Academic journal article Journal of Political Studies

Governance System of Pakistan: Continuation of Colonial Policies

Academic journal article Journal of Political Studies

Governance System of Pakistan: Continuation of Colonial Policies

Article excerpt


This paper attempts to explain why Hospital Autonomy (HA) Reforms in Pakistan could not succeed in achieving its stated objectives. Use of sense making technique is employed which consists of frame, cue and relationship. Frame of the reforms is developed using constructs like governance system of Pakistan, its connection to the past, legacy of bureaucracy, accountability traditions and the status of rule of law in Pakistan. The study shows that the current structure is strongly influenced by its colonial heritage, with most of the ingredients of the governance system persisting till today. The HA reforms, imposed by IFIs, were likely to challenge the unchallenged position of bureaucracy in the context of Pakistan. Though initially it dented the coveted position of bureaucracy, but later the bureaucracy was able to bounce back and reclaim the lost territory. These reforms hurt the public badly as user charges were increased and subsidies disappeared.

Key Words: governance system of Pakistan, colonial impact, accountability, rule of law, Pakistan, power, Hospital autonomy reforms

The Reforms:

HA Reforms were introduced in Pakistan in early 90s as they were introduced in many other countries including Indonesia, India, Jordan, and Thailand (Saeed, 2012). Hildebrand and Newbrander (1993) explicate in detail the assumptions, objectives, and modus operandi of the reforms. These reforms were implemented first in two hospitals at Federal level as test cases and later were implemented in most of the teaching hospitals of the Province of the Punjab.

The process had a complete support of the provincial political government who led it from the front. The implementation process in Punjab commenced with the promulgation of Punjab Medical and Health Institutions Ordinance 1998. Later, almost all the tertiary hospitals were granted autonomous status in phases. In the former setup, bureaucracy was solely responsible for the running of the hospitals. All the decisions regarding hospitals including financial, HR, administrative, purchasing, infrastructural development were made by the bureaucracy. Though subsequently doctors were made the heads of the hospitals, yet they were literally powerless and depended on the bureaucracy for the day to day running of their organizations, as were other specialists/technical experts in their respective institutions.

This setup continued for a couple of years before it was terminated by the military government of Gen. Musharraf who had assumed power after staging a coup d'état against the political government. A revised version of the Ordinance was launched in 2002 which lasted for around a year. However, this also had to be halted in wake of protests and agitation of doctors' community. Later an enquiry commission was instituted to examine the charges and to enquire into the issues which led to the abandoning of the reforms. Subsequently, in the light of the findings of the commission, the bogey of reforms was again put on track in 2003 by launching another version of autonomy reforms which is still in place.

However the experience of granting autonomy to teaching hospital has not been able to realize the objectives which were set initially. The four stakeholders identified during the data collection process are donors, politician, bureaucrats and doctors. All of them enjoyed a unique status during the process and were able to influence it at different stages. As mentioned earlier that these reforms were initiated by the IFIs, they had a unique meaning of the concept of 'autonomy', however this concept also had local meanings which were embedded in the historical developments, power struggles among various groups in society and social context. Once this reform intervention was made in the society, it became part of the ongoing flow of the events in the country and different stakeholder got engaged in the process of sensegiving and sensemaking (Gioia and Chittipeddi, 1991) of the concept. …

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