Decentralization

In

Pakistan

Historical Perspectives1950 – 1960 General strategy for the provision of public

services in Africa under Colonial Administration   1970 – 1980 Under adoption of Rural Based Strategy

by Donors & Governments, Decentralisation considered appropriate for effective Management, Planning and Community Participation

1980 – 1990 New-Right Thinking approach i.e. Privatisation Limitation of state role Quasi- market in public sector Decentralised service provision

Pakistan2011

-

1. A component of Development Sector

Reforms programme

2. Low efficiency & quality of health and

education

3. Political will

4. Pressure from donors

(Cont…)

Rationale for Decentralization: “Classical Agenda”

Decentralization is predicted to improve development sector performance:

Improve allocative efficiency

Improve production efficiency

Improve quality, transparency,

accountability, legitimacy

Greater equity

Rationale for Decentralization: “Real Agenda”International Attempts to keep country

together by granting autonomy to all localities, by forging ‘asymmetrical’ federation- Uganda

Absence of any meaningful alternative governance structure to provide local government services- East Europe

Need to improve service delivery to large populations and the recognition of the limitations of central administration- East Asia

Pass on responsibility to carry out programs to the field because the central levels have run out of options to improve health services - Pakistan

Mostly motivated by political concerns:

Part of the democratisation process as discredited autocratic central regimes are replaced by elected ones under new constitution- Latin America

Spread of multi-party political systems is creating demand for more local voices in decision making- Africa

Pressures from regional & ethnic groups for more control & participation in the political process- Ethiopia

Elements of Decentralization Decentralization

inherently implies the expansion of choices at the local levelAmount of choice transferred from central level to institutions at periphery systems

What choices local officials make with their increased discretion; and

What effects these choices have on the performance of the development system

Prerequisites forEffective DecentralizationSystem of accountability that relies on transparent information, enabling community to monitor performance

Instruments for decentralization - constitutional, legal, institutional and regulatory framework that allow effective & equitable services in line with political objectives

Capacity building of local staff to undertake new responsibilities, and development of management & support systems

Rationale (Cont’d)

Key principle to implement in Pakistan because:

Management near to PHC and Education facilities

Less prior permission from central government

Increased Community Participation and resource mobilisation

Innovative approach could be adopted without involving whole country

Effective implementation in remote area

Inter-sectoral co-ordination

Committed & motivated workforce

Pass on responsibility to carry out programs to the field because the central levels have run out of options to improve health/eduation

services - Pakistan

Different forms are not mutually exclusive;any model have characteristics of different types superimposed upon one another

Deconcentration*› Functional› Prefectoral

Integrated Un-integrated

Delegation* to semi-independent bodies Devolution* Decentralization to local bodies Federalism Public Sector Market Fragmentation

 “Transfer of functions with in the

central government hierarchy through

the shifting of workload from central

ministries to field officers, the creation

of field agencies or the shifting of

responsibility to local administrative

units that are part of the central

government structure” (Collins, 1994)

Deconcentration: Salient Features

• Shifting of power from the central offices to peripheral offices of the same administrative structure

• Semi autonomy to field officers for routine decision-making

• Some planning functions according to central government guidelines

 

Example: Many Developing Countries

Field officers directly linked & controlled by the ministry 

Resources, guidelines and decisions about recruitment, selection, transfer and promotions conveyed from vertical hierarchy 

Community need not well perceived 

Example: - Ex - District Health System in Punjab Health Department

Field Officers are Sub-ordinate to Prefect (Commissioner, Governor)  Communication through Prefect.Example: British India before IndependenceWhere:1. Collector/ District Commissioner exercised

powers of Finance & Judiciary2. Double Control system i.e.

a. Technical matters of field officers e.g. recruitment, pay, training, promotion, transfer controlled by the Ministry &

b. Performance accountability to the Prefect

“Transfer of functions or decision-making authority to legally incorporated local governments, such as states, provinces, districts or municipalities”

(Collins, 1994)

  “Shifting of responsibility and authority from central offices of the ministry of health to separate administrative structures still within the public administration (provinces, states, municipalities)”

(Bossert, 1995) Cont….

