By Shehryar Nabi

The Friday Times: 08 Jan 2016

Will a busier provincial government benefit people more?


One October morning, Aizaz Akhtar received an unusual request from his boss, Chief Minister Shahbaz Sharif, to accompany him on trip to a mystery location in Kasur. With Sharif and his staff, Akhtar rode a helicopter, hopped onto a disguised bus and eventually found himself at a hospital. He had been brought along for a surprise government inspection.

Used wrappers were scattered across the floor, which looked like it hadn’t been swept for a long time. Bedsheets were stained. Sharif called for the hospital staff to step into reeking, unclean bathrooms that were out of service and demanded an explanation for why they had been neglected.

Upset by these conditions, Sharif cracked down on the management. The district official overseeing the hospital prayed to keep his job, but that did not save him. Sharif made it clear that he had not performed satisfactorily and suspended him from duty.

As the head of the chief minister’s Special Monitoring Unit (SMU), Akhtar’s job was to now create a scorecard to rank cleanliness for all hospitals in Punjab. The method arms the chief minister with troubling data points to pressure department secretaries into disciplining the officers in charge.

“The use of data is absolutely essential to the way they think now in terms of the job that needs to get done. The data is evidence for them to take action,” Akhtar says.

Extend this process to health, education and sanitation and you have what is called the Reforms Roadmap, an initiative by Sharif to fix inefficiencies within the government of Punjab that have left many people underserved.

According to the World Bank, the rate of children who die before their fifth birthday is higher in Punjab than any other country in South Asia due in large part to low access to basic public healthcare. The Population Council estimates that over 300,000 thousand young children die in Punjab from health complications every year.

In primary education, an Annual Status of Education Report found that in most districts, over thirty percent of class five children cannot demonstrate basic reading and math skills because of underperforming government schools.

Over 30% of class five children lack basic reading and math skills

The government has reported some promising results of the Roadmap approach. According to its own data, Basic Health Units are now almost fully stocked with their required medical supplies and provided patients with 17 million more units of critical medicine than last year. Vaccine coverage has surged above 90 percent. Teacher attendance and training is above 95 percent province-wide and overall studentenrollment is nearing 90 percent.

But some of the most important outcomes are still not moving. SMU found that although district hospitals in Punjab are almost fully stocked with medicine, about half of patients had to purchase them elsewhere because the medical supply had been poorly managed. Despite high enrollment and more teachers, students still demonstrate low levels of education. The question the Roadmap now faces is how its investment ininputs will make a meaningful impact on the quality of life.

SMU, the nerve centre of the Roadmap, is a small office within the chief minister’s secretariat where a staff of 20-somethings and a focus on technology give it the air of a startup company. Its guiding principles are that of “deliverology”, an approach to government effectiveness devised by world-renowned government delivery expert Michael Barber who plays a central role in the Roadmap. First introduced through Barber’s Punjab Schools Roadmap in 2010, the approach represents a break from past efforts at reform.

Traditionally, the federal government would take loans from international development banks such as the World Bank and the Asian Development Bank on the condition that whole departments would be reformed. But after years of implementation, progress was still not obvious because the changes failed to reach the lowest tiers of government, where citizens are most directly affected.

Instead of trying to restructure departments, the Roadmap’s method focuses on making progress on manageable, clearly defined indicators on what it considers essential inputs such as medical stockpile, student enrollment and staff attendance.

External monitors – army veterans selected for their discipline – are sent to government facilities in each district to report data on these indicators on mobile devices. SMU then analyzes the data and identifies problem areas. These are brought to the attention of the chief minister, who uses the alarming numbers to prod officials into action. If they fail to act, they risk losing their jobs.

SMU has also introduced new technologies to improve government efficiency and track data more accurately. These include a digitized referral system for requesting medicines and a station in hospitals to mark staff attendance by recording biometric data.

The Roadmap has started addressing quality directly. Feedback is being collected from patients to identify and address problems that lead to the misallocation of drugs in district hospitals. School textbooks in reading and math (other subjects, like Islamiyat, were left to the Education Department) are being upgraded to reflect international education standards.

Critics of the Roadmap say it has taken far too long for quality to become a central concern. But Hafsa Iqbal, an associate at SMU who works on education, thinks that inputs had to be in place before it could shift priorities.

“If the teachers are not coming to school and teacher attendance is not up to par then how do you improve quality? It was more about getting the basics right and then focus on quality,” Iqbal says.

Some who work in education think that while the Roadmap is giving the government much-needed mobilization, using the chief minister’s authority as an incentive from the top without fixing problems within departments will not yield meaningful changes. A development researcher who spoke on the condition of anonymity thinks that without addressing perverse incentives to manipulate data at the local level, numbers could be easily used to show the illusion of progress.

“The changes will not be decimal changes on a chart. You can see them permeate: people start to see kids who are becoming more functional and you have teachers who are much more committed. But those aren’t the stories coming through,” the researcher says.

A civil servant who wished to remain anonymous thinks that the Roadmap’s methods could actually demotivate government employees.

“Our feedback from the ground was that some of this stuff was really demeaning for the teacher as though the teacher was a culprit on a payroll. It’s not sending a good message down,” the civil servant says.

Fawad Shams, a freelance education consultant, argues that genuine reform will only happen when communities become central to the decision-making process.

“The biggest issue is the absence of any kind of public sphere where one would have teachers, parents, community members and technocrats come together and have a debate or dialogue about reforms. Instead what you see is a set of bureaucrats heading every sub department within the sector and decisions made with the stroke of a pen, unilaterally, pursuing quick fixes,” he says.

But Akhtar strongly believes that the technology and data-driven approach is creating meaningful reform because it is gradually instilling a work ethic of high performance within the government.

“We are using this method to embed it as a culture to deliver public services to the people of Punjab. And once they get it, any new government which comes in is going to have to work the same way,” he says.

As SMU starts to implement quality-focused projects and takes a closer look at the effect its model is having on learning and health in the coming months, a clearer picture on whether a busier government has translated into a better life for Punjabis will come into view.