Law, Social Justice & Global Development
(An Electronic Law Journal) 

Who ‘Writes’ the Budget: A ‘Close-Up’ of the Politics of ‘Development’ Projects: Implications for Health Care Delivery, Democracy and Good Governance Towards a Human Rights Based Development Approach

Dr. Shaheen Sardar Ali
Reader University of Warwick 

s.s.ali@warwick.ac.uk 

This is a commentary published on: 8 November 2002 

Citation: Ali S, 'Who Writes the Budget: A Close-Up of the Politics of Development Projects: Implications for Health Care Delivery, Democracy and Good Governance towards a Human Rights Development Approach’, 2001 (1) Law, Social Justice & Global Development Journal (LGD). <http://elj.warwick.ac.uk/global/02-1/ali3.html>

Editors Note
This is the third of a series of articles on the author’s experiences as the Minister for Health, Population Welfare and Women Development in the NWFP, Pakistan. This commentary is being published as part of the open forum on Law, Social Justice and Global Development (LGD). It forms a part of three commentaries that have been published in this issue and contextualises the experience of an academic in the governmental processes. Readers are welcome to send in their comments and reviews to the author and/or the editors of this journal. Selected comments may be published subject to the editorial pen. Please send in your comments to Manish Narayan at m.narayan@warwick.ac.uk 

Keywords: Human Rights, Health Services, Gender, Development, Budgetary Processes, Governance, Human Rights

1.	The Background

1.1	 The Venue
Office of the Minister for Health, Population Welfare and Women Development, NWFP. 

1.2 The Scene
A host of officers of the Department of Health gathered round the table, Minister chairing a meeting to discuss a circular from the Finance Department asking for the annual budgetary proposals of the Department of Health. The Finance Minister’s memo also lay on the table asking all Ministers to ‘take a close and hard look’ at the draft budgetary proposals for the coming year before an impending meeting of Cabinet on the subject. 

1.3 The Question
Apparently simple and straightforward:

‘How do we formulate our annual budget; what are the parameters guiding us in this process and who is involved in it?’

The silence in the room was pregnant. You could almost hear a pin drop. From my limited experience in government I had learnt that when a response was not immediately forthcoming, it meant that there was no plausible answer to provide and the silence was the time in which it was being carefully tailored in the minds of the ‘government’ before being shared with the Minister. 

I repeated my question:

‘Gentlemen,’ I said, ‘Who prepares the budget in this department and how is it prepared?’ 

Again the telling silence. Any ‘sensible’ person would have let the question go by unanswered and perhaps at a more opportune moment in time, queried my private secretary to evoke an ‘appropriate’ response. Not the persistent (read ‘stubborn’) academic-turned Minister, used to extracting responses from recalcitrant pupils! And especially not now when the honourable Finance Minister was breathing down our necks (I beg your pardon, Fareed Sahib but you were driving us hard!) The look on my face that meant you will jolly well respond to my question or we can sit here till the cows come home, got the better of everyone. Furtive exchange of glances ensued, accompanied by fidgeting in their seats and elbow nudging. Finally, one courageous officer cleared his throat and declared almost under his breath: 

‘Actually Madam there is very little to prepare. All we do is look at last year’s budgetary allocations and add ten percent to it. That becomes the following year’s budget. One of the Superintendents in the Directorate General Health Services has been doing it for years. It is really quite easy Madam so you don’t need to worry. Nearer the time, we will give you a copy to look at’.

