getting all of them published. There were no handouts beginning with the ubiquitous words “He said”. They were all about decisions, work actually accomplished, without any praise added on my part because Sardar Sahib’s orders and findings spoke for themselves.

By the way, he used to hold a meeting with all his officers every morning at eleven. Yes, every morning, where cases were discussed and his advice sought by them on ticklish matters. In that meeting he once asked me, “You have been a government publicist. Do you find the work different here?” “Yes sir,” I replied, “There is no comparison. All my life I have been issuing contradictions and clarifications about government actions which were marked by prevarication and dissimulation. Here I am telling the truth for the first time.”

A feeling of nostalgia overcame me when, the other day, I visited the Ombudsman’s office to see someone I knew there. Actually all the old guard had either retired from service or retired from life itself, for 18 years had passed since I had been there. At first I thought of calling on the Wafaqi Mohtasib too who is a stranger to me, but then changed my mind for he might think I had come to ask for some kind of favour. A gentleman from the Frontier, carrying a very fine reputation, he is probably the first incumbent of the post without a judicial background.

This reminds me of what Sardar Sahib used to say. “The Mohtasib must of course use his judicial and judicious mind, but forget that he is a judge. He explained it this way. “Here he is not to dispense justice according to the letter of the law. The ombudsman concept expects him to provide relief under the Islamic principle of “Ehsan bil adl,” that is, justice tempered with mercy. It is most important to remember that. It is easy to administer justice as the law dictates, but not easy to find ways of giving relief to hard-pressed citizens trying to fight merciless bureaucrats.” He was truly a visionary.

Sardar Sahib created some fine precedents, unheard of so far in the corridors of the establishment, and left them for his successors to follow. They were rarely followed. Apart from the daily meeting with his officers, and the daily session where any complainant could come and talk to him, he invariably took a round of the office every day. “This keeps people on their toes,” he said.

Then he sent out some excellent advice to the government so that its secretaries (if they were interested in the public good) could emulate his example. One of them was to devote an hour every morning to an open house where any member of the public could see them without appointment. A round of the office was also prescribed because, as he said, “I know of secretaries who had never met their section officers, or even a deputy secretary as it happened in one case, so how could they keep an eye on the disposal of urgent files?”

This man, with such an attitude towards his work and towards complainants, has been succeeded by a number of incumbents since he relinquished office in August 1987. Of those, only two endeavoured to match him. I am pained to tell you that one of them was more interested in managing his vast property than in his duties.

Justice S.A. Salam made a number of fine recommendations before he left. One: all recommendations of all ombudsmen should go through at the highest elevel, and either dropped or implemented sincerely. Two the provinces should be compelled to have their own ombudsmen because the Wafaqi Mohtasib has no jurisdiction to take up complaints against provincial government agencies.

Three ministries, corporations and agencies should be stopped from going in appeal to the President against the Mohtasib’s findings unless the decision to do so is taken by the highest authority in the ministry, etc. There were many others. I do not know what Mr Salam thought about the possibility of their acceptance by the president and prime minister. But I have no hopes in that regard. They are not bothered.

Let me add my recommendation too. If the president and the PM genuinely want the Mohtasib’s office to function meaningfully, they should publicly uphold its presence and thus ensure quick redress of the people’s grievances against federal government agencies.

Corrupting practices

THE appointment of Paul Wolfowitz as president of the World Bank was greeted with dismay because of his cheerleading for the invasion of Iraq while a member of the Bush administration. If fears that Mr Wolfowitz would turn the bank into an arm of the White House have proven unfounded, he has nevertheless set the bank on a course that has run into opposition.

Most recently, the UK has withheld 50 million pounds from the bank to push it to focus on accountability and human rights, rather than reforms linked to privatisation and liberalisation, a process known as conditionality. Hilary Benn, the international development secretary, is right to try to hurry the bank along.

The main controversy stirred up has been Mr Wolfowitz’s decision to concentrate on tackling corruption, through halting loans and aid to countries that the bank deems to have unacceptable records. Some of the world’s poorest countries, including Chad, Bangladesh and Congo, have since suffered the effects. Mr Wolfowitz argues that in most cases the funds have been paid after safeguards were put in place, and that fighting corruption and fraud is an important part of development in that it rewards countries with good governance.

—The Guardian Service