By Ishtiaq Ahmed
So Much Aid, So Little Development: Stories from Pakistan
By Samia Altaf
Lahore: ILQA Publication, 2015, 204 pages, Rs. 895
William Shakespeare was the past master of the art of depicting tragedy humorously. That such a skill can be employed by a medical doctor to illustrate something as removed from the world of fiction as the relationship between foreign aid and development in Pakistan, is quite an extra-ordinary achievement. Academic works and technical reports on foreign aid and its impact on third world countries are legion. The very nature of such writings makes them reading-worthy for experts and for students who take courses on that subject. Dr Samia Waheed Altaf’s book can be read almost as a novel or a play, but it is with hard, ugly facts that she puts together a range of stories, which shed light on what goes on from the time a development plan is formulated till it is “implemented” in the field.
The general public relies largely on experts or journalists who ventilate their opinion in the press. On the whole, interested people know that foreign aid achieves little in stimulating genuine development. Billions of foreign aid has poured into Pakistan but poverty, illiteracy, bad health and other such egregious indicators of underdevelopment remain constant and may even have worsened over the years. That corruption permeates throughout our society and the higher you are placed in the bureaucratic and political hierarchy the greater your vantage point to partake in that corruption, including in the misuse of foreign aid, is a commonplace. Then of course there is no dearth of grand conspiracy theories about foreign aid being a devious trap through which alien powers control the destiny of developing and dependent states.
The author shows that the relationship between foreign aid and economic and social development in third world countries in general and Pakistan in particular is much more complex and multifaceted. It needs to be evaluated in the backdrop of the asymmetries of power that exist between the donors and the recipients, the information and knowledge gap and concomitant culture clashes which are attendant in the donor-recipient equation, and in the behaviour of the various structures that mediate development aid in the implementation process. All these different levels have to be included in a holistic framework to understand what goes on. This, the author manages to capture in her very readable book which is rich in vivid descriptions of meetings and visits.
Altaf declares at the outset that her book ‘is about one participant’s understanding of why international development projects fail in Pakistan – and by analogy, why they fail in other developing countries’. She does this by presenting a range of stories from her experience in the delivery process pertaining to the Social Action Plan (SAP) during 1993-2003, when the Government of Pakistan and the World Bank cooperated to provide access to social services, ‘including primary education, with a particular focus on girls; primary health; family planning; the rural water supply; and sanitation – and to improve their coverage and quality’. She does this by presenting a spectrum of stories about the bureaucracies involved in the donor-recipient interaction. She also asserts that her book is about Pakistani women; their vulnerabilities in a society that, despite its rhetoric of inclusion of women in the development process, refuses to accept them as equals. The author was hired on the project as a technical expert by the Government of Pakistan to work on SAP as an external consultant (which means she was not a regular civil servant) to propose incentives to attract more women to work within the rural health delivery system.
I shall present some central characters (whose real names have been changed but who represent actual happenings). From the donor end the typical foreign staff hired by the World is usually narrowly-trained technicians from Europe or the United States who lack an understanding of the social conditions and institutions of a developing country but who arrogate themselves the role of experts and exploit them to the maximum. Lucymemsahib, a Canadian nurse, epitomizes such a character. We find her running away to buy clothes, jewellery, carpets and rugs during her working hours. Not surprisingly Punjabi male bureaucrats are only too pleased to please her. A peculiar blend of sensuality, exaggerated gallantry and colonial mentality place her on a high pedestal as Punjabi men from the higher echelons of the bureaucracy interact with her to discuss different aspects of the development aid. Lower down the order the admiration remains very visible and is represented in great willingness to render small services to her. Interestingly, the author notes that Lucymemsahib does not get the same sort of attention when she visits officers in Khyber-Pakhtunkawa or from men in the streets. She thinks this derives from the fact that in that province because light eyes and fair skins are more common than in Punjab. More substantively, we learn that Lucymemsahib is poorly informed on many matters but has strong opinions which she does not hesitate to express.