I could have murdered at that response and happily walked to the gallows, so angry was I at the limits of callousness, nonchalance and disengagement of government in dealing with taxpayers’ money and wealth of the nation. But who could I direct my anger and frustration at? Certainly not these officers huddled round the table, who felt a trifle uncomfortable at being quizzed on what they probably had never considered an issue to bother their heads over? Should I blame institutions responsible for training government functionaries for failing to teach them the ‘financial ropes’? Or, the few senior clerical staff who had risen through the ranks within government departments, had mastered the mysteries of figures and kept these precious secrets close to their chest, making them re-re-employable after retirement and leaving entire departments at the mercy of one ‘Lala’ or other! But, most important of all, was it not within the job description of our leadership to engage in an informed process of decision-making when it came to needs of institutions, the purpose of which was to provide service to the people? The bewildered look on the face of my colleagues in the Department of Health was indicative of the fact that the question I had posed had rarely been directed at them before. Or perhaps, the breadth of what the question entailed suddenly dawned upon them, resulting in the anxious expressions of a hitherto carefree group of government officials.

‘Right gentlemen, thank you for your information and for being so honest with me. Now shall we get cracking on getting a budget together? We will require certain crucial information before we start. I need all District Health Officers to prepare a list of health facilities under their command, complete with number of personnel, average number of patients accessing these facilities and annual budgets broken down under the various heads including salary, medicine and other equipment, funding committed towards maintenance and repair etc., On the development side, we need the status of all on-going and new projects, details of sunk costs and a fresh look at all of these. We start with a clean slate’.

This of course, was easier said than done. I could have asked for the moon and had better chances of succeeding. Ripples of discontent ran through the length and breadth of the Department of Health at what was perceived a useless exercise. To be fair to many colleagues in the department, they could not even comprehend to what end and purpose all this information was being generated and where it would lead us. I remember that during my numerous visits to the districts, I would invariably find an elderly head clerk or accountant lurking in the shadows during my meetings with the District Health officer. At first the purpose of the presence of this gentleman was not clear to me. One day however when I asked a DHO what the annual budgetary allocations to his district was, he looked over his shoulder and lo and behold! the grey haired elderly accountant briskly made his way towards him and whispered a figure into the boss’s ear. The boss then raised his voice and repeated the figure, a fact that did not go unobserved by me. In another district, the magical dictionary of the budgetary allocations, i.e., the accountant was on leave and so when I queried the DHO how much money was placed at his disposal for that particular financial year, he apologised and said:

Madam the accountant is on leave today, but I can let you have the figures when he comes back next week! How I, or anyone else for that matter, was expected to engage in any intelligent and informed discussion on the needs of the department of Health in that particular district without the budget document, of course completely evaded me. 

The ‘difference’ between the sitting ‘uninitiated’ members of the cabinet and the ‘normal, standard’ ministers was every aptly described by one ‘observer’ of the new government who declared: 

‘The problem with this lot (of Ministers) is that they talk too much and write too much. In the good old days, it was difficult to even get the honourable Ministers to sign on summaries. They simply had no time for this sort of thing. Now this lot will not only read all the summaries cover to cover, but also make corrections in them and then write pages and pages, and they can even type and use the computer!’ 

To me, as a researcher, data collection was the first and foremost step towards evolving a needs based, rational budgetary process. At a simple ethical level, how could I justify putting my signatures on a piece of paper when I was not even aware of how those figures had been arrived at? With finite resources, we simply could not afford to do the customary ‘add ten percent’ and submit act ever again I hope! 

So we set about trying to ‘do’ a budget with a difference (or so we thought!). When people ask me how I found my stint as Minister, I often respond by saying that no school, college or University could have taught me what these two years in government achieved in widening my horizons and approach to government and governance, people and institutions. I learnt that what we term as lack of resources and ‘takleef’ from God is actually very human-made and due to our sheer lack of applying our hearts and minds to make optimum use of our resources. We suffer and make our people suffer not because they were destined to lead miserable lives but because we, in our intellectual and physical apathy and laziness fail to apply ourselves to the job in hand. We love to rave and rant about our Muslimness, mechanically pray, day in and day out, have ‘dars’ in our homes, offer khairat and sadaqas; in fact everything to secure a place for ourselves in heaven. What we forget is that God up there can see beyond and through these outward offerings to Him, and has one question to ask: What about huqooq ul ibaad? What about service and love to My people on earth? 

