Governance

Road to Anti-corruption Published in The News International, October 3, 2017

Nishtar S, Gluckman P, Armstrong T. Ending childhood obesity: a time for action. Lancet 2016 Jan 22. pii: S0140-6736(16)00140-9. doi: 10.1016/S0140-6736(16)00140-9.

NCD Risk Factor Collaboration (NCD-RisC).A century of trends in adult human height. 2016 Jul 26;5. pii: e13410. doi: 10.7554/eLife.13410.

NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. 2017 Jan 7;389(10064):37-55. doi: 10.1016/S0140-6736(16)31919-5. Epub 2016 Nov 16.

Nishtar S. Delivering the WHO we need. BMJ, May 19, 2017 http://blogs.bmj.com/bmj/2017/05/19/sania-nishtar-delivering-the-who-that-we-need/

Nishtar S. Will you support a patient-centred R&D agreement? Response from Sania Nishtar, WHO DG candidate. Lancet Glob Health. 2017 Mar;5(3):e263. doi: 10.1016/S2214-109X(17)30026-8. Epub 2017 Jan 19.

Nishtar S. Open letter to WHO DG candidates: reply from Sania Nishtar. 2017 May 20;389(10083):1978-1979. doi: 10.1016/S0140-6736(17)31254-0. Epub 2017 May 9.

Nishtar S, Gluckman P, Armstrong T. Ending childhood obesity: a time for action. Lancet 2016 Jan 22. pii: S0140-6736(16)00140-9. doi: 10.1016/S0140-6736(16)00140-9.

Nishtar S. Delivering the WHO we need. BMJ, May 19, 2017 http://blogs.bmj.com/bmj/2017/05/19/sania-nishtar-delivering-the-who-that-we-need/

Nishtar S. Opinion: A new deal for health. Devex May 2, 2017. https://www.devex.com/news/opinion-a-new-deal-for-health-90171

Nishtar S. Open letter to WHO DG candidates: reply from Sania Nishtar. 2017 May 20;389(10083):1978-1979. doi: 10.1016/S0140-6736(17)31254-0. Epub 2017 May 9.

http://thelancet.com/journals/langlo/article/PIIS2214-109X(17)30026-8/fulltext

July 16, 2015: Sarah Whitmee, Andy Haines, Chris Beyrer, Frederick Boltz, Anthony G Capon, Braulio Ferreira de Souza Dias, Alex Ezeh, Howard Frumkin, Peng Gong, Peter Head, Richard Horton, Georgina M Mace, Robert Marten, Samuel S Myers, Sania Nishtar, Steven A Osofsky, Subhrendu K Pattanayak, Montira J Pongsiri, Cristina Romanelli, Agnes Soucat, Jeanette Vega, Derek Yach. Safeguarding human health in the Anthropocene epoch: report of The Rockefeller Foundation–Lancet Commission on planetary health. The Lancet 2015. Accessible here.

Sania Nishtar. Fusion Funds for Health, In Saving Humanity. Eds. Steven Hoffman and Julio Frenk. 2015, Oxford University press, New York. Published on May 29, 2015. Accessible here.

Published in The News International on April 12, 2015: It has been five years since enactment of the 18th Amendment to the constitution of Pakistan and four years since the end of the term of several committees that were given the mandate to iron out related implementation issues. Despite progress, major issues still lurk that negatively impact performance of the federal and provincial governments. These issues need to be addressed urgently. Just for clarity, this comment refers only to the provincial autonomy-related covenants of the 18th Amendment and matters arising as a result of abolition of the concurrent legislative list….

Published in The News International on January 06, 2015: The drug pricing policy is on the prime minister’s table for the final approval. Three dimensions of pricing need to be segregated: 1) Initial price setting, either of originator brands of new chemical entities (NCE) or their generic substitutes; 2) rationalisation of prices of medicines currently in the market; and 3) grant of annual price increase. With regard to the first dimension, notwithstanding existing controversies, there is clarity in the policy direction since the prices of NCEs are to be fixed under the regional basket formula and that of generic substitutes,…

Published in The News International on December 13, 2014: Plunged in the corner of an orthopaedic ward in a hospital in Pakistan, ZU, a 19-year-old labourer struggles with pain and discomfort, his leg arched over a metal frame at 45 degrees. Two bricks hang from a cord tethered to a nail stuck deep in his lower thigh, preventing the fracture he sustained a week ago from misaligning. Every now and then he gazes at the door to see if his brother is back from the village with the money needed to fix his leg. The only goat they possessed had…

Published in The News International on November 19, 2014: For the last seven years, every November around 800 thought leaders from around the world convene in the United Arab Emirates for the World Economic Forum’s Summit on the Global Agenda. Knitted as a global knowledge network of around 80 Global Agenda Councils on a wide range of subjects, the event is widely recognised as the world’s largest brainstorming event. A handful of Pakistanis are also invited each year. Typically every year trends with regard to challenges and opportunities of the upcoming year come under discussion and are outlined in an…

Gutierrez H, Shewade A, Dai M, Mendoza-Arana P, Gomez-Dantes O, Jain N, Khonelidze I, Nabyonga-Orem J, Saleh K, Teerawattananon Y, Nishtar S, Hornberger J. Health Care Coverage Decision Making in Low- and Middle-Income Countries: Experiences from 25 Coverage Schemes. Popul Health Manag. 2014 Nov 13. 25393442 Accessible here

Published in The News International on October 31, 2014: A special cabinet meeting has been scheduled for today (October 31) to conduct a performance review of all ministries, divisions and departments. In this context, I am offering some reflections from my tenure as federal minister in the interim government last year. These reflections relate to the systemic constraints, which in my opinion, stand in the way of effective governance and hence hamper the government’s performance. The frame of reference is government ministries and the issues highlighted are of a long-standing systemic nature. First, an objective assessment of performance is possible…

Nishtar S. Reflections from my tenure as minister. Lancet 2014 Sep 3. pii: S0140-6736(14)61284-8. doi: 10.1016/S0140-6736(14)61284-8. Epub 2014 Sep 3 Accessible here

Published in The News International on August 07, 2014: Privatisation is subject to intensely polarised political discussions, which cloud important policy imperatives that need to be appreciated. Six points are being outlined in this respect. First, we must get the framing on privatisation right. Privatisation must not be viewed through the narrow lens of sale of state enterprise to bridge fiscal deficit. Privatisation is deeply linked to the fundamental question of the role of the state in the economy and is part of a broader economic liberalisation and deregulation agenda. It is one of the policy choices a government can…

Published in The News International on July 22, 2014: Sometimes the rationale of a policy decision becomes apparent long after the actual decision itself. The imperatives created by the polio travel conditionality will help us understand why it was critical to re-establish Pakistan’s Ministry of Health (officially named the Ministry of National Health Services, Regulations and Coordination (NHSRC) under Pakistan’s Rules of Business). Imagine the scenario had the WHO travel conditionality, involving polio vaccination for individuals travelling out of Pakistan, come into effect before the May 2013 decision to create the Ministry of Health. There would have been mayhem at…

Nishtar S. Health in the post-2015 agenda: three considerations in moving forward. Nishtar S. East Mediterr Health J. 2014 Mar 13;20(2):71-2. Accessible here

Published in The News International on February 13, 2014: Corruption is not just a cost; it is a curse that deeply affects individuals as well as the state system. It is the single most important obstacle to economic growth and development. It is devastating for investment and growth on the one hand, and denies the poor of equal opportunity and basic services, on the other. We seriously underestimate the costs of corruption. The story of a family published in Part 1 of this comment – which led readers to communicate several other similar examples to this writer – is one…

Published in The News International on January 07, 2014: However, assessing governance effectiveness is a challenging task from an empirical standpoint and often information has its limitations in conveying the real impact of poor governance at the granular level – a level that can indicate the quantum of human suffering as a result. It is with a view to outlining this granularity that I have chosen to narrate the story of a family rather than attempting an assessment of governance through the standard governance empirics approach. The family lives not very far from a cosmopolitan city and has 13 members…

Published in The News International on November 07, 2013: The Supreme Court of Pakistan instructed the provincial authorities in April 2012 to hold local government elections “without delay”. The reason was simple. The provinces had long been delaying the legislative process and the holding of local government elections. As the order showed, the Supreme Court had enough of the excuses presented by provincial officials and ordered the Election Commission of Pakistan (ECP) to conduct elections, maintaining that this constitutional requirement needed to be met one way or another. Subsequent to this, however, an issue emerged as the dates for the…

Published in The News International on November 01, 2013: Earlier last month, the Supreme Court directed the government to put in place the necessary institutional arrangements at the Pakistan Telecommunication Authority, in particular hiring of the three members central to the governance of this regulatory body, so that the long awaited 3G spectrum and licence auction could be expedited. In compliance a number of steps were taken by the government. However, the premise of the public policy discourse on 3G centres on the notion that the auction will yield revenue in foreign exchange, badly needed to offset part of the…

Bhutta ZA, Nishtar S. Health and research in Pakistan – Authors’ reply. Lancet 2013; 382(9900):1246 Accessible here

Published in The News International on September 06, 2013: The government has established an organisational framework for national security by reconstituting the Defence Committee of the Cabinet (DCC) as the Cabinet Committee on National Security (CCNS). While the committee formulation remains the same, the new entity has a broader and more significant mandate. As opposed to the DCC, which had an advisory role, the CCNS has been given a policymaking mandate with the responsibility to frame a national security policy. There is a popular notion in Pakistan that a policy is what is stated officially and articulated formally. However, according…

Published in The News International on August 23, 2013: Lying in a surgical unit of the Khyber Teaching Hospital in Peshawar is an elderly woman with half her abdominal wall practically eaten away by infection – the outcome of a surgery carried out in a district hospital, which was mismanaged in the first place and became infected later. She has several gaping openings, through which the insides of her abdomen and muscular tissue can be seen. For those who have the stomach for such sights, I have posted the picture on my website (www.heartfile.org). Surgeons in Peshawar are patiently treating…

Published in The News International on July 10, 2013: As I stepped down from my role as a caretaker federal minister last month I attempted to introduce two precedents through my Handover Papers – voluntary submission to accountability and a formal process of handing over government. In one of these, I reflected on some of the challenges that have constrained the government’s ability to govern. Twenty-one caveats have been outlined, referring to the government’s core business, its institutions and instruments of governance, the modalities of policymaking, human resource considerations and key governance attributes. In this article I elaborate on the…

Published in The News International on June 21, 2013: Accountability and transparency are deeply misunderstood in our country. For decades, the two have been regarded as being synonymous with politically motivated anti-corruption efforts. Nothing could be further away from the truth. Transparency opens a window into the world of government operations. Accountability, on the other hand, provides a measure of how government is performing and shows the nature and underlying motivations for decisions. Developing transparency and accountability systems builds confidence in government and presents avenues for engagement with businesses, citizens and the civil society for achieving inclusive and sustainable growth….