Cont…. A Devolved Unit has

› Budgetary allocation

› Freedom of Revenue generation & Expenditure

› Elected members

Conducive to Community Participation 

More Accountability to people

Example:  

LGP 2000 in Pakistan

Decentralised units receive powers from national government & constitution 

Example: States in USA & India

 

Market mechanisms are introduced in the health care delivery  

Purchase & Providers have decision-making authority

 Example: National Health Service In UK

Decentralization: Problems & Issues Weak Local Management Lack of Skilled Staff  Weakening of the Ministry Planning Implementation Problems  Equity in the delivery of services Unequal Resources  Political domination Local Elites Control

Decentralization: Conclusions

Inherently implies expansion of choices at

the local level

Is predicted to improve health sector

performance through increased efficiency,

quality of services, accountability, equity

Could be political, administrative, fiscal,

market - major overlaps

Conclusions: Cont…. Is not a single transfer of a block

of authority & responsibility, but a set of functions that pertain to finance, service organisation, human resources, access, governance

Preliminary data indicates that results have been mixed at best

Issue at hand is how to better adopt decentralization policies to achieve national health policy objectives

Decentralization: ‘Not a Magic Bullet’

Benefits: Improved delivery & utilisation of

services; enhanced capacity for district health planning, increased funds etc

Constraints: Conflict between civil

servants & politicians, procedures not streamlined; retrenchment of staff undermines performance; resistance of health personnel; problem of defining role of DoH vis-à-vis local government

NGOs Codes

&

Registrations

History of NGOs in Pakistan Origin goes back to 1947 Many formed for humanitarian and

relief for refugees Initially for many years the work was

on rehabilitation etc 1970s martial Law promoted philosophy

of welfare and social work 1980s many NGOs emerged. 1990 an upsurge to take advantage of

available funding

History of NGOs in Pakistan According to UNDP the number is upto

to 16000. If un-registered NGOs and CBOs are

added it would be 25000-35000 Only few have comparable

credentials, sufficient resources, coverage, linkages, delivery mechanism and documentation system

According to CIDA (DFATD)100 effective NGOs in Pakistan

Laws Governing NGOs

6 Laws Socities Registration Act 1882 (for professional,

cultural and education bodies) The Trust Act 1882 (Provides legal cover for private

acts of Charity) The Voluntary Social Welfare Agencies (Registration

and Control) Ordinance 1961: To regulate and assist the development of NGOs undertaking Welfare work

The Companies Ordinance 1984 (Allows NGOs to set themselves as non-profit companies)

Income Tax Ordinance 2001 (sets oyt the Tax Exemption which NGOs are eligible for)

The Foreign NGOs and those in receipt of government funding are required to register with the EAD and CBR

Regulatory Framework

The Ministry of Social Welfare and Special Education and the Provincial Welfare Departments are responsible for registering and monitoring organizations under the Voluntary Social Welfare Agencies (Registeration and Control) Ordinance 1961.

The District Offices and Industry Department are responsible for registering organization under the Societies Act 1860

The Income tax exemption are granted by the Ministry of Finance and these are not automatically granted. NGOs can apply for exemptions if they are registered with the CBR

Reporting Requirements

Organazinzations registered under the Voluntary Social Welfare Agencies Ordinance 1961 are required to maintain accounts and submit an annual report and audit report to District Officers

Registered Societies must submit a copy of the membership annually.

Not for profit companies must submit annaul returns, audited accounts and other documentation for examination. Accounts are open for Public Scrutiny.

The EAD asks INGOs to explain their plans. EAD role is strategic to coordinate activities of Government and NGOs so as to minimize duplication of effort and focus on unmet needs,

NGOs which benefit from Tax exemptions are required to submit annual audited accounts, a lost of donors and benefeciaries and other financial information of the CBR

NGO Types

Advocacy and Lobbying: include organizations focused on legal rights, literacy, women’s issues, Human Rights, Minorities etc.