One cursory glance at the budget figures and it was crystal clear where most of the problem rested. Budgets are classified as ‘recurrent’ and ‘developmental’. A recurrent budget is that part of the budget that is picked up on an annual basis and consists of salaries of personnel, maintenance and on-going expenses to run institutions, in our case the various facilities of the Department of Health. A breakdown of the recurrent budget shows that approximately 90% of the funding is tied up to salaries of personnel serving in these institutions. The government of Pakistan, and certainly of the NWFP is the largest single employer in the country/province. Due to a traditionally under developed and lack lustre private sector, pressure on successive governments has been to act as an employment agency and recruit people left right and centre. For the short term of course, when political leaders are playing to the gallery, as they are wont to, this affords them easy popularity and a quick fix to win the next election as well as please party workers and constituents. But, in the long term, this has resulted in a near paralysis of any effective strategy for a policy of sustainable development in the country. 

An appendage to this quick fix mass recruitment into government, that leaves very little fiscal space for meaningful service delivery by government institutions, is the lack of a meaningful accountability process for government employees. That is why everyone wants a ‘pakki sarkari naukari’ knowing full well that once through the door, they will only come out at the other end with a pension. While there is nothing wrong with aspiring to remain in office until retirement, for many people it means whiling one’s time and trying to cream off whatever benefits one can without providing an honest dedicated public service. This appropriation of government as one’s own private milking cow, costs the country very dearly.

After ‘extracting’ some form of information from the districts regarding health facilities and how these were accessed and utilised by the public, we set about to try and decipher the logic, if any, behind the various levels of facilites, the staffing and funding formula. That all allocations, whether in terms of human resources or material funding simply defied any logic and screamed the terms, foul play, at worst and apathy and inertia at best. The example of Basic Health Units (BHUs) of the NWFP and an imaginary comprehensive referral system on which these budgets were based is a prime example. This is how the story of betrayal of our unfortunate people goes:

Once upon a time, researchers in some high flown international organisation, research centre or university (probably in the west?!), dreamt up a brilliant idea of primary health care in developing countries. They developed a blue print of how every ‘x’ number of miles, we should build a health facility where basic health care could be provided (and called these Basic Health Units or BHUs for short). Beyond basic health care, if the need arose, the patient would be provided a referral ‘slip’ to proceed to the ‘secondary’ health care facility (the Tehsil or District Headquarters Hospital, THQ and DHQ for short) and if there too he/she required further specialised care, then a referral to a tertiary institution would be provided. This theoretically sound primary/secondary/tertiary nexus looked and sounded perfect and so, as has happened many a time, without further ado and of course much thought, was adopted, lock, stock and barrel in many developing countries, including Pakistan. I must add here that one of the reasons for making this look more attractive to developing countries, was the accompanying facility of grants in aid (read a few skinny carrots) as well as loans to implement this idea.

What transpired thereafter is a tragedy of errors (to partially borrow from one of the titles of Shakespeare’s famous plays). Landowners (and a spattering of other people) with the right connections were made rich virtually overnight because suddenly there was a surge to purchase land by the Departments of Health in the country to build these BHUs. Governments thrive the world over on vaguely worded and evasively formulated rules and regulations. Vagueness and ambiguity can always be manipulated to the advantage of ‘special’ people and at the same time provide a safe exit point for whoever has engaged in the manipulation. ‘Show me a face and I will show you the rule’, is an oft-cited saying in government circles. Thus, applying the rule of having a BHU within a designated radius meant that Mr A and Mr B or C could sell off their land, happily situated within that radius to government in return for a decent sum of money. Intelligence also demanded that in order to increase the book value of the land, ‘paper sales’ of the land be undertaken prior to formal evaluation by the Acquisition Officer. The owner of the land would then produce this as evidence of the value of the land. What resulted was BHUs constructed half way up a mountain, in the middle of graveyards, on the bank of a river, miles away from habitation or in the thickest part of a forest! 