Nishtar S, Boerma T, Amjad S, et al. Pakistan’s health system: performance and prospects after the 18th Constitutional Amendment. Lancet 2013 May 16. doi:pii: S0140-6736(13)60019-7. 10.1016/S0140-6736(13 )60019-7. Accessible here

Nishtar S, Bhutta ZA, Jafar TH, et al. Health reform in Pakistan: a call to action. Lancet. 2013 May 16. doi:pii: S0140-6736(13)60813-2. 10.1016/S0140-6736(13)60813-2. Accessible here

Ahmed QA, Nishtar S, Memish ZA. Poliomyelitis in Pakistan: time for the Muslim world to step in. Lancet. 2013 May 4;381(9877):1521-3. doi: 10.1016/S0140-6736(13)60764-3. Epub 2013 Apr 24. Accessible here

Rifat Atun, Shabbar Jaffar, Sania Nishtar, Felicia M Knaul, Mauricio L Barreto, Moffat Nyirenda, Nicholas Banatvala, Peter Piot. Improving responsiveness of health systems to non-communicable diseases. The Lancet, 12 February 2013: doi:10.1016/S0140-6736(13)60063-X Accessible here

Published in The News International on February 06, 2013: Pakistan’s national and human security challenges have never been so pervasive. A war along the northern borders and relentless insurgency threatens the writ of the state, pitting law-enforcement agencies against people. Vested-interest groups exploit and deepen existing polarisation on ethnic, sectarian, political and religious fronts, resulting in carnage. These problems have created unprecedented pressures on an economy already plagued by serious structural problems, crippling power shortages and poor governance. Human security and state security have become inextricably linked. Our unique pattern of polarisation has become a threat to state security. Compounding all…

Published in The News International on December 29, 2012: The brutal assassination of nine grass-roots level health workers in Pakistan, who were involved in a door-to-door immunisation campaign in an attempt to secure children from the crippling disease of polio, adds an unprecedentedly grave dimension to the ongoing carnage in Pakistan. Pakistan’s parliament was quick in passing a unanimous resolution and there was widespread condemnation of the killings from all factions of the society – and rightly so. These incidents have deep-seated implications for the global drive to eliminate an infectious disease for a second time from the planet. Additionally,…

Published in The News International on December 05, 2012: The bill creating a much-needed federal drug regulatory authority – Drug Regulatory Authority of Pakistan – was enacted into law recently. The World Trade Organisation (WTO) agreements have made it binding on all countries to have independent drug regulatory authorities, without which key flexibilities permissible under the Doha Declaration on Public Health cannot be availed. On the domestic front, the 18 Amendment to the constitution omitted the entry “Drugs and medicines” along with the Concurrent Legislative List, which had earlier given provinces the mistaken notion that drug regulation could be a…

Attaran A, Barry D, Basheer S, Bate R, Benton D, Chauvin J, Garrett L, Kickbusch I, Kohler JC, Midha K, Newton PN, Nishtar S, Orhii P, McKee M. How to achieve international action on falsified and substandard medicines. BMJ. 2012 Nov 13;345:e7381. doi: 10.1136/bmj.e7381

Published in The News International on November 05, 2012: The concept of development, through which governments view social policy in environments where capitalism is the mode of social organisation, may be up for a major rethink, globally. This year, policy signals at agenda-setting global convening and major publications seem to be heralding new directions. But in each of these, the onus of responsibility is seen to be swinging more squarely towards domestic policy. Three points are being outlined to draw attention to the potential levers of change and possible insights for Pakistan. First, there is a palpable emphasis on “investment”…

Published in The News International on August 15, 2012: Great trepidations shadow Independence Day. With the country’s increasing isolation in the arena of international politics, poor state governance, and a polarised society, Pakistan survives today primarily on the resilience of its people. This is a time to reflect on where we stand in the broader global context and appreciate the nature of the imperative. Foremost, it should be recognised that Pakistan today exists in a world where interconnectedness and interdependence is the new global order, creating opportunities but also risks. An increasingly multi-polar world with rise of the emerging market…

Published in The News International on March 06, 2012: Currently, there is just one drug quality testing laboratory in each province but most are either inoperative or lack infrastructure, equipment, or qualified competent and experienced staff. It is critical that the government invests as well as attracts investments in this area.   An appropriately structured arrangement can have public-private resonance, offering a commercially viable investment opportunity. A sustainable system can also be developed which serves a public goal by ensuring quality of medicines.   This is also a time for a deeper policy review of the problem of substandard medicines….

Pakistan’s deadly cocktail of substandard drugs. The Lancet – 5 March 2012. DOI: 10.1016/S0140-6736(12)60277-3 Download Attached file # 1

Published in The News International on March 05, 2012: In 1937, more than a hundred people died in the United States as a result of using a drug formulated with a toxic solvent in what came to be known as the Elixir Sulfanilamide Tragedy. The incident was a wakeup call for the then US administration and led President Roosevelt to sign the Food, Drug and Cosmetic Drug Act into Law in 1938. The new law significantly increased federal regulatory authority over drugs and mandated the creation of the US Food and Drug Regulatory Authority (FDA). The FDA was created as…

Published in The News International on November 23, 2011: At the recent meeting of heads of Commonwealth states, Australia put polio squarely on the table with a 54 million dollar promise. This adds to the existing pledges towards the disease eradication goal, which has collectively received more resources than any other global health intervention, to date. There is one problem though and Pakistan is in the dock once more—this time as a living threat to the global goal of eradicating a disease for the second time from the face of this planet. The weight of the allegations is mighty. After…

Heartfile Health Financing: striving to Achieve Health Equity in Pakistan. Draft background paper 26 – World Conference of Social Determinants of Health. Download Attached file # 1

Published in The News International on September 03, 2011: Pakistan’s Ministry of Health was abolished on the 30th of June and a number of federal health responsibilities were placed under the jurisdiction of seven other government ministries/divisions. The dynamics of this change and the questions emerging as a result thereof have been discussed in these columns on July 23. This comment presents an option for the way forward with regard to entrusting national/federal health responsibilities to appropriate institutions at the federal level. Most of these functions are linked to each other. Information, a key responsibility, has to be consolidated across…

Published in The News International on August 16, 2011: In this rapidly changing globalized and inter-connected world, some recent events are compelling us to redefine existing norms and practices. Burgeoning tensions earlier in the Middle East highlighted the need to accord higher priority to mainstreaming democracy. Recent riots in Europe underscore the salience of social reform whereas the global financial crisis necessitates greater attention to transparency within global and domestic financial and regulatory systems. Pakistan is undergoing unprecedented transformations in this changing world. The country has opted for deep-rooted reform of its federating system through the 18th Constitutional Amendment at…

Rabkin M. Nishtar S. Scaling Up Chronic Care Systems: Leveraging HIV Programs to Support Non-communicable Disease Services. J Acquir Immune Defic Syndr 2011;57(2):87-90. Download Attached file # 1

Published in The News International on July 23, 2011: On June 28, a notification of the Government of Pakistan articulated a plan for completing the process of devolving many subjects, including health, as part of the final stages of implementing the 18th Constitutional Amendment. As a consequence, the Ministry of Health (MoH) was abolished and Pakistan became the first federal country in the world without any central coordination for health. Whilst making this change, those at the decision making helm, however, rightly understood that there are “national” roles in health, which cannot be devolved and retained them at the “federal”…

Published in The News International on June 25, 2011: The establishment of a drug regulatory authority is once again on the policy agenda, this time round as part of implementation of the 18th Amendment-relevant devolution of health. In principle this is a step in the right direction. Whilst the service delivery functions of health need to be devolved, it is equally important to recognize that national health functions need to be served federally, as is the case in most federations around the world. In a recent analysis  (http://www.heartfile.org/pdf/HEALTH_18AM_FINAL.pdf) four subjects have been described as falling within the purview of health’s…

UN High-Level Meeting on Non-Communicable Diseases: addressing four questions: The Lancet, Volume 378, Issue 9789, Pages 449 – 455.