Policy Advocacy : Relatively new in Pakistan. Purpose is to participate in Policy issues be it the Government or other NGOs.

Emergency Rehabilitation and Relief Organizations: Majority in Pakistan

Implementation of Development projects and Programs.

/Service Delivery and CBOs

Role of GOP

GOP has been positive about it First five years (1955-1965) a permanent

Social Welfare Section was created which now a part of Planning Commission

Income Tax Ordinance exempts NGOs from income Tax which helped NGOs in sustainability and resources

Many Govt. sponsored institutions provide financial grants to NGOs (Zakat Council, SAP, National and Prov Health Council, National and Prov Education Council, TVO, National Trust for Population Welfare.

Role of Donor Support in NGOs in Pakistan The term donor is used to bilateral and

multilateral funding agencies in Pakistan Does not include Pakistani Philanthropies Funding agencies typically provide funds

for economic and public sector development, particularly for large scale infra structure development.

In the absence of internal resources bilateral and multilateral funding agencies have received an important role in social development and support to NGOs

Role of Donor Support in NGOs in Pakistan Multilateral agencies include UN agenciesFocusing on MCH, WATSAN, RH, Gender

and Health etc.- Bilateral sources are JICA, CIDA, DFID

Norwegian AID etc- There are also several INGOs active in

Pakistan : OXFAM, STC, Asia Foundation, Action Aid etc

- Since NGOs are often not a part of the Planning phase, there are always problems in implementation.

Impact of Ngos on Poverty in Pakistan Give the Fish ? Mix record Relations betrween NGOs and the

government have at times marked by tension

NGOs are reported to have not moed forward to address fundamental in-equity issues that create the problems in the first place

NGOs prefer to work on relief work rather than focusing on problems or poverty and in equity.

Problems of NGOs in Pakistan Registeration process in complex Bureaucratic procedures and red tapism

causes delays Funding problems by withdrawl of INGOs Restriction to work in specific areas. Corruption of politicians and bureaucrats Security Failure to meet the legal obligations.

Also, sources of funding and amounts produces environment of suspicion.

NGOs vested interests

Registration

For those NGOs that do choose to register, the benefits,

although not necessarily enjoyed by every registered NGO, include:

1. the ability to enforce by-laws; 2. statutory requirements that force an NGO to

become organized; 3. legal status “at the official level and among

donors;” 4. the ability to open a bank account; 5. the ability to sign contracts; 6. the ability to indemnify employees; and 7. the ability to qualify for financial assistance and

tax exemption

Registration Process

There are four main registration laws: 1. the Societies Registration Act of

1860, 2. the Trusts Act, 1882, 3. The Voluntary Social Welfare

Agencies (Registration and Control) (VSWA)

Ordinance, 1961, and 4. The Companies Ordinance, 1984

SocitiesSocieties are composed of a governing body and members. The governing body is the groups of

governors, council, directors, commission trustees, or other body entrusted with the management of the affairs of the society and must consist of at least three members. Basic Requirements to Establish a Society

At least seven founders, A signed Memorandum of Association, A copy of the society’s rules and regulations, A fee of 50 Pakistan rupees, and An application submitted to the Registrar of Joint Stock Companies in the province in which the NGO is located.

The Memorandum of Association must include: 1. the name of the NGO; 2. the province in which it is located; 3. the objects for which it is established; 4. names, addresses, and descriptions of the members of the governing body; and 5. the signatures of those members.

