BEYOND SENATE POLL

 2021-03-15
THE election for the Senate chairman and deputy chairman on Friday has accentuated the crisis
of credibility swirling around Pakistan ipolitics.Ithas also deepened the fault lines between the
government and the opposition and is likely to lead to greater acrimony in the coming weeks.
While both slots were won by candidates of the government, the opposition`s refusal to accept
the results due to what it says is faulty ruling by the presiding officer rejecting seven votes for
their candidate Yousuf Raza Gilani means the election will now be subjected to a gruelling legal
battle.

The Senate elections this year have been marred by multiple controversies all leading to a dismal
conclusion that political parties are unable, or unwilling, to frame the basic rules of the game and
then adhere to them in letter and spirit. The discovery of hidden cameras in the main Senate hall
was a travesty that could not have been imagined and yet it happened in broad daylight for the
whole world to see. The summary rejection of the votes by the presiding officer was also done
rather crudely and is now being challenged for reasons that appear to have some weight. The no-
holds barred fight between the government and the opposition is wreaking havoc across
institutions, processes, traditions, and even the basic values of right and wrong. It paints a picture
of a system in peril. It is difficult to visualize how a semblance of normalcy can be returned to
our politics and how adversaries can build a basic minimum working relationship. Every day
brings new controversies.

The Senate elections also illustrated our inability to hold a simple and straightforward election. A
sum total of 100 votes were to be cast in the upper house of parliament and not in some
backwater polling station. We could not even manage this with consensus. If this is the state of
our electoral capability, how would we be able to hold a national election in the near future?
Before that, how will we be able to conduct a local bodies poll that has many times more
candidates than a general election? The state of affairs is indeed worrisome and unless some
urgent steps are taken to frame a common understanding of how to move forward, we could be
heading into an uncertain political future. The Senate election has however presented an
opportunity to both sides to cooperate. The issue of the hidden cameras is to be probed by a
committee comprising members from the treasury and opposition benches. These members
should get to the bottom of this mystery, identify those responsible and take appropriate action.
If they are not willing to even protect the dignity of the house they belong to then it would be
hard to imagine how they can shoulder the heavy responsibility of representing an entire nation.

RDA BENEFITS
 2021-03-15
OVERSEAS Pakistani workers have shown a tremendous interest in the Roshan Digital Account
initiative of the State Bank. Pakistanis living and working in 100 countries across the world have
so far opened 100,000 accounts to transfer a total sum of $671m back to the country of their
origin in almost six months after the initiative was launched by the prime minister.

Half of these deposits are said to have been shifted to local banks in the last two months as more
non-resident Pakistanis learn about the scheme. The market expects the number of accounts to
grow further and RDA deposits to jump to $1bn before the end of the current fiscal on June 30
and to $1.5bn-$2bn by end December, shoring up the country`s weak foreign exchange reserves.

Lucrative interest rates compared with the nearly Opc return they are getting in their host
countries as well as the ease of moving their money into and out of Pakistan by clicking on their
mobile devices whenever they need to is believed to have contributed significantly to the success
of the initiative. In addition, the facility to non-resident Pakistanis to invest in property,
government debt papers and the stock market, and to pay online tuition fee or utility bills through
their digital accounts must have also served as a huge attraction.

By way of example, non-resident citizens of India as well as China have had a crucial role to
play in the economic progress of their home country. They have not only helped by remitting
their savings for investments but have also played an important role in changing the world`s
perception of their countries, resulting in the inflow of massive foreign direct investment.
Overseas Pakistani workers have also been doing much to help their country by contributing to
the stability of the nation`s external account via large remittances that are equal to our annual
exports. It is regrettable though that it is only now that the government and the central bank have
taken steps to facilitate them in moving their savings back home. It is hoped that the success of
these digital accounts will encourage the central bank to come up with more initiatives to
persuade overseas Pakistanis to invest in the manufacturing industry and other productive
segments of the economy in order to enhance growth, create jobs and make up for the drying
foreign investment.

VIOLENCE AGAINST DOCTORS

 2021-03-15
IT is an unfortunate reality in Pakistan that doctors and other health professionals often have to
face the wrath of angry attendants in case of death or injury to a patient. A number of such ugly
incidents have been reported from Sindh recently, prompting medical professionals to call for the
highest offices in the country to intervene and protect them from such violence. Addressing a
press conference in Karachi on Friday, doctors belonging to the Pakistan Medical Association
and the Ophthalmological Society of Pakistan demanded the prime minister, chief justice, army
chief and Sindh chief minister initiate a judicial inquiry and bring elements involved in attacking
medical professionals to book. Giving details of the incidents, the doctors said a senior eye
specialist at a private hospital in Karachi said to be one of the few retina specialists left in
Pakistan was attacked by attendants after a procedure allegedly went awry, while doctors were
also attacked in Dadu and Ghotki.

Medical negligence is a very serious matter, especially when the death of a patient or disability
occurs. However, there can be no justification for attacking medical staff and ransacking
hospitals. As doctors have rightly pointed out, protecting medical professionals and probing
cases of medical negligence is the job of the Sindh Health Care Commission and its
corresponding bodies in other provinces. However, medics say cases of violence are rising
because the regulatory body is not doing its job. To prevent this situation from deteriorating, it
must be made absolutely clear by the state that violence against health professionals will not be
tolerated and that those involved will be punished. Moreover, there should be a well-defined,
transparent procedure if allegations of medical negligence do emerge, and doctors found guilty
must be penalised. Already Pakistan faces a brain drain. If more doctors and other medical
professionals decide to pack up and leave because they want a safer working environment, it will
mean greater distress for this country`s fragile health sector.