Published in The News International on May 28, 2011: The events of May 2nd and 21st have left the nation embarrassed and demoralized. The challenges arising as a result thereof may compound Pakistan’s existing problems. Many find it difficult to search for beacons of hope within the myriad of problems at a time like this. Within this context, this comment is an attempt to explore if there is reason for hope, and if so, what is it, that needs to transpire to turn the tide in a positive direction. Whilst trying to frame an answer to this question, I am…

Nishtar S, Mehboob AB. Pakistan prepares to abolish Ministry of Health. The Lancet May 4, 2011

Published in The News International on April 23, 2011: As one of the key instruments of governance, regulatory functions have increasingly been in the spotlight, subsequent to the 18th Constitutional Amendment. Regulation can take many forms but in the current context it refer to interventions initiated by the government to correct market failure, or the use of state power to impose constraints on organizations and individuals through a range of instruments issued by the government or non-governmental bodies to which the government has delegated regulatory powers. Amongst the things that can be regulated, price, quality, and numbers are the most…

Published in The News International on April 02, 2011: The Implementation Commission of the 18th Constitutional Amendment, in its recent session, has taken the final decision to devolve the Ministry of Education. The next round of deliberations will decide the modalities of devolving another set of ministries, including the Ministry of Health (MoH). My comment in these columns on December 25, 2010—the Vanishing Ministry—outlined several institutional considerations that need attention whilst making decisions in this regard. One of these refers to the question of the national role in health and related institutional arrangements. Lessons from other countries are instructive in…

Published in The News International on March 19, 2011: Young doctors in the largest province of the country are on strike for the 17th day running. With revolutionary fervor from the lawyers’ movement and the Middle Eastern revolutions shaping our societal political culture, it seems that the movement is having a snowball effect. An increasing number of young doctors, groups and associations are galvanizing support for the Young Doctors Association, the apex body, which lent impetus to this movement. Their cause is becoming a rallying cry for drawing attention to a number of systemic constraints in relation to human resource…

Nishtar S. The Challenges of Scaling up. Lancet 2011;377:986.

Published in The News International on February 12, 2011: World Bank’s report ‘Tackling Non-communicable Diseases in South Asia’ made headlines in Pakistan, yesterday. This is an important subject and its significance should be appreciated by policymakers. The report highlights the magnitude of burden attributable to a set of diseases, widely prevalent throughout all countries of south Asia—diseases which are linked by common risk factors, are largely preventable through cost effective interventions, but which have remained outside of traditional public health planning. It is now well established that certain heart diseases, stroke, diabetes, and some cancers and chronic lung conditions are the…

Published in The News International on January 29, 2011: The government and opposition factions appear to be converging on a ten-point Agenda focused on eliminating some of the currently prevailing governance distortions in Pakistan. Articulated as a set of “Demands” by one particular opposition party, the points have been endorsed by others and have been admirably embraced by the incumbent federal government. The ten-points, per se, are non-controversial and there appears to be a broad consensus that action towards them will contribute positively in an environment where mistrust and malfunction are now deeply ingrained. This comment is aimed at explaining…

Published in The News International on January 05, 2011: The government and opposition factions appear to be converging on a ten-point Agenda focused on eliminating some of the currently prevailing governance distortions in Pakistan. Articulated as a set of “Demands” by one particular opposition party, the points have been endorsed by others and have been admirably embraced by the incumbent federal government. The ten-points, per se, are non-controversial and there appears to be a broad consensus that action towards them will contribute positively in an environment where mistrust and malfunction are now deeply ingrained. This comment is aimed at explaining…

Published in The News International on January 01, 2011: At the recent meeting of the Global Agenda Council of the World Economic Forum in Dubai some of the top issues in the global risk landscape and their possible mitigates were highlights. Ironically, a few of us from Pakistan could relate to most systemic risks as being endemic to our sovereign environment, each of them inextricably multi-dimensional in their scope. As global experts underscored the salience of effective governance structures, accountability, and clarity in multi-stakeholder concerted action as the means of addressing these risks, one could not help reflect on ones…

Nishtar S. H1N1 crisis in Pakistan—lessons learnt. NTS Working Paper Series, Working Paper No. 4, 2011. Centre for Non-Traditional Security Studies, Singapore.

Nishtar S, Khalid F, Ikram A, et al. Protecting the poor against health impoverishment in Pakistan: proof of concept of the potential within innovative web and mobile phone technologies. Background Paper to the World Health Report, 2010, Health Systems Financing (World Health Organization)

Published in The News International on December 25, 2010: The Implementation Commission of the 18th Constitutional Amendment is due to present its final recommendations to the Parliament for approval next week. Statements issued in the run up to that have already indicated that subsequent to abolishing the Concurrent Legislative List, a number of subjects, inclusive of health, education, rural development, population planning, social welfare, culture, tourism, youth affairs, etc., will be fully devolved to the provinces and their respective ministries will be abolished. As per the plan, their service delivery functions are to be devolved to provincial departments and their…

Published in The News International on November 22, 2010: Pakistan Development Forum (PDF) 2010 was convened at a time of unparalleled challenges—with several macroeconomic issues, a grinding fiscal crunch, competing priorities for resource allocations, an energy crisis, ongoing war, relentless insurgency, and an unprecedented need for resources in the aftermath of the worst disaster on this planet in recent history, characterizing the country’s needs. Within this context, pronouncements at the forum highlighted some windows of opportunity at the margins of these significant challenges. This comment alludes to six in particular, emphasizing that stronger stewardship is needed to reap the potential…

Samb B, Desai N, Nishtar S, Mendis S, Bekedam H, Wright A, et.al. Prevention and management of chronic disease: a litmus test for health-systems strengthening in low-income and middle-income countries. The Lancet 2010;376(9754): 1785-97.

Published in The News International on November 06, 2010: The recent outbreak of Dengue, which is commanding widespread attention, is an important insight into several health and overarching governance issues. Before those are alluded to, a brief comment is offered on the current situation. It is indeed a sign of progressive attention to welfare that hotlines, round the clock media coverage, front paper trackers and policymakers’ responses and reprimands have been galvanized in response to a public health concern. 4,363 cases of suspected Dengue Fever have been reported in Pakistan with 2,062 confirmed cases and 15 deaths until 22nd October…

Published in The News International on October 23, 2010: Drawing attention to the budget process during the month of October may appear a little out of step specially when there are so many other governance-related storms whipping. A closer look however indicates otherwise. The budget process for a fiscal year starts in the month of October with the Ministry of Finance issuing budget calls to all the ministries and departments seeking detailed reports of expenditures and estimates of demands for grants. Subsequently, the standard momentum takes course with the process coming to fruition in June with the budget’s presentation in…

Published in The News International on October 02, 2010: In the last eight weeks, ‘coordination’ has come to be viewed as the epitome of flood relief, and the lack thereof, a major failure of stewardship agencies. The emphasis on coordination in the given context is not without reason. The massive need for response that the flood has generated, coupled with grinding fiscal constraints, create an imperative to minimize duplications and maximize synergies. Whilst the need cannot be overemphasized, it is the approach to coordination that needs to be placed under the analytical lens. What do we mean by better coordination?…

Published in The News International on September 22, 2010: Financial constraints, which parallel the unprecedented need for financing to rebuild and rehabilitate in the aftermath of the recent floods are calling for efforts to mobilize resources to bridge a huge gap. Currently, several conventional channels are being utilized and explored further to achieve that objective. There have been public pronouncements to the effect that the Public Sector Development Program (PSDP) will be radically reshaped with priorities for reallocation of development resources redefined and that a reformed GST will be levied with effect from October 1 to bridge the fiscal gap….

F. Sabih, K. M. Bile, W. Buehler, A. Hafeez, S. Nishtar, S. Siddiqi Implementing the district health system in the framework of primary health care in Pakistan: can the evolving reforms enhance the pace towards the Millennium Development Goals? Eastern Med health journal Volume 16 (September) Supplement, 2010.

A.Y. Alam, S. Nishtar, S. Amjad, K.M. Bile Impact of wealth status on health outcomes in Pakistan. Eastern Med health journal Volume 16 (September) Supplement, 2010.

Nishtar S. Corruption in health systems — Lancet 2010; 376(9744):874.

Published in The News International on September 04, 2010: Disasters are a true litmus test of governance. Many attributes of governance interplay in disasters, before, during and after a situation. This comment flags five governance lessons, evidenced by the response to the recent catastrophic floods. The first attribute relates to strategic planning, which raises an important question: was it possible to predict the behaviour of the monsoons this time round? Whilst it is true that the scale of the disaster could not have been predicted, the calamity clearly hasn’t dawned as a surprise. Findings of a vulnerability mapping of Pakistan…

Published in The News International on August 17, 2010: The Khyber Pakhtunkwa Child Protection and Welfare Ordinance 2010  is due to be presented to the Provincial Assembly any time now. The Ordinance is meant to be an improvement on the previous legislative enactments. However, a recent review circulated on a virtual civil society network by an NGO working in the area of child protection has raised some valid points about the Ordinance’s technical and normative weaknesses—in particular its lack of conceptual clarity in relation to corporal punishment, the divergent stances signalled as regards its abolition and restrictive definitions of sexual…

Published in The News International on July 24, 2010: Some of the statements in wake of the recent meeting of Friends of Democratic Pakistan and strategic dialogues aimed at defining areas of priority for the use of incoming bilateral assistance from Untied States have been positive and encouraging, including the bold admission by Secretary of State ìwe have not done a good job of connecting our partnership with concrete improvements in the lives of Pakistanisówith this dialogue we are working to change thatî. However, when such statements are accompanied by others from the Pakistani side, which label these dialogues ìtransformationalî…

Published in The News International on July 11, 2010: July 11, World Population Day, holds special significance for Pakistan, the sixth most populous country in the world where the importance of Population as the denominator for planning and development must be clearly appreciated. In a country where food, water, energy, education, healthcare, social welfare, and job opportunities are already scarce for the existing population of 173.5 million, the addition of another 173.5 million over the next 34 years will pose a crippling burden in view of prevailing resource constraints. Population therefore, is a true denominator for development. Additionally, a burgeoning…

