|
By Sandhya Srinivasan The process of structural adjustment began in Pakistan in 1988. Privatisation and cuts in public sector spending caused a sharp drop in economic growth, an increase in poverty from 17 to 35 per cent and a worsening of people's health. The tragedy is, scarcely anyone in Pakistan is protesting these damaging policies
The Structural Adjustment Programmes (SAPs) required of borrowing countries by the World Bank and International Monetary Fund have been sharply attacked by many sections in the affected countries. The campaigns range from trade unions fighting changes in labour legislation to health activists opposing the privatisation of public health services - though their actual impact may be limited. For example, India was one of the more active participants of the People's Health Assembly in Dhaka, Bangladesh, where health organisations, trade unions, civil liberties groups and political parties from 93 countries joined hands against a system of international trade biased in favour of rich countries. However, one hears little of Pakistan, a country which might seem to have many characteristics in common with India, and which has suffered the consequences of SAPs for longer. Researchers in Pakistan witness to the consequences of SAPs have consistently protested, even if their voices are not loud enough. Despite having the highest gross national product per capita in South Asia after Sri Lanka, Pakistan's health indicators - such as infant mortality, maternal mortality and malnutrition -- are far below the average for low-income countries. Forty per cent of the disease burden in this country of 140 million people is from diarrhoea, acute respiratory infections, tuberculosis, and preventable childhood diseases. Between 8 and 33 per cent of mothers are anaemic. Twenty-five per cent of Pakistani babies weigh less than 2,500 grams at birth. Ninety-one of every 1,000 children born die before their first birthday. One in two children between one and five years old is stunted, weighing abnormally little for his or her age - indicating long-term under-nutrition either from lack of food or from chronic diarrhoea. The root causes of all these problems: poverty and inadequate health services for the poor - a situation that researchers feel is being aggravated by the SAP. Pakistan's use of World Bank loans goes back to 1952. It was in 1988, however, that a $1 billion loan from the IMF forced the government to make major and controversial changes in economic and health policy. "This started the process of so-called reforms," says Karachi-based political economist S Akbar Zaidi, former associate professor at the Applied Economics Research Centre, University of Karachi, and author of Issues in Pakistan's Economy (Oxford University Press, 1999). The dependence on structural adjustment-related loans has only grown in the last 13 years. In the Fiscal Year 2000, the World Bank approved a Structural Adjustment Loan of $350 million requiring changes in "public sector governance in banking, tax administration, public utilities, and public expenditure". "The reforms meant privatisation, cuts in public sector spending, something called 'getting prices right' which meant utilities' prices rising, subsidies falling, greater participation by the private sector in all social services - water, utilities, electricity - and very rapid devaluation," says Zaidi. The result has been a sharp drop in economic growth, an increase in poverty and a worsening of people's health. In 1988, 17 per cent of Pakistan's population was below the poverty line. "Today that number is 35 per cent," says Zaidi. Unemployment has shot up, the rupee was devalued from Rs 25-30 per US$ to Rs 67-68 per US$. "Economic growth has been cut by half, from 6 per cent earlier to 3.2-3.3 per cent today." People have also suffered from the substantial cut in development spending. Two decades ago 7.3 per cent of the Gross Domestic Product (GDP) went towards development-related spending. Today, barely 2.8-2.9 per cent is spent in such areas. The government spends just 0.7 per cent of GDP on health, where private sector curative services dominate, accounting for three-fourths of total healthcare spending. "Education is about 1.8 per cent, but defence is twice the rate of health plus education, which gives you an idea of the government's priorities," says Zaidi. What has happened as a result? "Just the fact that poverty has risen addresses everything else," says Zaidi. It will have led to a deterioration in the health of women and children who are far more vulnerable. "The infant mortality rate was falling in the 1980s, but now it has actually risen in some pockets and in parts of north Pakistan." Dr Afzal Mohammed Khan of the department of community health at the Aga Khan University objects to the World Bank's acceptance of a weak public sector in health, and its promotion of the private and voluntary sectors in health while ignoring the need for effective and accessible public health services. The Bank argues that the private sector's dominance "releases fiscal resources that can be allocated to other high-priority uses". It suggests that the government limit public services to a few targeted interventions, and improve the quality of existing private health services. "Should we not question the pattern of financing, the low priority for public health?" asks Dr Khan. If the government put more money into public health, it could be improved, and more people would use it. "One-third of the population lives below the poverty line and suffers more than 50 per cent of the burden of disease." They pay for health services by transferring resources from food, from education. Dr Khan describes the plight of a rural doctor who watched a family sell a seven-year-old child to pay for another family member's operation. How serious is the opposition to structural adjustment? "There's no opposition to anything in Pakistan," says Zaidi, echoing a frequently-heard comment. "There's no opposition to the jehadi groups, to Islamic fundamentalism, there's no opposition to militarisation, there's no opposition to globalisation, to IMF and World Bank policies, even when their consequences are so clear." NGOs, which are largely foreign-funded, have been co-opted by the mainstream. "There are very few individuals who actually have any role to play in any anti-globalisation, any anti-IMF/World Bank campaign. Trade unions are dying out, there are no social movements in Pakistan. Democracy has been written off, and military government is here."
|
