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Lecture, Dialogue & Presentation by Dr.
Samia Altaf
Samia Altaf is the 2007-2008
Pakistan Scholar at the Woodrow Wilson International Center for Scholars,
Washington DC. She is writing about the effectiveness of donor assistance to
Pakistan. She is an international health/public health physician with
extensive work experience in the United States, Pakistan and India. In the
U.S., she has worked at the county and state level and was the Medical
Director for the Washington D.C. Department of Health's Medical Assistance
Administration. She has worked for the World Health Organization and CIDA in
India and Indonesia. In Pakistan, she has consulted for the Government of
Pakistan, worked for UNICEF and for Agha Khan Medical College where she
holds an Adjunct Faculty position. She has just finished a four year
assignment with USAID Pakistan, working as Acting Director and subsequently
as Senior Advisor, Office of Health. Her book length manuscript
about aid effectiveness and the health sector in Pakistan is under review by
the Wilson Center press.
Lecture, Dialogue & Presentation:
- Donors and
Development - a lecture
Understanding the Aid Crisis in
Pakistan.
Dr. Samia Altaf discusses why Pakistan
hasn't seen sufficient health and demographic change despite receiving more
than $10 billion of aid from the United States since September 11, 2001.She explains in depth, her
personal experiences and observations about this dilemma.
Venue
The Elliott School
of International Affairs
Washington DC
The Sigur Center's Lecture Series on
Sub national Asia
Listen to the audio
- Making Aid Work - a dialogue
National development is a complicated
undertaking for any emerging nation. For Pakistan it involves especially
delicate judgments because the constraints imposed by feudal tribes in
distant territories, match the concerns caused by having a nuclear arsenal.
In this charged environment, the failure of international development aid
resonates with profound impact. Dr. Samia Altaf explains why.
Venue
The Woodrow Wilson Center, Washington DC
Watch the video
- Aid Effectiveness in Pakistan - a
presentation
Case Study of the
Health and Population Sector
Venue
The Woodrow Wilson Center, Washington DC
Watch the video
Event
Summary
Between 1950 and 1999, the international donor community contributed nearly
58 billion dollars to Pakistan, said Dr. Samia Altaf, Woodrow Wilson Center
Pakistan Scholar, on July 9, 2008. According to the International Herald
Tribune, the country has received more than ten billion dollars of aid from
the United States since September 11, 2001. Yet, “In spite of the large
inputs that have been going in, the outputs have not been commensurate,”
particularly in the social sector, Altaf appraised. During the discussion
following the presentation, Dr. Mehtab Karim, a senior advisor at the Pew
Research Center, illuminated this inconsistency further: “For the last eight
years, since the year 2000, none of the health and demographic indicators in
Pakistan have changed. [The] contraceptive prevalence rate has remained at
the same level, below 30 percent. And infant child mortality has been
stagnant for the last 10 years or so.” Currently, Pakistan ranks 136 out of
177 on the United Nations Development Programme Human Development Index.
Culminating her year of scholarship at the Wilson Center, Altaf discussed
the current state of foreign aid in Pakistan, specifically within the health
and population sectors. Drawing on professional experience with the U.S.
Agency for International Development (USAID), UNICEF, and other
international aid agencies, she discussed past shortcomings and present
opportunities to improve aid effectiveness in her native country. Altaf is
currently writing a book that describes the disparity between the infusion
of development aid to Pakistan and the poor performance of the country’s
social services. According to Altaf, previous studies place blame on poor
human resources, insufficient infrastructure, and government corruption. Her
effort to define the problem, however, departs from these explanations: “I
do not agree that corruption and poor human resource and lack of
infrastructure is the problem because we knew that those were the problems
when we went in to help Pakistan. Those were the problems which precisely
motivated us—the donor community and the technical experts—to go in and help
Pakistan.”
In a qualitative approach, Altaf observed 16 institutions within the health
and population sectors of the Pakistan government, along with the World Bank
and other donor agencies. She focused on identifying issues at the
micro-level to feed into policy suggestions relevant at the macro-level.
From her field research Altaf concluded that, “The success or failure of the
program depends upon the program design that includes (or excludes) the
implementation challenges and incentives of the people managing and running
those programs.” She explained that the workers “in the trenches” of these
projects are not involved in designing program activities and have very
little flexibility in making changes at the last stages of implementation.
In addition, the local program managers, being political appointees, lack
commitment to programs for long periods of time—time necessary for a program
to be effective.
Altaf’s findings suggest a circular pattern of role-playing by major actors
in which incentives are aligned with disbursing funds, but in a manner that
prevents them from asking critical questions. Because effectiveness is not
prioritized, the same results are generated year after year, failing to
achieve success in social service development programs. The government of
Pakistan, donors, contractors, and NGOs all benefit from this current
revolving door arrangement, despite the lack of progress for the people they
serve. “The incentives of all of these actors have not changed. They are
very clearly aligned in a certain fashion with each other and if each of
them continues to play the scripted role that is assigned to them then it is
to the advantage of all of them,” Altaf summarized. She also revealed how
finance cycles of donor organizations limit the ability to address public
health concerns in the long-term. Emphasis is placed on meeting the
deadlines of the intertwined institutional processes rather than the needs
of the Pakistani people. Political expediency has trumped any attempt at
meaningful reform towards efficacy, she maintained.
Despite the grim picture Altaf’s presentation portrayed, she believes there
are opportunities for improvement. “All of these actors on stage are very
good at doing the job and the script that they are assigned, so they just
need to be assigned new scripts,” she stated. Altaf argued that reform must
first begin with program redesign that accounts for implementation
challenges and specific local conditions, aspects that are usually
considered after programs are implemented—when it is too late. She also
recommended reducing the size of the programs to focus on specific
geographic areas in Pakistan; assigning different donors to fund parallel
projects in different regions to foster healthy competition; and organizing
programs in such a way that results become self-evident to all stakeholders
throughout their long-term duration.
Altaf concluded her presentation by explaining that the United States’
failure to produce aid efficacy in Pakistan has put its credibility at
stake. The people of Pakistan can see that the programs are not working and
“they are basically doubting our credibility and our intelligence,” she
said. However, Altaf remains optimistic: “To me, from the smartest country
in the world with the most resources at its disposal, the repository of
technical expertise – certainly we can put our heads together and come up
with a solution to this problem.”
Drafted by Jackson Droney
Courtesy: Dr. Robert M. Hathaway, Director Woodrow Wilson Center,
Washington DC
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Samia Altaf