This state of affairs was not confined to the Department of Health but also ‘applied’ to the Department of Education. I remember Gilani Sahib, Minister for Education, remarking one day that he had gone to a school where the building was at one end of the village and the playground a mile away at the far end of the village. When he queried the reason for this strange arrangement, he was told that that is where the land was available so they bought some of it at one end of the village and some at the other! And after all, I would say, Gilani Sahib, children did need to stretch their legs a bit, so travelling a few miles to the school playground really was no big deal and why was the Minister so appalled?

Another farce conducted at the expense of the national exchequer, was the scheme whereby patriotic people ‘offered’ to ‘donate’ their land to construct a health facility or a school or a water supply scheme. The trade off here was that in return for donating land, at least one of their family members would be given a pukki sarkari naukari in that same facility. Hats off to these patriots who had their maths organised to a point where in return for a few kanals of land, that was anyways lying barren and worth very little, they managed to land permanent jobs for their sons/sons in laws, nephews and so on. In many parts of the province, BHUs became the private hujras or deras of the people who had supposedly donated land to government to construct these BHUs because, as later events revealed, they virtually ended up owning the building because government assigned teachers, doctors and other personnel did not bother to come and serve in these back of beyond places. They chose instead to connive with the right persons in headquarters and draw salaries for doing nothing or bullied ‘people’ to get postings in places of their choice.

If we had confined ourselves to sinking millions of rupees into BHUs in the middle of nowhere and fill the coffers of some chosen few, it may have not resulted in a continued recurrence of expenditure to the budget of the province. But, as an innovative nation that excels in turning perfectly simple things into complex situations to benefit the right faces, we, in Pakistan decided to enhance the status of these BHUs and post doctors there as well. Rumour has it that in the NWFP this idea was ‘invented’ by some imaginative government functionaries to cater to the job dilemma of the sons of some very highly placed gentlemen. These special sons apparently had their hearts set on becoming doctors and serve ailing humanity. The only hitch was that they lacked the will to work hard enough to achieve the required marks in their pre-medical examination and also perhaps sufficient acumen. Be that as it may, in the true haakimaana shan, about a dozen seats were added to the already oversubscribed Medical College, ensuring their entry. It was of little relevance that the budget for Medical Colleges that year and for subsequent years would go up by at least 15 lakh rupees because Medical education, like all higher education in the public sector in Pakistan, is heavily subsidised by government. We spend at least one lakh and eighty five thousand rupees every year on every student admitted to Medical College.

But then, as if making one’s son a doctor was not enough, after these special specimens of the human race graduated, they needed employment. Out came the brilliant idea of creating positions of medical officers in all BHUs and of course employing these newly qualified doctors against those posts. What a qualified doctor can do to sharpen the diagnosis of a patient, ‘armed’ with a thermometer and a blood pressure apparatus, is beyond one’s comprehension. But then comprehension and common sense has nothing to do with budgets, particularly when progeny of great people need to be employed!

How then does one budget for a department where one is not sure of how many health facilities are functional, how many are under-utilised and how many are ‘over subscribed’ and need extra support or upgrading to provide further services. The above jigsaw of variables determining budgetary allocations in the Health sector is enough to put anyone off writing a rational, logical budget. I decided therefore that one way of unpicking some of these unfathomable budgetary heads was to do a pilot project to analyse existing budget lines of the Department of Health. We chose District Charsadda for this exercise and so to Charsadda we ventured accompanied by a few enthusiastic colleagues to try our hands at this new learning initiative. We spent a few day touring the length and breadth of the district and came away amazed and dazed at what we experienced. First of all was the sheer waste of resources both human and material. For instance, every BHU was assigned the following staff: a doctor, a Lady Health Visitor (LHV) a Female Medical Technician (FMT) a Male Technician (MT), a Dai, a Behishti and a Caretaker. The premises of the BHU were built on about 8 kanals of land and included the doctor’s consulting room, the LHV/FMT room, a dispensing room, a toilet a store and a small kitchen and verandah. The premises also had a doctor’s residence, the LHVs residence and the caretaker’s residence. I have yet to see a single toilet for patients functional and where people, travelling from miles around are expected to go when the need arises is beyond my comprehension. This speaks volumes for the public-oriented and people-friendliness of our government institutions and service outlets! I came to be known as that minister who always asks about the toilet because everywhere I went, whether it was an office or a hospital, I insisted on inspecting the toilet first!

