Posts Tagged ‘Samia Altaf’

Still learning as we go along … are we?

July 23, 2016

By Jacob Steiner

A review of So Much Aid, So Little Development: Stories from Pakistan published by the Johns Hopkins University Press in 2011. The book was republished in 2015 by Ilqa Books in Pakistan and is available there in book stores and online.

Some months back I visited a rural support program in a Central Asian country, executed by one of the world’s biggest development organizations with an excellent repute here and in similar areas in Pakistan. A European consultant, with ample experience in the area and his field – sustainable construction solutions – had recently visited the project. The outcome of this visit, a number of manuals as guidelines for the local execution, had just been printed and handed over to the local engineers. Among them seismic proof housing, and split latrines. These toilets are currently a very fancy topic in sanitary engineering for developing countries when discussed among experts in the West. They are very easy to construct, turn human excrements safely and without special treatment into fertilizer and are hence theoretically a sustainable and environmentally friendly solution. But the link between smart and fancy ideas in the donors’ offices in Europe and sustainable solutions on the ground seem to be a hindrance that few want to deal with.

In default of pre-constructed toilet seats for this system in the respective country, the technical expert thought of a solution. Food bowls in two different sizes were acquired at cheap prices in the local market and assembled to a locally made split toilet. That sounds awfully convincing in a report, “using locally acquired material”, “supporting local merchants”, “easy to assemble”. The local program manager and a village engineer have already assembled the first sample. Sure, a smart idea from their friend the expert. They acknowledge his input and technical expertise, and are convinced that his intentions are the best. “But what will the people say when we propose to them to use food bowls to shit in?” They both laugh heartily. No, that won’t work, but they’ll do it anyway. Results need to be shown, reports are due and they are already behind schedule. It’s a comical situation, if it wouldn’t be frustrating to see so much effort, and money, brought to waste. A new book on similar encounters in Pakistan shows how this phenomenon may be an essential part of failures in international development initiatives.

Samia Waheed Altaf, former senior advisor of the Office of Health in the USAID Mission in Islamabad, has collected such comically frustrating episodes from her participation in the Social Action Plan (SAP) in the 90s in her So Much Aid, So Little Development – Stories from Pakistan (Wilson Woodrow Center Press, May 2011). The SAP was developed by the Pakistani Government and funded by the World Bank from 1993 to 2003 and targeted health supply services amongst others in Pakistan with a multi billion $ budget. It’s probably the most famous failure of aid and development in Pakistan. A number of papers have already been published on this issue, most notably from the CGDEV, which also Altaf refers to time and again. These papers are looking at why that could happen and how it could be avoided in future, providing mainly the dry figures of wasted inputs and unintended outcomes. They are essential reading to grasp how so much money could be invested in the country in recent decades with so little progress and conclude with definite policy recommendations. But they seldom go beyond the gross calculations of a development economist. Altaf portrays how these figures of failure are produced by the “human factor”…

Read the full review here.

Jacob Steiner’s addendum to the review:

There are other reviews out on the book.

In Dawn, by Sakuntala Narasimhan (you may go to the SouthAsianIdea to comment and discuss it with other critical minds) and in Regional Studies, Volume 45 by Claudia R. Williamson.

They are interesting to read together, since they are written from the two perspectives, the Western ‘Expert’ (in this case a researcher) and the Eastern Intellectual (in this case a journalist). Those two which Altaf manages to include in a single narrative. And they are more or less stuck in precast conceptions of the problem. Williamson wants to read more on where failure is to locate in the local institutions, Narasimhan criticises the Western Experts decadence and ignorance. They are both not wrong in their criticisms, their understanding of where failures may be located. But they are both looking for where they are convinced failure emanates from and seem not to be too receptive to an alternative explanation – a change in mindset and acknowledging responsibility. This is which I think both parties – the International (Western) Expert and the Local Expert – should take from the book. If everyone just understands it as a confirmation of ones own best intentions, brought to no avail because of the failure of the Other, we stay stuck in the dilemma. Question expertise – of others and your own – and be prepared to reassess opinions.

Manan Ahmed has been writing on the ‘Expert’ problem on a wider and more political/historical scale. I think his thesis in this aid example so well documented by Altaf is backed up on the local scale and just confirms how this is an issue that should be studied with more depth in future.

Back to Main Page

 

 

 

Advertisements

Depicting Tragedy Humorously: Foreign Aid Without Development

February 7, 2016

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.

So Much Aid

The book is available online from Readings in Pakistan (at a special price), Buyhatke in India and Amazon elsewhere.