Published in The News International on July 03, 2010: There was a misplaced euphoria in some social sector circles last year over the expansionary fiscal policy evidenced in Budget 2009/10 and the increase in allocations for the social sectors indicated therein. However, as months unfolded, budgetary cutbacks became apparent owing to grinding fiscal constraints and the donor pledges upon which initial social sector projections were hinged remained unrealized. Learning from this example, not many rational analysts were perturbed by the scale of outlay this time round in the 2010/11 budget books, given that it appeared comparatively more realistic. In any…

Published in The News International on June 19, 2010: This comment is a review of the health sector policy announced in the budget speech as part of which a new health insurance scheme will be launched for the poor under the rubric of the federal government’s safety net program. There are two elements in this policy intent. One relates to protecting the poor and the other centres on the means of enabling that. The standalone rationale for both of them is strong. In principle, the decision by the government to financially risk-protect the poor against the vicissitudes of health is…

Published in The News International on June 07, 2010: Pakistan is faced with many unprecedented challenges. Ongoing acts of terrorism, the executive-judiciary confrontation, threats of environmental disasters looming with the Hunza lake bursting at its seams and a storm whipping up in the Arabian sea, a relentless energy crisis, a tough balancing act in the forthcoming 2010-11 fiscal policy, and many others. With many pressing governance concerns at hand, health reform may appear low on the list of priorities. That notion is misplaced for three reasons. Firstly, health reform is usually an elective process or a course, which is adopted…

Published in The News International on May 29, 2010: “In order to judge the character of a nation, look no further than its health system.” This yardstick doesn’t project a positive image of Pakistan, with respect to all the three measures of the performance assessment of the health system–equity in health outcomes, fairness in financing and responsiveness of the system. But even more serious than the poor health status of the country’s population are the wide inequities prevailing across income groups, rural or urban status of living and across genders. A recent analysis by the writer has shown statistically significant…

Published in The News International on May 22, 2010: Ever since the enactment of major health reforms in the United States, global interest in the subject has burgeoned. For Pakistan, health reform should be an imperative for reasons that have been glaringly apparent. Cases of alleged malpractice by the private sector have soared to new heights over the last several months. There are various versions of healthcare ‘bills’ circulating as structural solutions to this deep-rooted problem, albeit with limited technical potential to impact change and almost no stakeholder buy-in. The menace of spurious drugs and procurement graft relating to medicines has…

Published in The News International on May 08, 2010: Calls to create more provinces in Pakistan have intensified ever since NWFP was renamed Khyber-Pakhtunkhwa. People of district Hazara are out on the streets with their demand for Hazara province. A motion was moved in the Senate during the 18th Amendment session with the suggestion that district Bahawalpur be given a provincial status and pictures of students carrying  placards of ëSariaki provinceí have been featured in newspapers ever since. While the renaming of NWFP is symbolic and recent attention to this subject motivated by ethno-lingual fervor, it is important to pay…

Nishtar S, Bile KM. The public-private niche in health — opportunities for the Friends of Democratic Pakistan. J Pak Med Assoc 2010; 60(5):333-4.

Published in The News International on April 24, 2010: The 18th Amendment to the Constitution is being hailed on a two-fold premise: one, that it will proclaim and empower the Parliament as supreme; and two, that it will fundamentally redress the basic anomaly of Pakistan’s parliamentary system of government, which has been presidential in substance after the 17th Amendment and, therefore, configure its true parliamentary form. It is acknowledged that the Amendment has rectified a fundamental distortion in the Constitution. Its importance notwithstanding, the Amendment does have its limitations in upholding parliamentary supremacy in a context where distortions are pervasive….

Published in The News International on April 09, 2010: The 18th Amendment Bill is being widely hailed for repealing some of the distortions introduced in the Constitution in previous years under military rule and for returning the parliamentary form of democracy closer to its truer shade in Pakistan. A multi-partisan consultative process has enabled a consensus over a set of provisions amongst political actors, who came to the negotiating table with diverse ideologies and motivations. Commendations are, therefore, due to the team that led the process. However, there are many caveats in relation to the way forward. Significant as it…

Published in The News International on April 03, 2010: Pakistan’s prevailing situation should lend impetus to strategic thinking about a holistic vision for a National Security Policy. The imperative to do so is two-fold: one, the contemporary understanding of security within the context of a nation state has broadened from one centered on territorial sovereignty and therefore, military and political prowess, to one encompassing a holistic vision. The latter enables addressing both, factors upon which territorial sovereignty is dependent as well as human security—economic security, environmental security, food security, demographic security, and health security assume importance in this respect. Two,…

Published in The News International on March 22, 2010: The Ministry of Health has stepped up efforts to enunciate the National Health Policy 2010 and bring the process, which commenced with the initiation of a Health Policy Task Force in 2008 to fruition since the availability of donor resources has been made conditional on pronouncement of a health policy. Development of a new vision for a health policy is a complex process in Pakistan’s context for a number of reasons. Pakistan’s mixed health system has many systemic flaws, therefore, a reform agenda must be implicit in a health policy. The…

Published in The News International on March 22, 2010: The evidence generating institutional arrangements of a state qualify to be its fourth pillar, since evidence constitutes the basis of decisions in every state domain. Within this context, the draft bill to make the Federal Bureau of Statistics (FBS) an independent body, scheduled to be presented in the next parliamentary session assumes great importance. The bill uses grant of autonomy as an instrument to create a new agency—Pakistan Bureau of Statistics (PBS)—by restructuring and reorganizing three existing data collection organizations. The rationale and design for this approach has been published in…

Nishtar S. Scaling up Financing for Health. Lancet 2010;375:983 and can be accessed at http://www.who.int/bulletin/volumes/88/1/09-067868/en/

Published in The News International on March 08, 2010: Although effective governance—or the lack thereof—has an impact on every aspect of our societal, social and economic lives, nowhere is its imprint more vivid than in determining the status of women in a society. This comment uses the International Women’s Day, which is being globally observed today as a peg to briefly outline the linkages. This year’s theme of International Women’s day entitled “Equal rights, equal opportunities: progress for all” is particularly relevant to governance, since upholding women’s political, economic and social rights and striving towards achieving equity and equality of…

Nishtar S. Choked Pipes: Reforming Pakistan’s Health System. Oxford University Press, 2010 ISBN: 978-0-19-547969-0

Nishtar S. Choked Pipes — Reforming Pakistan’s Mixed Health System (invited editorial). J Pak Med Assoc 2010;60(4):252-3 and can be accessble at http://www.who.int/bulletin/volumes/88/1/09-067868/en/

Published in The News International on February 27, 2010: The International Crisis Group’s Report on Civil Service Reform has sparked conversations around the need and potential avenues for restructuring Pakistan’s civil service. This, however, is not the first time that a report on the subject has been made public. Ever since the country’s creation, more than thirty commissions/committees have been constituted and convened to frame normative guidance relevant to this area. A detailed account of past efforts has been summarised in the report of the National Commission for Government Reform (NCGR), the most recent of these initiatives, which was tasked…

Published in The News International on February 20, 2010: The potential standoff between government and judiciary has finally been averted. Process-related concerns notwithstanding, the saga’s culmination appears to be a product of sound technical advice, heed to provisions of the constitution and a process of consultation. These attributes of governance will surely pay dividends whenever they are mainstreamed in decision-making in matters of state. There is a lesson to be learnt here. But as always, reflections are becoming centered on conspiracy theories, power struggles, personal rivalries and institutional divides–in other words, power politics. By contrast some systemic considerations related to…

Published in The News International on February 13, 2010: Members of the forum of Friends of Democratic Pakistan (FoDP) have been convened for the fourth time since the announcement, which led to the creation of the forum in September 2008 on the sidelines of the UN General Assembly. Whilst the initial meetings in New York, Tokyo and Istanbul were framed in the traditional mode with bilateral and multilateral development agencies and countries dominating, the fourth has taken a slight deviation from what is the norm in diplomatic-development-engagement in Pakistan’s history to also focus on public-private partnerships. This was evident in…

Published in The News International on February 06, 2010: The poor man is under tremendous stress as a result of numerous economic hardships including high unemployment, inflation, scarcity of essential commodities, and limited ability of the state to target welfare services. These hardships often prompt those who hold welfare of a common man close to their heart to question the relevance of issues that dominate current national debates — for example, constitutional amendments, the Supreme Court’s judgment on the NRO, power relationships between the pillars of the state, the accountability bill and issues of internal sovereignty — in relation to…

Published in The News International on January 20, 2010: Discussions around the Punjab Health Care Bill 2009 have intensified following some instances of alleged medical negligence in Lahore. The purpose of this comment is to clarify many policy and institutional implications of this bill in an attempt to avert a confrontation. To begin with it is acknowledged that as the steward of the health sector, it is the responsibility of the government to ensure the provision of quality health services. Health being a provincial subject, it is also perfectly legitimate for the provincial government to legislate in this area. There…

Published in The News International on January 11, 2010: A review of 2009’s grand challenges can provide useful insights for planning 2010. Although issues were pervasive in many state sectors, their salience is being underscored in a few domains with a view to outlining possible policy directions that appear plausible for perusal. By far the greatest challenge related to undermining of internal sovereignty in the settled areas of NWFP and the rapidly fading writ of the government in the Federally Administered Tribal Areas (FATA). Although a military operation appears to have quelled the insurgency in some parts for now, these…

Published in The News International on December 31, 2009: The National Finance Commission (NFC) will be announced by the Prime Minister in Gawadar today. Felicitations are due not only for the amicable coming to fruition of a process fraught with long-drawn disputes, but also for the innovations which have been introduced with regard to a set of new criteria. Indeed, the dispensation of vertical and horizontal distributions from the divisible pool have ensured a better deal for the smaller provinces, and can pave the way for better federal-provincial and inter-provincial relationships. Before some of the constraints that stand in the…