ORGANISATIONAL ETHICS
BY M U R A D M OOS A K H A N & S A M E E R N I Z A M U D D
I N  2021-03-15
MANY organisations include `ethics` in their vision and mission statements and policies without
truly understanding what it means to be an ethical organisation. Outside a few countries in the
West, the concept of Organisational Ethics is largely unknown. OE is defined as `everyday
practices in which organisational values are demonstrated in organisational structures and
behaviours, as well as in day-to-day practices and decision-making processes at all levels of the
organisation`.

In daily organisational life, ethical values are not only about doing things right but also doing the
right thing. Rules-based organisations emphasise the former. The latter relates to ethical
organisations.

Often ethics is restricted to legal codes and regulatory compliances. But OE is beyond these. It is
about having an ethical perspective to every action and decision that takes place in an
organisation.

Amongst others, this includes conflict-of-interest issues, appointments and promotions, appraisal
systems, institutional policies, compensation and benefits, moral distress in employees, resource
allocation, as well as the organisation`s business model.

The last is particularly important, as it is not only about making profits but how profits are made.
Historically, organisations, especially the manufacturing and service industry, placed great
emphasis on quality, starting as early as the 1920s. This gained momentum in the 1950s post
Second World War as the demand for cheap goods rose. Quality control developed quickly and
became a main theme, initially of the Japanese style of management and later in other countries.
Over time, the idea of improving not only the quality of products but also every aspect of
organisations` functions became popular. This was the start of total quality management, which
encompassed concepts such as customer focus, the involvement of employees, continuous
quality improvement and the integration of quality management into the whole organisation.

While the quality movement improved the efficiency at production lines and quality of products,
it did little to address corruption in industry, highlighted by several highly publicised scandals in
some of the largest global corporations such as Enron, WorldCom, Arthur Andersen and Big
Pharma amongst others. Part of the reason was because in their desire to improve quality
andincrease profits, few organisations paid attention to their organisational culture. As long as
profits were being made no one was concerned about culture, not realising that the ethical culture
of an organisation is critical to its performance. Staf f commitment and turnover, job satisf action
and morale, as well as stress and burnout are directly linked to it. Few organisations understand
that quality is always the by-product of ethics and not vice versa.

An important element of OE is ethical leadership, ie `the duty of leaders to foster an environment

that engages and supports ethical values at all levels of the organisation`. Prioritising ethics is the
primary duty of leaders, as integrity always flows f rom top down. One cannot expect employees
to behaveethically if they see the leadership not adhering to organisational values. An ethics-
driven decision made by a leader has ramifications that can have a lasting impact on the
organisation.

Similarly, many organisations have policies that are vetted from the legal, financial and
administrative aspects but rarely f rom the ethical aspect. This leads to ethical principles being
frequently compromised.
Examples include inequitable distribution of resources, favouritism and nepotism in
appointments and promotions, harassment and abuse of employees amongst others.
Carriedoutfrequently andrepeatedly this leads to a culture of corruption, resulting in erosion of
credibility and reputation of the institution.

While the principles of OE apply to all organisations, they have particular relevance for
healthcare organisations. HCOs deal with a highly vulnerable population, whose health and life
is at risk. The power differentialbetween a healthcare provider and patient has the potential of
exploitation of the latter by the former. A strong OE programme can prevent this.

Unfortunately, in many HCOs there is `ethical bifurcation`, where clinicians and researchers are
held accountable for ethical standards when dealingwith patients but there is no similar
requirement for the administrative and policymaking areas. This weakens the overall ethical
culture of an HCO.

Today, many HCOs have been transformed into big businesses and terms like `patients`,
`compassion`, `ethics`, `caring`, and `humanism` have been replaced with terms from the
business world such as `customers`, `clients`, `volumes`, `revenues`, `projections`, `targets` and
`incentives`. Such terms devalue the medical profession,making it more like a business than a
moral enterprise. Also, in today`s highly complex healthcare systems, where AI and algorithms
are becoming norms and healthcare is highly commercialised, it is imperative that all systems
and processes of an HCO are strongly embedded in ethics and integrity.

In countries like Pakistan with weak governance structures, the problem is further compounded:
despite legislation and policies, there is lack of accountability. Leaders may behave unethically
and are not answerable to anyone. Conflict of interest, lack of transparency, giving and taking
bribes, misappropriation of funds, nepotism and favouritism in appointments are some of the
issues that plague many organisations in Pakistan.

Similarly, there is a booming multibillion-dollar private healthcare industry here that is totally
unregulated. Without any oversight, exploitation of patients through various means is not
uncommon.

Almost 90 per cent of healthcare expenditure in Pakistan is out of pocket, which means patients
end up paying the high cost of corruption in HCOs.

Willem Landman, head of the Ethics Institute of South Africa, wrote, `In an organisation, ethics
needs to be institutionalised and operationalised, with a view to building an ethical organisational
culture.

Organisations should actively manage ethics by having an unwavering board and executive
commitment to ethics, (re)writing Codes of Ethics,induction training on ethics and ongoing
ethics awareness training, Ethics Lines (helplines and hotlines), and effective ethics
communication. This can only be done through an Organisational Ethics programme.

In today`s challenging world, all organisations need to invest in ethics through an organisational
ethics programme.• The writers are members, Bioethics Group, Aga Khan University.