On arriving at the first BHU, I found all the personnel lined up (I have my strong suspicions that there had been a ‘leak’ of this visit and we found everyone in a state of unusual preparedness!) In a small establishment like a BHU and with an average turnover of 30 patients, I was rather surprised at the number of people assigned. In an attempt to unravel the rationale of having so many people at a BHU, I asked the doctor, LHV, MT and FMT what they did. All of them said that they put a thermometer in the mouth of the patient, recorded their temperature, checked the blood pressure and asked the patient what the signs and symptoms of his illness were. Thereafter, the doctor prescribed some medication. Imagine the luxury of one of the poorest countries in the world assigning four health professionals to check blood pressure and temperature of her patients! Since a BHU was supposed to be just that: a place where basics were addressed, nothing further could be provided in terms of health care. In an ideal world, the MT, FMT and LHV were supposed to be supporting the community in access and provision to basic health care including ante natal and post natal care to pregnant women, vaccination and routine immunisation to children and pregnant women. But in a real world, the LHV and FMT were at loggerheads with each other and vied with each other to ‘catch’ patients within the community. This resulted in fewer women and children receiving any real benefits from a BHU and they increasingly relied upon private hours of these health personnel for their health care needs. The doctor, who was supposed to be the boss and line manager of all health care services provided at the facility was anything but a boss and often at the mercy of these support staff who had strong connections within the community. I have personally had to intervene, unsuccessfully at times, to support a doctor to carry out orders of the health department where ‘powerful’ LHVs and FMTs have defied not only orders of an administrative department of government, but also orders of the court. 

The functions and training of the LHV and FMT are identical except that FMTs do not have midwifery training. One major outcome of trying to rationlaise budgets was to withdraw FMTs from certain BHUs and assign them as nurse auxilaries at facilities where they were required to provide cover due to the acute shortage of nursing staff. At least four dozen FMTs were also sent to train on the midwifery programme to enable them to come at par with LHVs so we could extend cover to more facilities.

Another interesting find of the Charsadda ‘adventure’ was to discover that our health planners, budget makers and implementers of policies were oblivious of the ground realities. Under some loan that we would have jumped to grab, numerous X-ray machines were acquired and promptly deputed to health facilities round the province. X-ray technicians also existed as a cadre within the Department of Health but in assigning either the machines or the technicians, no one bothered to ‘match’ the two. Even where by sheer fluke, an X-ray machine and technician happened to be assigned in the same facility, the third crucial factor i.e., availability of electricity was seldom investigated. Thus my field visits detected a strange situation: There were health facilities where x-ray machines sat snugly in their containers, unopened because either there was no electricity or no technician and another set of facilities where there were no machines but technicians were duly assigned who sat in the sun or the shade, depending upon the weather, and twiddled their thumbs! X-ray films were budgeted for non-functional x-ray machines and no one ever noticed the discrepancy because field visits from headquarters were prone to be ‘paper’ visits, or no one ever bothered to go through the budget with a fine comb. As a result of the field visits, we developed a policy of retraining existing personnel to become x-ray technicians. Hopefully this will have been followed up and we would by now, even at a conservative estimate have at least two dozen machines in operation resulting in saving of thousands of rupees of patients.

I found a similar discrepancy in one of the Rural Health Centres in Hazara. On my visit there I saw a lady huddled in a corner of the facility virtually staring into space. As we drew closer, she walked up and greeted me. 

‘I am Dr. so-and-so’, she said, ‘the dental surgeon’. 

‘But there is no dental unit here’, I mused, ‘so what are you doing here?’