Published in The News International on December 19, 2009: In a landmark decision on December 16, the Supreme Court has ruled on the legal validity of the National Reconciliation Order (NRO) and has termed it void ab initio for being ultra vires of the Constitution. In layman’s terms, the NRO stands null and void since its inception and all benefits acquired, accrued or incurred under it stand withdrawn. This decision is a very important cog in a chain, which is paving the way for strengthening the moral basis of anti-corruption reform in Pakistan. The sequence of events began with a…

Published in The News International on December 12, 2009: The Balochistan package, the implementation of which the Prime Minister envisages finalizing by December 15, has been received with views on both extremes of a spectrum. The ruling stakeholders term it as a significant milestone whereas the Baloch nationalists have rejected it outright. From a review of the package it seems that the Parliamentary and Cabinet Committee mandated with the task of developing the package has carefully gone over the various bones of contention and has made an effort to make some allowances in the five-tiered package, without disturbing the current…

Nishtar S. Pakistan, Politics and Polio. Bull World Health Organ 2010. 10.2471/ BLT.09.066480

Published in The News International on November 28, 2009: The Special Committee on Constitutional Reform, which was constituted to frame recommendations with regard to the construct of the 18th Amendment to the Constitution of Pakistan, is likely to come up with its recommendations soon. The focus of attention of the Committee and of the nation in general is on certain covenants of the Constitution—repeal of the 17th amendment in general and 58-2(b) in particular. Many political actors have also come up with specific recommendations with a focus on these and related issues. An amendment to the constitution is not a…

Published in The News International on November 07, 2009: The emotional turmoil, which the nation was going through over the fate of ethical standards in accountability norms and the threat of the widening gulf between justice and law appear to be easing with indications and pronouncements by the government that it will not seek validation of the National Reconciliation Ordinance (NRO) through the Parliament. With this decision, the NRO will stand repealed on the expiry of a period of four months from July 31, 2009—the date of the short order of the Supreme Court in which the November 3, 2007…

Lagomarsino G, de Ferranti D, Pablos-Mendez A, Nachuk S, Nishtar S, Wibulpolprasert S. Public stewardship of mixed health systems. Lancet 2009 Nov 7;374(9701): 1577-8

Published in The News International on October 31, 2009: Aid conditionality appears to be a subject of recent controversy—not all conditionalities are controversial though. Some—as pointed out by the writer in these columns on October 22—particularly those related to governance reform may be useful for a country, if the structural changes stipulated are carefully implemented. However, in doing so the country must have the capacity to analyze how the generic approaches embodied within aid instruments can be germane to strengthening a specific aspect of governance or management within a country context. This comment focuses on one of International Monetary Fund’s…

Published in The News International on October 22, 2009: The recent discussions regarding the Kerry Lugar Bill and the debate about the value of aid in general on its sidelines, brings to the fore the understanding that both sides—donors as well as Pakistan—have very high expectations of aid in terms of what it can deliver and catalyze. Before setting such high hopes, it is critical that we impartially analyze the past impact of aid on various outcomes in Pakistan. Whilst doing so, it is important that we move beyond polarized and politicized discussions on the subject; balance sensitivities with pragmatism;…

Published in The News International on October 12, 2009: A number of civil society organisations have drawn attention to the need for strengthening Pakistan’s existing Freedom of Information (FOI) legislative framework on September 28 —the Right to Know Day. FOI is not to be confused with media freedom. FOI is an important component of the international guarantee of freedom of expression, which includes the right to seek and receive as well as impart information and ideas. It has to do with access to information and disclosure, which can enable public discourse in larger national interest on issues of governance. FOI…

Published in The News International on September 28, 2009: The meeting of Friends of Democratic Pakistan (FoDP), convened on the sidelines of the United Nations General Assembly in New York, concluded yesterday by signaling unprecedented support to Pakistan. This was evidenced in both the representation at the meeting as well as in the approval announcement of the Kerry Lugar Bill, which is aimed at facilitating economic, security and socio-economic assistance.  This comment with its focus on the development perspective is centered on exploring if aid is the answer to the current development challenges, the country faces. The importance of three…

Published in The News International on September 19, 2009: The Special Committee on Constitutional Reform is currently deliberating on the nature of constitutional amendments to be introduced through the 18th Amendment. Achieving balance of power should be an important outcome of this exercise. In addition, however, the potential within constitutional changes to foster improvements in the public policy domain should also be explored. Within this context, this comment draws attention to the need for updating the Principles of Policy, articulated in Part II, Chapter 2 of the 1973 Constitution. Principles are a set of values that guide action towards desired…

Nishtar S. Mixed Health Systems Syndrome. Bull World Health Organ 2010;88:74-75. doi: 10.2471/BLT.09.067868

Nishtar S. Amjad S. Synergizing health and population in Pakistan. J Pak Med Asoc 2009;Suppl3:S3-20

Nishtar S. Amjad S. Pakistan’s Health Population Mantra. J Pak Med Asoc 2009;Suppl3:S1-2

Published in The News International on September 16, 2009: The heartbreaking scene of 18 women succumbing to stampede whilst striving to get a bag of free sugar brings to attention the gravity of the ongoing commodity crisis.  Such crises provide an insight into the regulatory capacity of governments and the level of governance effectiveness. Examination of the causes of the present sugar crisis can help in analyzing how that is the case. Even under normal circumstances, sugar is a difficult domain to govern, with frequent tugs of war between the government, the sugar millers and growers. The constituency of growers…

Atun R, Dybul M, Evans T, Kim JY, Moatti JP, Nishtar S, Russell A. Venice Statement on global health initiatives and health systems. Lancet 2009; 374(9692): 783-4

Published in The News International on August 22, 2009: Reaffirming the commitment to national security can be a befitting commemoration of the country’s 62nd Independence Day. National security is defined as “the requirement to maintain the survival of the nation-state through the use of economic, military and political power and the exercise of diplomacy”. Conventional national security measures include maintaining effective armed forces and intelligence services, implementing civil defence and emergency preparedness measures and investments in critical infrastructure—all of them significantly important. However, security also has another dimension centered on human security as defined by the United Nations, according to…

Published in The News International on August 15, 2009: The release of Transparency International’s National Corruption Perception Survey, 2009, which assessed citizens’ perceptions as to the level of corruption in the four provinces of Pakistan, has sparked a debate about the prevalence of corruption in the country and the inter-provincial variations in the reported pattern. First of all, it is important to appreciate that corruption assessment is a challenging area in governance diagnostics because of definitional ambiguities, complexities in categorisation, overlap of forms and its linkage with the cultural and social milieu, within which activities are perceived as being corruptive….

Published in The News International on August 08, 2009: The fate of the devolution initiative is likely to be decided by the end of this year, regardless of the presidential sanction to the provincial draft proposal—currently in the pipeline—given that the Local Government Ordinance will stand omitted from the Sixth Schedule of the Constitution, after six years of passage of the 17th Amendment in December 2009. A turf battle is imminent in the wake of the most likely decision; provincial governments have already stated that they will completely abolish the current system whereas proponents of the devolution initiative, citing 140-A…

Published in The News International on July 25, 2009: The Petroleum Development Levy (Amendment) Ordinance, 2009, which offset the Supreme Court’s suspension of the imposition of the carbon surcharge was challenged on the basis of the Constitution’s Articles 2A, 4, 5, 8, 9, 25, 37, 38(d), 77 and 89. The resulting difference of opinion between the three pillars of the state—the executive, the judiciary and the legislature—raises some important issues to be resolved; both with reference to their respective constitutional domains as well as the matter of human rights and their legal enforcement. Many of us perceive human rights as…

Published in The News International on July 16, 2009: There is hardly any problem in the country, which cannot be tracked back to challenges and weaknesses at the level of governance—the crisis of the internally displaced persons (IDPs) is certainly no exception. Both the technocratic and political aspects of governance, inclusive of policy directions at various levels, to the dynamics and pitfalls of the public management process, have deeply impacted the IDP crisis—right from the manner in which it evolved to the style in which it was managed. Now that the IDPs are reported to be on their way back…

Published in The News International on July 06, 2009: The health sector was marked by six policy highlights in the expansionary fiscal policy of the government in the federal budget for 2009/10. These policy dimensions center on the following: scale up of the existing budget; pronouncement of a health insurance scheme; enhanced allocations for the two key national public health programs; a dedicated allocation for an action plan for emergency diseases; changes in tariffs for some essential medicines and increase in the excise tax with regard to tobacco. This comment briefly touches upon the context of each fiscal policy decision….