Both meet a number of female Pakistani officers as well, educationists, doctors and head nurses. Some look unapprovingly at the author wearing a sari instead of shalwar kameez since the national narrative has classified it with India and Hindus. She and Lucymemsahib have to listen to self-righteous sermons on the great purpose of creating a separate Muslim state, which with the grace of Allah was bound to succeed as an exemplary Muslim state. The funniest story is about a senior female officer demonstrating pedagogic originality by suddenly displaying an oversized male phallus, which she tells she uses to show women how the condom should be worn properly. It turns out that such demonstration attracts the attention of people around, even peons and clerks, but the lady is oblivious to the excitement her novel method has generated.
Then there is the interaction with the provincial director (PD) of the Provincial Health Department of Punjab on Cooper Road in Lahore. He is an orthopaedic surgeon, who simultaneously continues to be a professor and deputy medical superintendent at one of the government hospitals while me maintains a thriving private practice through various private clinics throughout the city. He tells the author that thousands of female staff would be used to deliver health services in the rural areas. When asked if they would be paid adequate salaries he tells her that they would be volunteers who would be working in their own communities and therefore get the moral satisfaction of doing something for their own people – while he himself draws three government salaries and runs his private practice!
In her extended conversations she realizes that an exhibition of Islamic piety permeates the conduct of the bureaucrats who ‘say things that sound so right but mean nothing’. Some of them blame conservative culture and values as obstructive to education, including family planning. One of them frankly told her that the purdah system is the biggest hindrance to progress and equal rights and status of women. However, the whole system, from top to bottom, is geared to convincing the World Bank to continue pouring in money. One bureaucrat tells her that the dollars are needed to finance the bomb.
All such stories are interspersed with funny remarks of the author, but a limit to such humour ultimately arises when she depicts the sadness and helplessness of young Pakistani women who are part of the SAP implementation chain at the ground level. She talks to a number of young women vaccinators working in the rural sector. They are given a small to go around and vaccinate children and others in the villages. The social and cultural systems circumscribing their lives are portrayed in sharp relief. Some express the desire to get an education and adopt a career but are told by their families that the proper role of women is to get married and raise families and obey their husbands.
With regard to her own role in SAP we learn that the Punjab bureaucracy reacts harshly to her independent and critical approach, which is treated as intrusive and presumptuous. They make it clear that any intrusion by an outsider like her into their domain is unwelcome. It finally ends with a report which describes Dr Sabiha ‘incapable of handling a task of this magnitude and seriousness’ and recommends that she be ‘relieved of any further duties related to the SAP’.
The British man-of-letters, historian, novelist and liberal politician, Horatio Walpole once remarked, ‘life is a comedy to those who think and a tragedy to those who feel’. Reading Dr Samia Waheed Altaf’s book convinced me that she is battling to maintain some balance between her thinking and her feeling selves. We learn that SAP cost the Government of Pakistan $8 billion, of which $450 million was in loans. She does not categorically say that foreign aid should not be solicited at all by Pakistan, but one is nevertheless led to conclude that such an inference from her book can be drawn. In a way, it is perhaps wiser not to take an absolute stand on it. We do have examples of foreign aid playing a positive role in some sectors. I was thinking of polytechnics which were established with Swedish development aid and some NGOs such as the Human Rights Commission of Pakistan do an excellent job too. But on the whole, foreign aid has failed to deliver development in Pakistan. I do very much hope Dr Altaf’s book will be used in courses on development theory and practice, not only in Pakistan but worldwide.
This review appeared in the January 2016 issue of Herald magazine. Dr. Ishtiaq Ahmed is Professor Emeritus of Political Science, Stockholm University and Honorary Senior Fellow, Institute of South Asian Studies, National University of Singapore. His book, The Punjab Bloodied, Partitioned and Cleansed, (OUP, 2012), won the Best Non-Fiction Book Prize at the 2013 Karachi Literature Festival and the 2013 UBL-Jang Group Best Non-Fiction Book Prize at the Lahore Literary Festival. His latest book is Pakistan: The Garrison State, Origins, Evolution, Consequences (1947-2011), OUP, 2013.