Back to Main Page

Designed to Fail: Why Foreign Aid Doesn’t Deliver

November 2, 2011

By Sakuntala Narasimhan

The World Health Organisation (WHO) notes in a publication released earlier this month that a “huge amount of new financial commitment, worth over $40 billion,” has been pledged by a collective of global agencies, towards maternal and child health projects in developing countries. The strategies that these projects will focus on include “innovative approaches” like the use of mobile phones “to create awareness and promote health” so that individuals and communities can have the information they need to make decisions about their health. Although the publication mentions the need to “address structural barriers to health,” the assumption is that lack of information and knowledge is the limiting factor. This assumption shows a woeful ignorance of the socio-cultural complexities that make up the local matrices within which “development” work has to be undertaken, which is why in spite of the hundreds of billions of dollars that have been poured into developing countries as aid in the last five decades, there has been no commensurate improvement in the social sector parameters in terms of adequate food, shelter, access to healthcare and education. (more…)

“Helping the Poor”: The Idea, the Reality and the Shadow

February 22, 2011

By Anjum Altaf

Between the idea and the reality, Eliot wrote, falls the shadow. The phrase is so well known as to be almost cliché, but as with many clichés, there is truth to it. There is universality, too – the metaphor could extend to many areas; there are shadows everywhere. Foreign aid, for example: there is the idea and the reality, the theory and the practice, the intent and the execution.

The theory of foreign aid is simple enough: If those lacking capital and technology and ideas were provided with such, they could be launched on the path of progress. In practice it has rarely ever worked like that – there is more to the equation than capital and technology and ideas.

There is the shadow that falls between the theory and the results, a shadow full of objectives stated and unstated, incentives of this party and that (and, of course, their representatives, who develop in the end their own interests, their own goals, their own shadows) – all this, more often than not, causing enough distortions for the reality to mock the idea.

This happens not only in foreign aid, but in any transaction where one party has advice or help or assistance that the other desperately needs, when negotiations are not equal, when representatives of each come with their own axes to grind. Consider the shadow now visible between the idea and the reality of sub-prime mortgage lending: the unstated objectives, the incentive distortions, the regulatory winks and nods, the quick fix to keep the game going for at least one more round. In 1961, Jane Jacobs, who had little to do with foreign aid, was astute enough to realize the pitfalls. Based solely on her observations of how federal assistance was implemented in low-income areas of American cities, she remarked in her seminal book, The Death and Life of Great American Cities: “I hope we disburse foreign aid abroad more intelligently than we disburse it at home.”

Much of this has been obvious for years to those in the aid and lending communities who have kept their eyes and ears open; what has eluded us is that blinding insight that lays it all bare, the kind of insight that comes most often from literature. As literature identified the existence of the shadow, it was literature again that unraveled its nature. Theodore Dalrymple has written an account of the writer Rhys Davies (1901-1978) whom he has called the Welsh Chekhov. I can’t vouch for that since I haven’t yet read Davies but I intend to, especially the story that illuminated for me the shadow of foreign aid – “I Will Keep Her Company,” published in The New Yorker in January 1964.

The story, in Dalrymple’s words, concerns a couple in their eighties, living in an isolated farmhouse in the Welsh hills and snowed in. The old woman has died and the husband, refusing to acknowledge her death, is staying by her bedside. There is in the story a district nurse assigned to the care of the couple:

Meanwhile, Nurse Baldock has geared up a rescue operation involving a snowplow, a van, and a helicopter. She is, as her name seems to suggest, conscientious and bossy and, having completed a diploma in social studies in her spare time, believes herself entitled to a promotion. She had visited Evans a few days previously, when his wife had just died, and was prevented from removing the body by the snow. Now she is returning, determined to get his agreement to leave for the old-age home. When she finds him dead, she utters a bitter yet self-satisfied recrimination:

“This needn’t have happened if he had come with me, as I wanted six days ago! Did he sit there all night deliberately? . . . Old people won’t listen. When I said to him, “Come with me, there’s nothing you can do for her now,” he answered, “Not yet. I will keep her company.” I could have taken him at once to Pistyll Manor Home. It was plain he couldn’t look after himself. One of those unwise men who let themselves be spoilt by their wives.”

In a few pages, with a highly sophisticated simplicity, Davies arouses emotions and thoughts as impossible to resolve into full coherence as life itself. John Evans’s death is both tragic and a triumphant final expression of the love that gave his life meaning; we oscillate between sorrow and joy, between discomfiture and reassurance, as we read. As for Nurse Baldock, she encapsulates the mixture of good intentions, condescension, and careerism that is the modern welfare state. Rationally, we cannot refuse to endorse the efforts to rescue Evans; it would be a terrible world in which his predicament evoked no response. At the same time, we know that these efforts are not only beside the point but, at the deepest level, incapable of being other than beside the point.

