I had the pleasure of spending last Friday evening at the home of Ahmed Ali, current President of COPAA (Council of Pakistan American Affairs), where we ate more than we should, but for a good cause. The cause is human development.
“Human Development” as a concept was coined by Amartya Sen, the Nobel Prize-winning Indian economist. He put forth the idea that economic development should not be measured strictly in terms of per capita income, which is the traditional method of comparing national wealth, but should also look at broader factors. Sen argued that development must mean something to the average person in a Third World country. If the richest ten percent see their incomes double, while nothing changes for the rest, traditional measures would see that as “progress”, but in reality little or no benefit touched the populace. Sen felt that the criteria such as education and health status had to be included in measuring a society’s level of development. He created a “Human Development Index”, in which factors such as literacy rate, life expectancy, and infant mortality were thrown in with the dollar value of average incomes. Nations could then see how they did in “Human Development” for a given level of income compared to their peers. Some poor countries with good education and health programs ranked much higher than their income alone would suggest, while others (unfortunately, including Pakistan), ranked worse in human development than even their meager incomes would suggest they should.
The present government of Pakistan has decided to make a major push to rectify this. President Musharraf has created the “Chief Executive’s Task Force on Human Development” which is charged with the task of mapping out a comprehensive strategy for human development in Pakistan. Besides being a government effort, there is a policy of bringing on board the NGO’s and the Pakistani expatriate community. Dr. Nasim Ashraf, a prominent Pakistani-American physician, is the team leader of this task force. Dr. Ashraf, even more importantly, has been deeply involved with the Human Development Foundation of North America. HDF was created as a project of APPNA to allow emigrant Pakistanis to give back to Pakistan.
Dr. Ashraf was the speaker at Ahmed Ali’s house as he came to raise funds for HDF. According to him, the key factors that enable successful human development projects in village Pakistan are three. First is basic health care. Second comes education for girls especially, and finally there must be economic reward to families that choose to participate in these projects. This means that HDF projects require health, education, and financial components.
HDF health teams have chosen to create trained non-physician workers, mostly women. It is practically impossible to get Pakistani physicians to work in remote villages, even harder than getting American physicians to work in small towns and Indian reservations. Women workers get easier access to the home, where they can teach the basics of cleanliness and health care. In HDF project areas covering 150,000 people, dramatic health results were achieved. Infant mortality was cut to half, maternal (childbirth) mortality dropped 75%, and population growth slowed from 3% to 2%. All at an annual cost of a dollar per person.
Schools are also a priority and HDF makes sure that the village gets committed to the project. They require the villagers to build the school with their own labor, and provide as much of the funds as possible. A PTA is set up and then the school gets started. They provide an accelerated curriculum so that many children complete 5 years of primary school in 3 years.
The economic component is also very important. This may mean funding a small dam in Balochistan which might costs 35,000 dollars but is an impossible price for the locals to raise by themselves. It also means microcredit lending, with small loans of 50-500 dollars made to villagers to allow them to create small businesses that supplement household income. One barber borrowed 15,000 rupees to build a small shed so that his customers could come rain or shine, a move that boosted his monthly income threefold, and gave a measure of security to a large family just scraping by.
Dr. Ashraf made the point that properly done, rapid human development is possible in Pakistan at a cheap price. To scale up HDF’s programs to the national level would cost 2 billion dollars a year. With 5 million expatriate Pakistanis, he commented that if even 1 in 10 contributed 1000 dollars a year back to Pakistan, that would be 500 million dollars. If the government and multilateral donors (World Bank, Asian Development Bank, etc.) do their part, then the human development of Pakistan becomes inevitable.
I hope that he is right, and wish him success. What worries me is that Pakistan’s unstable politics may well derail a good policy. Nawaz Sharif put forth an ambitious human development initiative under his “Pakistan 2010” plan, but that was discarded along with him. No matter how good a plan Musharraf’s Task Force creates, how is it to be that Pakistani governments after next October’s handover of power will carry it out as their own? Musharraf often speaks of how his reforms and policies will remain in place, but even if he is President, there will still be a new Prime Minister. Pakistan’s development remains hostage to its politics.