‘Nothing’, she said. ‘I come from Abbottabad every day and go back after duty hours. The dental unit is being constructed and so until it is operational I just commute and do nothing’. 

I asked the DHO why this was so and he replied:

‘Well I have to go by the book. She is assigned here so she should come every day’. 

‘Is this not a sheer waste of resources? Why can’t she serve where there is a dental unit functioning?

‘Oh yes’, he responded, ‘we are in dire need of a dental surgeon in another facility where the dental surgeon is on leave’.

‘So why did you not think of this before?’ I asked. 

‘Well, we can never be sure what goes down well with government and what does not. Now that you have said it is fine, I shall issue orders right away!!’ 

On average, we discovered that every BHU had a budget of around 5 lakhs out of which a paltry sum of about 65,000 rupees was assigned to medicines, bandages etc., The rest of the money, just over 400,000 was eaten away by salaries and establishment costs. This allocation was irrespective of how many patients accessed it. So BHUs that were servicing a daily average of 70 patients had the same allocation as one that was dealing with 10 or 30. Likewise, a civil dispensary, that does not have a doctor on board, catering to 4-5 patients per day was assigned 64,000 in its medicine budget. But what was most shocking was the fact that a Rural Health Centre (RHC) catering to 495 patients per day, was given a paltry 1,48,000 rupees to spend on medicine! For how long had this gross mismatch continued, we have no idea. Perhaps since decades when the BHUs and RHCs were constructed and put into service! The Civil Hospital Shabqadar, looking after an average of 200 patients per day was being allocated 67,000 rupees annually for medicines, almost the same as a Civil dispensary and a BHU. Could one expect any better from the clerical staff of an administrative department who had never received any instructions or guidelines as to how one needed to spread out the budget to meet the needs of various health facilities in the province?

Travelling into the various parts of district Charsadda, the ideal example of the politics of development evinced itself, loud and clear. I had looked at the facility map of the district before setting out on my travels to Charsadda to give myself some initiation into the field visits. I saw two large facilities within one kilometre of each other. One was supposed to have been the old Tehsil headquarters hospital. This facility was situated near the population (although rural population is usually spread over larger areas) and had an operation theatre, laboratory inpatient accommadation, staff quarters as well as private rooms. In fact, all in all, a perfectly adequate health facility for the area. About 25 people, whose job description completely evaded me, were loitering around the place. But, for reasons unbeknown to me, only one kilometre down the road, a state of the art 80 bed hospital was commissioned covering an area almost equal in size to the tertiary hospitals in Peshawar. All major specialities, including surgical, medical, ENT, Paediatrics and gynaecology were available. Apart from half a dozen inpatients, the place wore a deserted look and people ran helter skelter on learning of my arrival, trying unsuccessfully, to make the place look used. The old hospital had been converted into a woman only hospital and also wore a deserted look for the simple reason that both hospitals now had gynaecologists and female medical officers, so that day 5 patients had visited one and about a dozen had ventured to the other one kilometre down the road! But the bottom line was that it made the public representatives look good to their constituents since they could boast of making big sarkari buildings and employ numerous people. 

People research and write a lot about the weak periphery of the Department of Health. The role that people like myself and others in position of decision making and implementation play in contributing to this weakness is evident from a few glaring features of our planning processes. Each year we advertise to train specialists as well as technicians. How do we assess what specialisms to advertise? Your guess is as good as mine or the person walking past the newspaper stand! As a result of a thoughtless policy, we have ended up in a virtual lack of crucial and life saving specialisms including anaesthesia technicians. Thus most of our hospitals in the periphery lack life saving facility status as they do not have trained personnel to provide anaesthesia. No anaesthesia means no surgery, not only elective but emergency. The oft spoken sentence logged in these hospitals is: Take the patient to Peshawar if you want to save their life. We cannot operate here. Of course going to Peshawar means hours and hours of travelling on bumpy roads in hired vehicles and costs thousands of rupees. And then we wonder why we have one of the highest maternal morality rates in the world. Why has no one questioned the economy of scales of this skewed system of service delivery? Peshawar is overburdened and consultants are engaged in thriving private practice because the predominant majority of their patients are NOT from Peshawar; they travel TO Peshawar due to poor or simple lack of planning of government to provide comprehensive health cover in the periphery. If some thought had been given to needs based budget making, this glaring discrepancy would have hit us in the face immediately, but only IF someone had bothered to look for real reasons behind people wanting to come and see the BIG, vilayat returned doctor! 