There it is: The Evanses are the recipients, Nurse Baldock the donor, “encapsulat[ing] the mixture of good intentions, condescension, and careerism” that is the modern aid enterprise. Her judgments of John Evans echo the familiar comments of the aid executive – poor people “won’t listen,” “men [have] let themselves be spoilt” by their unwise ways. If only he had heeded her advice; if only poor countries would follow the instructions given to them by the well-intentioned donors.

The notion of “helping the poor” is a noble one, but it comes with this shadow that falls between people, states and their citizens, donors and recipients, between individuals and representatives, and this shadow grows darker and deeper as we try to pretend that it is not there, that it can be fixed with one quick step (always one quick step, just to keep us going for the next round).

Perhaps the story offers another insight as well. Nurse Baldock, with her plow and her van and her helicopter, her diploma in social studies, the full weight of the state behind her, is immeasurably more powerful than a weak, devastated, poor old man. Of course to her it is simple; she knows what is right, she knows what he needs far better than he himself could. But what if Nurse Baldock could meet John Evans as her equal?  What if she could try, instead of helping him by force, to engage with him? In this light, might the shadow finally begin to fade?

Theodore Dalrymple’s article (The Welsh Chekhov) can be accessed here.
Nurse Baldock is reincarnated as Lucymemsahib in our fellow panelist, Samia Altaf’s book (So Much Aid, So Little Development: Stories from Pakistan) forthcoming from the Johns Hopkins University Press in May 2011.
For more on foreign aid on this blog, see:
Should Pakistan Receive More Foreign Aid?

How to Aid the Health Sector in Pakistan
Remaking Public School Education in Pakistan

 

 

Pakistan Picaresque

January 9, 2008

A chat over tea at a government office in Islamabad reveals why billions in aid have done so little for Pakistan’s poor… 

By Samia Altaf

Not enough nurses. Not enough jobs. Nurses working as “doctors.” Trained nurses being encouraged to leave the country. Untrained and uncertified “nurses” being recruited in sheer desperation by private hospitals. What a strange and paradoxical situation! Yet there is no discussion of these crucial issues. And new training programs are being developed, because there is pressure from international organizations to include more women, supposedly to meet the human resource ­shortage.

My companion sat shaking her head. Mrs. S. was starting to look restless. She signaled to the attendant for tea. In a government office, a tea break can become a project unto ­itself.

“The problem with women,” Mrs. S. volunteered conversationally, again adjusting the dupatta delicately on her hair as the tea service was laid out, “is that they all want to get married.” Quite a problem, and one the world over. “So eventually they must leave the profession to take care of their husbands and children.”

We let this pass, and raised another possible solution to the “problem” with women: training more male nurses. As the primary wage earners, they would not be compelled to leave once they married, and they could tend to the male patients, making it easier to attract women to the ­profession.

“Not a good idea,” according to Mrs. S. And why ­not?

“Because men are very unreliable. As students, they will agitate the girls,” she continued in the same conversational mode, oblivious to the effect of her remark on her audience. “If they are in classes together, they will induce them to strike on petty matters.”

“But the girls are under no obligation to do their bidding,” Lucymemsahib ­said.

“Yes, but the poor girls have no choice but to follow the boys. It is natural for them to do so. By themselves, girls never cause any problems. They quietly do what they are told or get married and go away.” Mrs. S. warmed to her subject. “Look what is happening in Liaquat National Hospital, Karachi.” Liaquat hospital is a major training institution for nurses, one of the few in the country that prepare male nurses. About a third of each entering class was male (as is still the case today). During the weeks before our visit to Mrs. S., the nursing students at Liaquat had gone on strike, demanding better living conditions, apparently at the instigation of male ­students.

“All because of these boys!” Mrs. S. continued. “So many headaches these boys are causing us.” She struck her forehead with the palm of her right hand in the traditional gesture of frustration, causing the dupatta to flop off her hair. She hastily retrieved it. “And the girls are not listening to us either. They are naturally listening to the boys. Stupid things!” She shook her head in ­indignation.

Lucymemsahib looked at Mrs. S. as if she had come from another planet. Thankfully, the tea arrived at this point, and we fell to it with gusto, under Mr. Jinnah’s enigmatic smile from his perch on the wall. Mrs. S. very generously ordered her attendant to run out for some mint chutney to go with the samosas, which were really out of this ­world.

[The complete article can be accessed at the Wilson Quarterly (Winter 2008) here.] 

Samia Altaf was the 2007-2008 Pakistan Scholar at the Woodrow Wilson International Center for Scholars in Washington, DC. Her book (So Much Aid, So Little Development: Stories from Pakistan) was published by the Johns Hopkins University Press in 2011).

Back to Main Page