Published in The News International on June 22, 2009: The Finance Bill 2009, which gives effect to the financial proposals of the federal government for a year, is the government’s key instrument of fiscal policy and in many ways, a reflection of its policy stance to achieve stated endpoints in many state domains. Within that remit, the purpose of this comment is to bring to the fore some considerations relevant to equity, social justice and the social sector, with a view to generating a debate on the subject, within the context of the forthcoming parliamentary sessions that will now convene…

World Health Organization Maximizing Positive Synergies Collaborative Group, Samb B, Evans T, Dybul M, Atun R, Moatti JP, Nishtar S, Wright A, Celletti F, Hsu J, Kim JY, Brugha R, Russell A, Etienne C. An assessment of interactions between global health initiatives and country health systems. Lancet 2009;20(373):2137-69

Published in The News International on June 11, 2009: The government has decided to increase spending in the development sector in the coming year as is evidenced by the expansionary fiscal policy adopted in the forthcoming budget for the year 2009-10. Approval of the highest ever Public Sector Development Program by the National Economic Council comes at a time when many fiscal space constraints are evident—decline in revenues, competing priorities particularly in the wake of the ongoing security situation and efforts to curtail the fiscal deficit in order to keep it within stipulated limits. The rationale for the approach has…

The Holders of Public Offices (Accountability) Act 2009, which currently exists as a Bill and is to be introduced in the National Assembly, will perhaps be one of the most vital instruments of governance in Pakistan, over the coming years; its connotations and covenants defining responsibility for decisions and actions. Given its importance, the relative lack of informed and constructive debate on the subject in civil society, political and analytical circles is indicative of a deep-seated phenomena in the country’s societal political culture—we tend to engage in trivialities of governance and remonstrate when the manifestations of poor governance are apparent,…

Published in The News International onApril 28, 2009: The donor’s conference in Tokyo and the meeting convened by the Friends of Democratic Pakistan on its sidelines concluded on April 17 with a 5.28 Billion US$ pledge in economic assistance to Pakistan, congressional approvals permitting. A number of references have been made to this forthcoming package of assistance as being analogous to the post Second World War Marshall Plan, particularly in Pakistan, with the expectation that the outcomes will be likewise. It is important to understand that comparable impact is unlikely for a number of reasons. First, the Marshall Plan was…

Published in The News International on April 11, 2009: The White House has recently released a White Paper on U.S. policy to Afghanistan and Pakistan, articulating a number of geo-political and development imperatives for the region. This comment will focus only on the dimension related to development assistance within the contemporary realm of aid effectiveness. The US policy paper outlines a strategy centered on stepping up economic support to Pakistan; the importance of this has also been reiterated by President Obama’s three-pronged call for increasing development assistance for the country in his speech on March 27, 2009 and is evidenced…

Nishtar S. How important are health systems in the prevention of cardiovascular and other non-communicable diseases? Nat Clin Pract Cardiovasc Med. 2009;6(3):170-1

Published in The News International on February 14, 2009: The issue of spurious drugs has been in the spotlight for some time now beginning with the suo moto action by the Supreme Court in 2007 and the subsequent regulatory actions by the then government to the more recent creation of a sub-committee of the Senate’s Standing Committee on Interior. The problem has elicited strong reactions by several governments—severe but fleeting and short-lived. The idea here is neither to analyze individual decisions nor to delve into their motivation but to explain that the presence of spurious drugs in the market is a…

Published in The News International on January 27, 2009: The government is on its way to revamping the country’s accountability infrastructure and statutes. It is evident from a review of news postings in early January, that the National Accountability Bureau (NAB) will be replaced with an Independent Accountability Commission (IAC) with the antecedent repealing of the current National Accountability Ordinance, 1999 (NAO) and promulgation of the Holder of Public Offices Act, 2009 (HPOA). It is important to ensure that this is not just a switch of acronyms but a substantive institutional restructuring and realignment of statutes as a step towards…

Nishtar S. Pablos-Mendez A. The Global Financial downturn—imperatives for the health sector. Lancet 2009;373:124. Download Attached file # 1

Published in The News International on January 05, 2009:  The December 22, 2008 issue of Newsweek featured an article on the downside of Chinese state reform. Entitled ‘Why China is too scared to spend’, the article drew attention to the weaknesses created in the Chinese health system with the advent of market reforms in the 1980’s, which did away with the communes that funded the Chinese system of work-unit based welfare. The consequent negative impact on the Chinese social sector hit healthcare the worst, as bare foot doctors in villages and affordable hospitals in towns were replaced by privatized state enterprise….

Published in The News International on December 14, 2008: There is an apprehension within the development circles that the economic impact emanating from the crisis in international commodity markets and the affects of the global financial downturn coupled with constrained fiscal space in the country as a result of a number of factors inherent to Pakistan’s domestic situation is likely to hit development budgetary allocations hard, over the coming months. Such a situation is indeed plausible. While the lack of full integration of Pakistan’s financial markets with international markets, to some extent precludes the adverse impact getting imported into Pakistan…

Evans T, Nishtar S, Atun R, Etienne C. Scaling up research and learning for health systems: time to act. Lancet 2008;372(9649):1529-31. Download Attached file # 1

Published in The News International on October 23, 2008: Pakistan’s security situation and the war on terror has become a top priority for the government. While the need to prioritize issues is understandable, attention to some other matters of the state on a war footing is also warranted. In many ways, the case of polio eradication is analogous to the war on terror given the international context within which it is being waged and the gains at stake. Since 1998, a Global Program on Polio Eradication spearheaded by WHO and involving many other agencies aimed at eradicating a disease from…

Published in The News International on September 30, 2008: The government has decided to repeal the National Accountability Ordinance 1999, and has drafted a bill to legislate for an alternative accountability mechanism; with the promulgation of these statutes, the National Accountability Bureau (NAB), Pakistan’s apex agency mandated in an anti-corruption role will be replaced by an alternative accountability body. The draft bill is not in the public domain and cannot be commented upon and the shortcomings of the earlier Ordinance have not been publicly debated. Notwithstanding, an opinion is offered as this clearly, can be an opportunity to address current…

Published in The News International on September 08, 2008: With the conclusion of presidential elections, the power configuration within the state has been defined. ‘Majority rule’ or ‘a few ruling with the consent of many’, described by the Greeks centuries ago, as a characteristic feature of democracy has been established within Pakistan and constitutional stipulations as articulated in Part III of the Constitution with reference to its Chapters on the President and Majlis-e-Shoora (Parliament) have been adhered to. At this stage, let us be reminded that while democracy, as understood conventionally is a necessary condition for a good government, it…

Published in The News International on August 17, 2008: 14th of August is as august as a day can get, both for Pakistanis who have witnessed the perils of partition and experienced the anguish of being in a subservient role as well as those of us born after independence; the latter can be attributed largely to ‘temporal depth’ – the characteristic understanding in nations of the past forming part of the present – and our collective consciousness, both of which we hope, will cascade to the next generation. Most of us would like to believe that the ‘nation’, as a…

Published in The News International on August 09, 2008: It is conventional for the commercial sector to assess and comment on the potential impact of a trade policy as was evidenced by the plethora of commentaries on the media subsequent to the enunciation of Pakistan’s National Trade Policy 2008/09, on the eve of July 18, 2008. The social sector seldom considers it within its remit to scrutinize possible impact of the course of action adopted on social outcomes nor does it create awareness about the need for trade policies to include elements relevant to their scope. However, the contemporary understanding…

Published in The News International on August 03, 2008:  Between the government and their critics, opinions relating to the government’s hundred-day performance are at the extreme ends of a spectrum. Unfortunately as a nation, we are not in the habit of being impartial in performance evaluation. The objective of this opinion is not to ascertain whether objectives were met or whether they were reflective of national priorities in the first place, but to emphasize that it is only through impartial empirics and the use of validated instruments and indicators, as opposed to self determined benchmarks, that meaningful inferences relevant to…

Published in The News International on July 14, 2008:  In the midst of all the overarching challenges the country faces, sectoral policy and strategy appears to be relegated to the background; the latter cannot be mainstreamed in any case without sound institutional governance, which is also a determinant of the currently prevailing broader issues. Let’s take the example of health where the government’s initiative to formulate a new national health policy could be the starting point for the much needed reform within the health sector. Certain sound technical choices can be made and if evidenced-based strategies are adopted to synergize…

Published in The News International on June 28, 2008: With all the four provincial budgets for the fiscal year 2008/09 tabled, the annual provincial development programs for the next year have been unveiled. Provincial development budgets range from 22.12-41.13% of the total outlays with Punjab spending the highest and Balochistan the lowest. 1.84-12.15% of the total provincial development budgets have been allocated for health with Sindh allocating the highest in relative terms. On the whole, provincial health allocations suffer from limitations that are somewhat similar to those described for the federal health budget in the author’s editorial in The NEWS…

Published in The News International on June 21, 2008:  Had it been conventional to place the budget in the public domain to solicit inputs of the civil society on the directions proposed therein, suggestions such as the one articulated in this opinion could have been more timely in terms of possible inclusion in the planning process. Given that this is not the scenario, the following five points are offered as policy inputs in relation to budgetary allocations for health, on the premise that some of these ideas will generate a discussion in the forthcoming parliamentary debates. First, it is important…

Siddiqui S, Masud TI, Nishtar S, Peters DH, Sabri B, Bile KM, Jama MA. Framework for assessing governance of the health system in developing countries: Gateway to good governance. Health Policy 2008 [Epub ahead of print]

Published in The News International on May 22, 2008: With economic, food and energy crises looming, criticism can be the most convenient past time. Such situations however, are also the litmus test for patriotism, given that a true commitment to the country warrants a look into the present and past for an objective empirical analysis only to develop insights for future planning and action. It is in an attempt to do the latter, that a viewpoint is offered. Crises illicit a knee jerk reaction to trouble shoot and inadvertently lead to fleeting short term solutions; however, it is equally important…

Published in The News International on April 06, 2008:  Perceived as an effort aimed at planning strategically the Prime Minister’s 100 day agenda is a step in the right direction. The points articulated therein are substantively valid if implemented in their true spirit. Their contents however, are a mix of long term aspirational goals, preferred policy choices, strategic administrative measures and a few immediate executive orders. Ideally the hundred day agenda should sift and separate the aspirational vision from the steps needed to implement the vision and subsequently cascade the latter into tangible processes that the government can pragmatically initialize…

Published in The News International on March 18, 2008: Elections 2008 will soon come to fruition with the formation of a new government. Regardless of who assumes office, being in the government is not going to be an enviable position if the ground reality is brought to bear, as it should. As practical action replaces rhetoric, limitations of the government to deliver on election catchphrases will become evident, particularly in serving the needs of the disadvantaged. The foreseen inevitable worsening of inflation is likely to put a tremendous pressure on the impoverished masses whereas the stalling macroeconomic situation will constrain…

Published in The News International on February 16, 2008: The pre-election political party debates relating to their positions on various sectoral processes of the state on national television, has prompted many of us to review party manifestos with the view to exploring strengths and weaknesses in an attempt to determine the deciding edge. Although the process may be indecisive, it leads one to acknowledge the fact that writing a manifesto must not be an easy task as bringing clarity and coherence to a range of party positions is a task that demands both strategic capacity and vision within party ranks….