The rules and regulations must contain: 1. membership requirements, 2. the makeup of the governing body, 3. meeting and quorum requirements, 5. procedures for the election and removal of officers, and 6. accounting and audit procedures

Trusts

A trust is a “’gift’ of property to a person or institution

providing benefit to both parties,” and may be either a public trust, which benefits the public

at large, or a private trust, which benefits individuals.The advantages to registering as a trust under the Trusts

Act include: 1. a high level of control over the administration and

management of the NGO - there is a succession in place and there are no members; 2. little to no interference from the outside; 3. a simple registration procedure; 4. irrevocability; and5. eligibility for income tax exemption

VSWA

A voluntary social welfare agency (agency) is “an organization, association or undertaking established by persons of their own free will for the purpose of

rendering welfare services in any one or more of [the proscribed] fields … and depending for its resources on public subscription, donations or Government aid.” The proscribed fields

• child welfare

• welfare and rehabilitation of released prisoners,

• youth welfare •

welfare of juvenile delinquents,

• women’s welfare

• welfare of the beggars and destitutes,

• training in social work

• welfare and rehabilitation of patients,

• family planning

• welfare of aged and infirm,

• welfare of the physically and mentally handicapped, and • social education • coordination of social welfare agencies

VSWA

Unlike the other registration acts, the VSWA Ordinance contains a penalty provision for

noncompliance. Any person involved with an agency that contravenes the provisions of the

VSWA Ordinance or makes false statements can be punished with up to six months in jail and a fine of 2,000 Pakistan rupees. Every director or officer of the agency “unless he proves

that the offense was committed without his knowledge or consent [is] deemed to be guilty of such offense.” 2.1.1.4. Nonprofit Companies

Companies Act

NGOs may register as nonprofit companies under § 42 of The Companies Ordinance, 1984,

“for promoting commerce, art, science, religion, sports, social services, charity or any other

useful object.

” A nonprofit company must direct its profits to achieving its objectives and not return any to its members.

Registering as a company requires more documents and greater

costs than for other types of NGOs. The Companies Act, like the VSWA Ordinance,

also specifies “stringent accounting, audit and reporting

requirements.”

Companies Act

Two steps:

1. At the SECP

2. The NGO must then register at the Registrar, Joint Stock Companies at the Directorate of Industries in the provincial office where the company is located.

NGOs Conduct

- Charter

- Regulatory framework

- Network

NGO-Code of Conduct Offer guidance on how International NGOs can work

in host countries by respecting and supporting the primacy of the Govt. responsibility for organizing HSD

A response to the recent growth in the number of international non-governmental organizations (NGOs) associated with increase in aid flows to the devlopment sector- Particularly Health.

It serves as a tool for service organizations , and eventually, funders and host governments

This code serves as a guide to encourage NGO practices that contribute to building public health systems and discourage those that are harmful. 

Drafted by HAI, Action Aid, Oxfam etc

NGO-Code of Conduct

Last decade has shown growth in Political will , funding support and Organizational Structures to improve devlopment work.

Although gains in HIV/AIDs etc but basic primary Health Care and MCH lost ?

It is now clear that NGO’s if not careful and vigilant can undermine the Public Sector and even Health Systems a whole by diverting Health Workers,, Managers and Leaders into privatized operations that create parallel structures and worsen the isolation of communities from Formal Systems

This code is intended specifically to address INGOs and their roles in trainings, securing and deploying HR in the countries where they work.

. There are six areas where NGOs can do betterThis code offers sustainable practices in each of

these areas of concern.

:1) hiring policies; 2) compensation schemes; 3) training and support; 4) minimizing the management burden on

governments due to multiple NGO projects in their countries;

5) helping governments connect communities to the formal health systems; and

6) providing better support to government systems through policy advocacy

Code of Conduct

- Signatories to this code recognize the role of Voluntary ethical codes and country based codes.

- -Codes like IRC and Red Crescent Movement and NGOs in disaster relief (1992), offer practical ethical standards for NGOs and donors engaged in development work.

- - These standards aim to improve the quality and impact of work

1. Hiring practices

Ensure long term sustainability of system

The role of international NGOs is to supplement — not supplant — the public policy role of host country governments and local institutions to strengthen and expand systems.

The NGO role is to provide research, support and expertise to strengthen civil society and local academic and research institutions in informing public health policy development.

