I am becoming more and more frustrated with the Government of Pakistan. These feelings have been there since the day I got here but it has now been intensified as I am taking classes in PHC and HSM.

I have already mentioned the inadequate provision of health care services for the people of Pakistan as well as decreased health expenditure based on GDP in my earlier blog. Second, is the issue of a decreased will to act and implement on behalf of the government and its ministries. Pakistan has beautiful health policies, probably the best in the developing world. However, these policies are only beautiful on paper. Pakistan lacks the will to properly implement these policies so as to achieve maximum health outcomes. I am having a hard time understanding whether this is about lack of will or lack of human and material resources. Let me give you an example. Pakistan's Polio Policy is top notch but there is an absence of proper monitoring and evaluation surveillance systems. Each year polio vaccinations, polio drops and Vitamin A capsules are dispersed to health care clinics based on rough estimates. Numbers from the previous year are simply rolled over to the next year. There is no up-to-date data available in order to analyze trends or patterns. There is a system in place, but it is not followed due to reasons X, Y, and Z. How is a program that is needed in a country with the highest polio prevalence rate supposed to survive and sustain when there is mismanagement and lack of accountability?

Second example, a country wide food program was implemented in Pakistan by AKU and other NGOs a few years back for primary and secondary school-aged girls. Based on the squatter settlements randomized, close to 4,000 schools were identified by the government. Upon initial assessment and field visits, some schools were only written on paper but did not actually exist. The government had claimed such schools when funds were being allocated to each school. If these schools did not exist, where were the funds going? I am sure you can figure this one out.

There is no sense of ownership and accountability. Money is pocketed by the elite and the powerful at the expense of citizens. These citizens are well aware of the corruption but their words are, "We have been dealing with this for as long as we can remember." When questioned as to why nothing is being done about it, they reply, "What can we do. This is how it is." This reminds me of a statement made by His Highness the Aga Khan at the Seerat Conference in Pakistan, " The anchors of moral behaviour appear to have dragged to such depths that they no longer hold firm the ship of life. What was once wrong is now simply unconventional, and for the sake of individual freedom must be tolerated. What is tolerated soon becomes accepted. Contrarily, what was once right is now viewed as outdated, old-fashioned and is often the target of ridicule." (1976) I fear that we have reached this state. Many Pakistanis have lost faith in their countrymen and their government, yet they chose to do nothing about it.
As for me, I will try to remain hopeful....