Alam AY, Iqbal A, Mohamud KB, Laporte RE, Ahmed A, Nishtar S. Investigating socio-economic-demographic determinants of tobacco use in Rawalpindi, Pakistan. BMC Public Health 2008;8(1):50

Published in The News International on January 30, 2008:  In its report entitled “The State of the World’s Children, 2008” UNICEF’s reiteration of Pakistan’s stalling position to meet the targets stipulated in the Millennium Declaration particularly with reference to MDG 4 and 5 adds yet another set of predicaments to the ones that already exist in the country, on a range of fronts. Much of what has been articulated in the report is not new though; we have known about our poor maternal and child health indicators for a while through state-owned data that is in the public domain and…

Published in The News International on December 31, 2007: With the elections of 2008 forthcoming, and a change of hands on the governments reigns envisaged shortly, it is evident that any new government in Pakistan will have many issues to grapple with – from terrorism and conflict to the energy crisis and stalling fiscal indicators; inevitably and understandably, these will be the substrate of the new government’s focus as a result of which certain critical systemic issues are likely to get relegated to the background – issues that ultimately tangle most governments in a vicious spiral over the long term….

Published in The News International on December 09, 2007: Pakistan’s ranking on the 7th position in the recently released Global Corruption Barometer by Transparency International should lend a serious impetus to address an issue, which is deeply ingrained in the institutional processes of the country, both in the public and private sectors and in many fiscal, ethical and moral shades. However it is important to recognize that corruption is not specific to Pakistan but is a systemic phenomenon, endemic to developing countries and prevalent in many in western nations. Corruption is also not a new occurrence in Pakistan but is…

Nishtar S. Time for a global partnership on Non-Communicable Diseases. Lancet 2007;370(9603):1887-8.

Ronis KA, Nishtar S. Community health promotion in Pakistan: a policy development perspective. Promot Educ. 2007;14(2):98-9.

Nishtar S. Public-Private Partnerships in the health sector – a call to action. The  Commonwealth Health Ministers Book; 2007

Nishtar S. Politics of health systems: WHO’s new frontier. Lancet. 2007 Sep 15;370(9591):935-6.

Published in The News International on August 05, 2007: Transparency International’s World Corruption Report of 2007 with its focus on corruption in the judicial system is of contemporaneous relevance to Pakistan with respect to the spotlight on the judiciary. However, its findings have also opened a debate in many sectors in the country owing to its inclusion of Pakistan amongst the 37 countries studied and the sectoral comparative rankings. The interest in the area has also been further exacerbated by reports of two recently conducted surveys in Pakistan. According to the first, a perception survey of civil servants conducted by…

Published in The News International on July 01, 2007:  For most of us, disease pandemics are forgone history; plague killed 12 million people in 1855, but we think of it just as a setting in Jean Plaidy’s novels. Influenza claimed 25 million lives in 1918, but it is just through references in written accounts that we know of that. Much as we would like to disbelieve it, we may, unfortunately, not be far from another infectious disease pandemic given that the imprints SAARS and Avian flu have left in epidemic outbreaks have many bearings, which can herald a pandemic. If…

Published in The News International on June 10, 2007: The federal budget for 2007 will be presented on June the 9th, subsequent to which a special parliamentary session will be convened to debate the budget. Within this context, this article focuses on budgetary allocations for the health sector with a focus on four areas: aggregate level of allocations, quality of expenditures, allocation distributions and the issue of leakages and pilferage from the system, with a view to lending impetus to a dialogue on the short and long term imperatives of allocations in the health sector. At the outset, it must…

Nishtar S. Health Indicators of Pakistan. Gateway Paper II. Heartfile, Pakistan’s Health Policy Forum, Federal Bureau of Statistics and Ministry of Health; 2007

Nishtar S. Health section. National Commission for Government Reform. 2007

Published in The News International on February 25, 2007: The recent divide of opinion about the construction of the medical tower in Islamabad, the indication that another is in the pipeline for Karachi, signaling of investments underway in high-tech equipment, the organ transplantation bill and concerns expressed subsequent to its tabling and the debate around the much-hyped medical tourism raise two important contemporaneous questions about the role of the state in the health sector in Pakistan. First: what is the role of the state agencies with respect to ‘health’ within a ‘social sector context’? And second: what is the role…

Nishtar S. Community health promotion – a step further. Promot Educ. 2007;14(2):61-2, 109-10, 124-5.

Published in The News International on January 30, 2007: Social policy is central to politics and one of the major responsibilities of governments. In many developed countries the entire political debate is structured around social guarantees that representative political contenders can offer to their electorate and subsequently, sustained access to the corridors of power determined by how the agenda is delivered. How does Pakistan fare in terms of delivering social services, is a question which needs to be addressed with clarity. This article outlines the rationale for developing a comprehensive social policy, within a social justice framework in view of…

Nishtar S. The WHO Director General election finale. Lancet 2007;369(9557):185 Download Attached file # 1

Published in The News International on January 07, 2007: Policy issues relating to drugs and pharmaceuticals have increasingly been in the spotlight in 2006; the impetus to this came from the saga of the sale of spurious drugs and the consequent suo moto action by the Supreme Court. Subsequently, a high level committee meeting on October the 2nd, 2006 decided to create a Drug Regulatory Authority (DRA); this positive regulatory change, which has the ‘potential’ to revolutionarize the regulation of pharmaceuticals in Pakistan was therefore very well timed. However this also generates the expectation that the regulatory authority will deliver…

Nishtar S. Pharmaceuticals–strategic considerations in health reforms in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S100-11.

Nishtar S. Human resource solutions–the Gateway Paper proposed health reforms in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S94-9.

Nishtar S. The Gateway Paper–proposed health reforms in Pakistan–interface considerations. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S78-93.

Nishtar S. The Gateway Paper–health service delivery outside of the public sector in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S66-77.

Nishtar S. The Gateway Paper–preventive and promotive programs in Pakistan and health reforms in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S51-65.

Nishtar S. The Gateway Paper–public sector service delivery infrastructure and health reforms in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S43-50.

Nishtar S. The Gateway Paper–financing health in Pakistan and its linkage with health reforms. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S25-42.

Nishtar S. The Gateway Paper–stewardship and governance in the health sector in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S14-24.

Nishtar S. The Gateway Paper–context and configuration of the proposed health reforms in Pakistan. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S2-13.

Nishtar S. Evidence from research and its implications for health reforms in Pakistan: the Gateway Paper perspective. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S112-9.

Nishtar S. Health reforms in Pakistan-configuring health beyond the health sector. J Pak Med Assoc. 2006 Dec;56(12 Suppl 4):S120-35.

Published in The News International on November 05, 2006: The explosive outbreak of Dengue raises several important policy questions for long term public health planning in Paksitan. Dengue is making headlines with widespread public attention and political response. True that Dengue and its potentially lethal complication, Dengue Hemorrhagic fever should be a national public health concern – as they are. By way of contextualizing however, here is a disease that does not spread from person to person and therefore does not require patient isolation and barrier nursing and fortunately its vector (the mosquito) will not be able to survive and…

Nishtar S. Lessons in tackling chronic disease. BMJ 2006;333(7573)820. Download Attached file # 1

Published in The News International on October 01, 2006: The Economic Coordination Committee of the Cabinet on Wednesday the 27th decided to allow foreign companies to invest in the insurance business in Pakistan on the premise that this would help attract Foreign Direct Investment (FDI). There can be no two opinions about this being a right assumption if the necessary regulatory environment is secured. But then the other important factor critical to the success of this approach has to do with the issue of demand, which depends on the real disposable income of the prospective policy holder and the individual’s…

Published in The News International on September 30, 2006: We have a history of starting things denovo in this country. Individually and institutionally, we must scrap past initiatives, create silos, never build on efforts underway and whenever the adage “we have never learnt from the past” is referred to it is often with a negative connotation. Why should the case of social protection be any different? But perhaps in the given context of ‘never having learnt from the past’, social protection is unique since the most substantive example of social protection in the country is neither cited nor quoted or…

Published in The News International on September 10, 2006: The configuration of the four health projects presented to August the 23rd’s Executive Committee of the National Economic Council (ECNEC) meeting raise some broader issues that need to be the substrate of contemporaneous conceptual thinking with reference to health and health sector allocations in Pakistan. Agreed that there can be no generalizations with respect to the patterns observed in the presentation of health cases to ECNEC; accepted that ECNEC also sees – and approves – the likes of mega budgeted primary health care and preventive interventions and acknowledged that the four…

Published in The News International on August 27, 2006: Why does technology get spotlighted in the discourse over health outcomes and the discussion on health sector reform? For the simple reason that health and technology have shared agendas. It is well established that in addition to serving as a sine-qua-non of therapeutics and diagnostics in the medial field, technology can not only reduce health-related costs but also medical errors, which are the fifth leading cause of death in countries such as Pakistan. This realization has lent impetus to the emergence of a number of institutional, individual and group professional efforts,…

Published in The News International on August 06, 2006: Perhaps no other health policy intervention in recent times has been the substrate of a greater controversy compared with restructuring the mode of primary health care service delivery in Rahim Yar Khan (RYK) as part of which the management of Basic Health Units, in twelve districts of the country, was handed over to the Punjab Rural Support Program in Punjab, beginning 2003. True that an overview of health policy and regulation in Pakistan can highlight many sore spots; the generic drug scheme of 1973, partial deregulation of prices of drugs in…

Published in The News International on July 02, 2006: ‘Playing health’ with a new stack of cards The planet earth’s environmental and ecological transformation is a subject of much ado as are the contemporary concerns around the power dynamics, which will determine the global epicenter economically, militarily and politically over next two to three decades. This is justifiably a subject of critical thinking and planning. But sadly, the implications of this makeover for the social sector remain largely unrecognized. In the health sector more specifically, the thinking that health needs to be delivered as a public good – modeled on…

Published in The News International on June 30, 2006: Flagging a 21.3% increase in the budgetary allocation for health as part of the unprecedented increase in the development expenditure in the fiscal budget of 2006-07, the recital of June 5, 2006 made a reference to health as being a provincial subject. True that health is a provincial subject and true that the provinces – and now under the Local Government Ordinance of 2001, the Districts – have legal responsibility to deliver services. But then the federal government has constitutional prerogatives relating to health, which have important fiscal implications both at…

Nishtar S, Lateef E. Tobacco Control – an integral component of the National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. Prevention and Control. Vol2, Issue 2, Pages 95-102 (June 2006) Download Attached file # 1

Nishtar S. Heartfile’s Contribution to Health Systems Strengthening in Pakistan. Eastern Mediterranean Journal 2006; 12(2)S38-S53.