The signatories to this code, view their role as time-limited; that is, as communities, local institutions and Ministries of Health become stronger and build capacity, the role of the NGO should diminish or evolve

Hiring practices

1. In areas where trained personnel are scarce, NGOs will make every effort to refrain from hiring health or managerial professional staff away from the public sector, thus depleting ministries and their clinical operations of talent

2. When hiring staff, NGOs will make every effort to employ available national expertise, particularly where unemployment of highly qualified nationals abounds. Where qualified nationals are available, volunteer labor will not be used as a substitute for paid staf

3. In places of scarcity, on rare occasions when NGOs hire health staff already working in the public sector, NGOs pledge to do so in coordination and with the consent of local health authorities. This coordination will be accompanied by a commitment to expand overall human resource capacity in the public sector through pre-service training, salary support and/or other means. Governments and NGOs should work collaboratively to address the chronic underpayment of health workers in all sectors

4. NGOs recognize that they have had a historical role in creating conditions that lead trained and skilled personnel to work abroad in wealthy countries. NGOs commit to avoid creating incentives for health workers to leave their developing countries for work in international organizations or locations. Instead, NGOs will provide incentives to stay in the public sector, including better working conditions, and good compensation and benefit packages

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2.Employee Compensation Practices NGOs commit to advocate for fair monetary compensation for work

done by all employees, across the health care system, including salaries for community health workers

NGOs that hire health workers, managers and other skilled personnel in the countries where they work will offer salaries that are “locally competitive,” striving for salaries that are not substantially more generous than the public sector while providing a fair and living wage to their employees.

NGOs sometimes pay “top-ups” (compensation payments that supplement public salaries) to public sector staff to secure their services for contract work. In general, NGOs will avoid this practice, as it creates inequities, increases burdens on existing staff and fails to add new workforce to the devlopment sector

NGOs will establish benefit structures that are based on the needs of employees and, at a minimum, match public sector practices, including retirement plans. Where public sector benefits or pay structures are inadequate, NGOs will collaborate with the public sector to improve them

Any privileges granted to expatriate employees will also be granted to national employees of similar qualification and responsibility, such as opportunity to work from home or access to personal transportation.

HR Training and Support Systems NGOs will preferentially invest in long-

term commitments to pre-service education and training.

In areas where professionals are scarce, INGOs will adopt measures that increase the number and capacity of professionals (PAIMAN/USAID MNCH)

NGOs will support training to support both the service and management capacity of Ministries (PHSR and Trips)

Minimize the NGO management burden for ministries. NGOs recognize the burden on

governments that have insufficient resources to organize

their own country’s affairs, while having to juggle the management burden of multiple

and sometimes-competing aid organizations from a variety of other countries.

Sector Wide Aproach (joint Planning, evaluation and Coordination within the Ministry’s own planning cycle.

Supporting Ministries to Engage Communities.- NGOs can play an important role as a bridge

between civil society organizations and government agencies, especially (but not

exclusively) in nations where populations or sub-populations are actively oppressed by

their governments- Strengthen capacity of communities to take

ownership (Community Mobilization-PPAF)- Helping the oppressed communities to

protect themselves.

NGOs will advocate for policies which promote and support the public sector. NGOs will actively advocate with civil society,

local institutions and donors for policies and programs that strengthen health systems overall. NGOs recognize that vertical programs and selective approaches exacerbate inequities in health systems and ignore underlying determinants of health.

We also recognize that funding conditionalities can limit or distort government expenditures and priorities.

These unnecessary limitations continue to create barriers to health and development and are unfair and inequitable.

NGOs will advocate for policies which promote and support the public sector

NGOs will work in solidarity with their Ministry of Health colleagues to oppose the detrimental policies of the International Monetary Fund, the World Bank and other lenders whose loan conditions limit government expenditures on health or education

NGOs will follow national labor laws and pay all relevant taxes on their income and assets in

the countries where they work, just as any

business would

Thank you