A further example of the politics of development projects presented itself during discussions of the Annual Development Budget for the year 2000-2001. I was horror stricken at a demand for 85 lakh rupees as development costs for land acquired for a hospital at a cost 14 lakhs. Because no government was willing to dedicate these huge sums in one go or even over a period of years, we ended up with an area devoid of health facilities not getting anywhere with improving health care. Every year the proposal to assign this exorbitant sum would be floated and each year it would get stuck off until the year I took office. I called for the officers in charge of development projects and queried them about this glaring mismatch between the cost of land and sums required to develop it before a building could be erected on it. What I heard can only be the substance that gory tales of cruel mis-governance are made of. Apparently, what was being passed away as land for the hospital was in actual fact, parts of a mountain adjacent to the existing facility. Since it was obvious that we could not erect a building on a mountain ridge, it had to be levelled and levelling a mountain meant 85 lakh rupees! I can tell you that it took quite a few gruelling sessions before I succeeded in extracting this vital piece of information. However, I owed this information not due to any special skills of investigation and interrogation but to my rather undesirable habit of going into the field and seeing for myself. When I threatened to undertake the unsavoury travel to this God forsaken place and have a look at the land myself, the truth was shared with me!

I did undertake that journey and believe me, came away feeling drained physically and emotionally. A small hospital built decades ago greeted me from afar. Run down and shabby by years of use and neglect, it nevertheless covered an adequate area. All buildings were single storeyed, built far apart, some of them declared dangerous for habitation. 

‘Where is this famous mountain we have bought?’, I asked. 

I was taken through the hospital premises and there, in the backyard of the facility I saw a rocky mountainous ridge staring me in the face. 

‘This is our land Madam’, declared the in charge triumphantly. 

‘But it does not seem as big as the measurements in the paper I read’. 

‘That is because we have some more behind this little stream, and a bit around that grave!’ 

‘And what do you propose we do with the stream and the grave Sir?’

‘We haven’t thought that far yet Madam because every year we put forward the proposal and it never gets approved’. 

Any person of average intelligence would have provided the way out of this impasse. Demolish the existing, declared unsafe buildings, start construction on this already level land and go vertical. No need to be adventurous and raze a mountain to the ground when you don’t need to or hope that by some miracle the grave will disappear, or that the stream will suddenly run dry!
	
Although examples abound on thoughtless conceptualising of development projects, yet a classical example of a land buying spree in one of the southern districts of the province, crying out desperately for development is beyond belief. This discovery also came about when we were discussing development projects. I was informed with due solemnity that we had purchased land to the tune of about 40 lakhs but were in dire need of developmental costs hampering ground breaking of the facility. 

‘How much money do we need and what is it for?’ 

As far as my geography went, I was sure that here there was unlikely to be a mountain in need of levelling so what sort of development costs were we incurring? 

‘Actually, the land is perfectly fine Madam’, came the response. ‘65 kanals of level land on the outskirts of this town that desperately needs a new hospital. After we bought the land, we discovered (read, we knew it all along but looked the other way) that there was a high-tension electricity line running the entire length of the land. Naturally we cannot build a hospital on such land because of the magnetic field created by these electricity lines and so we thought we would pay WAPDA 20 lakhs to pull out all the poles and place them on adjacent land. We have already paid 20 lakhs but now WAPDA wants another 8 lakhs’. 