Published in The News International on June 06, 2006: Budget 2006 is just around the corner with an indication that there would, both, be aggregate as well as program-specific enhanced allocations for health. This raises the question of whether these can translate into improved health outcomes over the short term. Here it must be understood that the relationship of health indictors does not necessarily parallel the level of resource inputs particularly if considerations relating to the utilization of funds and a reconfiguration of the health system are not brought to bear. Within this context, three questions emerge: how should we…

Published in The News International on May 28, 2006: Changes in public-private roles are interlinked with broader changes in the macro-economy. Limitations of centrally planned economies, the resultant privatization of State-owned enterprise accentuated by fiscal constraints and donor conditionalities have continued to promote a package of measures in the developing countries, which make private sector the engine of growth. The current Government of Pakistan polices hinge on this concept and have forged ‘partnerships’ with the private sector in order to finance infrastructure needs of the country and open new sectors on the premise that the role of the State is…

Nishtar S, Perry M, Lammare MC, Ritchie J. Global Consortium on Community Health Promotion. Promotion and Education 2006;XIII(1):7-8.

Published in The News International on April 30, 2006: A news feature in The NEWS on April the 4th has outlined the NWFP Department of Health’s intent to launch a social health insurance scheme for the province. Aimed at improving access of the marginalized to health services, this is, in principle, a step in the right direction as it potentially offers a ‘health systems’ rather than an ad hoc solution. It is envisaged that if the strategy is appropriately structured, it can obviate some of the equity issues that have arisen from the currently prevailing tertiary-care-heavy health financing patterns. The…

Published in The News International on April 23, 2006: Recently, a national strategy has been approved for revamping the ‘Primary Health Care System’ with structural changes envisaged at the District level based upon the results of a pilot experience in Punjab. The strategy aims to restructure the first tier of the health service delivery infrastructure – the Basic Health Units (BHUs). By infrastructure standards, Pakistan has one of the largest health service delivery networks at a basic healthcare level. This comprises of 5301 BHUs, each with a catchment population of 10,000 to 20,000 and 552 Rural Health Centers (RHC0s –…

Published in The News International on April 09, 2006: Civil service reforms need to be an integral part of social sector reform processes if sustainable solutions to currently existing issues within the ambit social sector service delivery are envisaged. Within this context, there seems to be some justification for the perception that civil service reforms may finally be part of a mainstream agenda in Pakistan. This is evidenced by the initiation of processes such as the creation of a Committee for Civil Service reforms, the establishment of a Civil Service Reform Unit in the Establishment Division, launching of the Professional…

Published in The News International on March 19, 2006: Released on January 9, 2006, the first publication of Pakistan’s Health Policy Forum (PHPF), the Gateway Paper entitled “Health Systems in Pakistan – a Way Forward” is set within a broad context. A context relevant to health on the one hand and one that cross cuts with broader social sector issues, inter-sectoral processes and mainstream governance and sustainable development challenges, on the other. Pakistan’s Health Policy Forum has recently been created as the country’s first health sector Think Tank with the overarching mission of providing an independent voice for the promotion…

Published in The News International on March 05, 2006: Given that diseases such as the Plague, SARS, HIV/AIDs and Avian Flu do not respect national boundaries, the news of Avian Flu in our immediate neighborhood, left a slim choice between treading the prevent-prepare-control options a week ago. However its detection on an NWFP farm yesterday, made choices much clearer. Ever since Avian Influenza (H7N3) hit Pakistan in 2003-04 and was subsequently curbed at source in the agriculture and health sector through implementation of animal and human health surveillance, disease control and mitigation measures, some level of gearing up for another…

Nishtar S. Health chapter. Vision 2030 of the Planning Commission of Pakistan Download Attached file # 1

Published in The News International on February 08, 2006: Recent controversies around the Pakistan Medical and Dental Council (PMDC), the efforts presently underway to break the resulting stalemate and more topically offered solutions now favoring a major overhaul highlight an opportunity to flag some fundamental questions about the role of this institution. Mandated with a normative and regulatory role within the ambit of the medical profession, PMDC is a statutory autonomous organization. The PMDC Ordinance of 1962 and the subsequent amendments introduced in 1967 and 73 provide a policy framework enabling it to set standards of medical education, register practitioners…

Nishtar S. Improving heart health in Europe. Circulation 2006;113(4):f16 Download Attached file # 1

Nishtar S, Bile KM, Ahmed A, Faruqui AMA, Mirza Z, Shera S, et al. Process, rationale, and interventions of Pakistan’s National Action Plan on Chronic Diseases. Prev Chronic Dis. 2006 Jan;3(1):A14. Epub 2005 Dec 15.

Nishtar S, Bile KM, Ahmed A, Amjad S, Iqbal A. Integrated population-based surveillance of Non-Communicable Diseases the Pakistan model. Am J Prev Med. 2005 Dec;29(5 Suppl 1):102-6. Download Attached file # 1

Nishtar S. The Gateway Paper: Reforming Health Systems in Pakistan – a Strategic View. Heartfile and Pakistan’s Health Policy Forum; 2005

Nishtar S, Mohamud KB, Razzak J, Ghaffar A, Ahmed A, Khan SA, Mirza YA. Injury prevention and control: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan. J Pak Med Assoc. 2004;54(12 Suppl 3):S57-68.

Nishtar S, Ahmed A, Bhurgri Y, Mohamud KB, Zoka N, Sultan F, Jafarey NA. Prevention and control of cancers: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan. J Pak Med Assoc. 2004;54(12 Suppl 3):S45-56.

Nishtar S, Ahmed A, Kazi Y, Khan A, Mohamud KB. Prevention and control of chronic chest diseases: National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. J Pak Med Assoc. 2004;54(12 Suppl 3):S42-4.

Nishtar S, Mirza Z, Mohamud KB, Latif E, Ahmed A, Jafarey NA. Tobacco control: National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. J Pak Med Assoc. 2004;54(12 Suppl 3):S31-41.

Nishtar S, Shera S, Rafique G, Mohamud KB, Ahmed A. Diabetes prevention and control: National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. J Pak Med Assoc. 2004;54(12 Suppl 3):S26-30.

Nishtar S, Faruqui AM, Mattu MA, Mohamud KB, Ahmed A. National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan – Cardiovascular diseases. J Pak Med Assoc. 2004;54(12 Suppl 3):S14-25.

Nishtar S. National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan–Common action area. J Pak Med Assoc. 2004;54(12 Suppl 3):S9-13.

Nishtar S. National Action Plan for the Prevention and Control of Non-communicable Diseases and Health Promotion in Pakistan–Prelude and finale. J Pak Med Assoc. 2004;54(12 Suppl 3):S1-8.

Nishtar S, Minhas FA, Ahmed A, Badar A, Mohamud KB. Prevention and control of mental illnesses and mental health: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan. J Pak Med Assoc. 2004;54(12 Suppl 3):S69-77.

Nishtar S, Zoka N, Nishtar S. S, Khan Y, Jehan S, Mirza Y. A. Poster as tool for disseminating health related information in a developing country: a pilot experience. JPMA 2004

Nishtar S , Mirza YA, Jehan S, Hadi Y, Badar A, Yusuf S, Shahab S. Newspaper articles as a tool for cardiovascular prevention programs in a developing country. J Health Commun. 2004 Jul-Aug;9(4):355-69.

Nishtar S. Public-private ‘partnerships’ in health – a global call to action. Health Res Policy Syst. 2004 Jul 28;2(1):5. Download Attached file # 1

Nishtar S. The SAARC Seven – regional cooperation for sustainable health outcomes. BMJ 2004. BMJ 2004;328:837.

Nishtar S, Gill JS, Wierzbicki AS. Smoking exposure in patients with and without angiographically coronary heart disease in a Pakistani population. J Am Coll Cardiol 2002; 39(9) Suppl B: 460B-461B.

Nishtar S. The National Action Plan for Prevention and Control of Non-Communicable Diseases and Health Promotion in Pakistan. Heartfile 2004

Jabbour S, Nishtar S, Prabhakaran D, Chockalingham A, Achiutti A, Agrawal A, Luna M, Garofalo F, Wielgosz A. Information and communication technology in cardiovascular disease prevention in developing countries: Hype and Hope. Int J Cardiol. 2003 Dec; 92(2-3): 105-11. Download Attached file # 1

Nishtar S. Coronary Heart Disease Prevention in South Asia. Lancet 2002; 360: 1015-18. Download Attach file # 1

Nishtar S. Prevention of Coronary Heart Disease in South Asia. Heartfile and SAARC Cardiac Society. ISBN 969-8651-00-4. Islamabad, Pakistan