My chagrin is too intense to be described in words; suffice it to say that the Governor heard of this story and he agreed that this project was simply not tenable in its present form and shape. On visiting the existing hospital we discovered a facility with ample land. We therefore assigned the architect to draw up plans for going vertical on the existing land. People of the area breathed a sigh of relief because in this down trodden part of the country where people moved around in donkey carts, building a hospital three miles away from the town was a recipe for disaster and a non-functioning public facility. For that year of course, the people of this far off land continued to suffer in silence while we in Peshawar trumpeted our development schemes as being of the people and for the people! 

2. Rehabilitation/Reclamation’ of Assets - Shifting the Development Paradigm?
One day following one of my numerous, frustrating trips to the field, I called a meeting of some of my officers to try and understand what could be done to spruce up the existing health facilities that were falling to pieces because we did not have the funding to reclaim these. I put forward a suggestion to the finance department saying I did not want a single new development project and wished to re-channel that funding to try and save facilities already in the service of the people. Imagine my utter disbelief when I was informed that come what may, financial regulations do not permit a department to re direct funding were it is needed. The officer put the notion very graphically by stating the following: 

‘Madam Minister, let me advise you very clearly that under existing rules, if a hospital building is falling down, you can only use part of the maintenance funds for it. Your development budget is only designated for new projects. So, theoretically, we could build a brand new building next to the old one that is falling apart and that would be no problem. But trying to save existing assets does not come under this purview. Of course, in certain circumstances, you may prepare a project proposal entitled, ‘improvement of existing facility’ but it will have to go through all the institutions that vet the budgetary allocations and in the end, may not even materialise because they fall outside the financial straitjackets we have woven around us! 

We then wonder as a nation why the lot of our people does not improve and the affects of government policies has no positive impact on the lives of the common person in the street. The lives of people would change for the better if they had a functional health care system, an x-ray machine that worked and had x-ray films to take x-rays, a laboratory that was adequately stocked with reagents to carry out routine tests, an operation theatre that had an anaesthetist, an oxygen cylinder, and the basics equipment required to conduct surgery. A hospital that has a leaking roof over the patients’ heads, leaking taps and blocked toilets, outdated and choked sewage systems can hardly benefit from a ‘new’ development project! But this eventuality can only be ensured if there is an on-going process of data collection and analysis of demand and supply, of which health facility is accessed by whom and how many, etc., If public representatives sit round the table and do not toss a coin on which constituency should have a school and which a BHU, but look at who needs which facility, then officers in the government can respond to those identified needs. There has to be a focal point and hub in headquarters of every service delivery department that keeps tabs on how the budget is being utilised and how needs are evolving over the current fiscal year. These assessments could then form the basis of the succeeding year’s budget.

In summation I would like to add that it is not lack of expertise alone that hinders our budgetary processes. Financial procedures are kept under wraps for some unknown reasons even from administrative departments. This results in departments of finance assuming the role of super departments and some sort of masterminds and holders of purse strings of the nation. Granted that keeping government departments in line with their budgets is a job for finance department, but not to the extent where all other departments are groping in the dark for clues regarding the paces through which projects have to be taken to reach fruition. Keeping financial wizardry close to ones’ chests is hardly the way forward for good, enlightened and responsive governance and finance departments would do well to engage with line departments, run training sessions to fill out those ghastly Planning Commission 1 (PC1) documents that we inherited from a bright gentleman who invented it in Harvard University a few decades ago. I am not aware whether the gentleman is alive to see the results of his invention, but he certainly has with the introduction of his PC1 invention, sounded the death knell of development and innovative ideas in our country. 

My parting question to all the brilliant minds of our finance departments is: Are we so devoid of imagination that we cannot create a contemporary, simple financial instrument that out matches the outdated, PC1? Further a field, will any of our brilliant Civil Services Academy and Administrative Staff College graduates rise to this challenge? After all, one of the lines of opening lectures when training our CSS officers is: Ladies and Gentlemen, you are the best, the very best, the cream of this nation, destined to rule over the populace! 

But Ladies and Gentlemen, can you rule over and above the PC1? I await your response with bated breath!