Dawn Editorials (with Summary and Vocabulary)

 

DAWN EDITORIALS

January 12, 2024 (Friday)

Day’s Vocabulary

  • Menfolk.    a group of men considered collectively, especially the men of a particular family or community
  • Aeons.         an indefinite and very long period of time
  • Vehemently.         in a forceful, passionate, or intense manner; with great feeling
  • Unscathed.            without suffering any injury, damage, or harm
  • Misogynistic.      strongly prejudiced against women
  • Relinquish.           voluntarily cease to keep or claim; give up
  • Ostracised.            exclude (someone) from a society or group
  • Vilified.       speak or write about in an abusively disparaging manner
  • Regressive.           becoming less advanced; returning to a former or less developed state
  • Patriarchal.          relating to or characteristic of a system of society or government controlled by men
  • Bigoted.      obstinately or unreasonably attached to a belief, opinion, or faction, in particular prejudiced against or antagonistic toward a person or people on the basis of their membership of a particular group
  • Alleviate.    make (suffering, deficiency, or a problem) less severe
  • Menace.      a person or thing that is likely to cause harm; a threat or danger
  • Denounced.          publicly declare to be wrong or evil
  • Akin. of similar nature or character
  • Espouse.     adopt or support (a cause, belief, or way of life)
  • Traction.    the extent to which a product, idea, etc., gains popularity or acceptance
  • Quash.         reject or void, especially by legal procedure
  • Quagmire. a soft boggy area of land that gives way underfoot
  • Assertion.  a confident and forceful statement of fact or belief
  • Germinated.         of a seed or spore) begin to grow and put out shoots after a period of dormancy
  • Philanthropist.   a person who seeks to promote the welfare of others, especially by the generous donation of money to good causes
  • Ethos.          the characteristic spirit of a culture, era, or community as manifested in its beliefs and aspirations
  • Fraught.     (of a situation or course of action) filled with or likely to result in (something undesirable)
  • Prudish.      having or revealing a tendency to be easily shocked by matters relating to sex or nudity; excessively concerned with sexual propriety
  • Horde.         a large group of people
  • Shooed.       make (a person or animal) go away by waving one's arms at them, saying “shoo,” or otherwise acting in a discouraging manner
  • Explicit.      stated clearly and in detail, leaving no room for confusion or doubt
  • Innocuous.           not harmful or offensive
  • Prose.           written or spoken language in its ordinary form, without metrical structure
  • Incontinence.      lack of voluntary control over urination or defecation
  • Horrendous.         extremely unpleasant, horrifying, or terrible
  • Palliative.  (of a medicine or form of medical care) relieving symptoms without dealing with the cause of the condition
  • Magnum opus.   a large and important work of art, music, or literature, especially one regarded as the most important work of an artist or writer.
  • Synthesis. the combination of ideas to form a theory or system. Often contrasted with analysis

Honour or Dishonour

Summary

  • Honour killings are a serious problem in Pakistan and other parts of South Asia.
  • They are often committed by family members against women who marry without their consent or refuse to marry someone of their choosing.
  • This practice is rooted in feudal and patriarchal mindsets that view women as property and second-class citizens.
  • There is no honour in killing women for exercising their free will.
  • Islam grants equal rights to men and women to marry of their own choice.
  • Honour killings are a violation of Islamic principles and basic human rights.
  • More needs to be done to raise awareness about honour killings and to bring about a change in attitudes.
  • Public figures, such as filmmakers and celebrities, can play an important role in speaking out against this practice.
  • Education and awareness campaigns are also needed to challenge harmful stereotypes and promote gender equality.
  • Pakistan needs to take steps to protect women from honour killings and to ensure that they are treated as equals in society.
  • This is essential for the country's progress and development.
  • Women must be respected, loved, and given the opportunity to play a significant role in all aspects of Pakistani life.

Article

Where did the term ‘honour killing’ come from? What is so honourable about conspiring to kill a female family member if she chooses to marry of her own free will? How long will women have to suffer this fate at the hands of the menfolk in their family or community?

A recent article in Dawn discussed another statistic in the mounting data of honour killings at home and abroad – an immigrant Pakistani family settled in Italy killed their daughter because she refused to marry a Pakistani boy of their choice back home. Instead, she wanted to spend the rest of her life with her Italian boyfriend.

Filmmaker Sharmeen Obaid-Chinoy won an Oscar for her documentary on honour killings, A Girl in the River: The Price of Forgiveness. She was lauded by the international community for being courageous enough to highlight a problem that has plagued this part of the world for aeons. If argued religiously, Islam is very vocal on the subject and grants equal rights to men and women to marry of their own choice. Then why are women treated as children of a lesser God? Is family honour solely their responsibility?

A recent television serial, Razia, also dealt with the treatment of females as second-class citizens, and touched upon the curse of honour killing as Razia’s brother and father, suspicious about her involvement with someone, conspire to kill her.

Public figures should criticise honour killings vehemently.

However, destiny intervenes and she escapes unscathed. The play, starring Mahira Khan, was extremely well-made and highlighted irrational and twisted attitudes of society without any overblown drama. The six-episode production was a laudable endeavour in the way in which it addressed so many social issues crisply, without a long-drawn-out narrative.

Feudal mindsets and misogynistic attitudes are largely to blame for the proliferation of this crime.

Historically, and even in contemporary times, women in feudal setups are expected to relinquish their share of the property voluntarily and those who resist are ostracised and vilified by the community. This mindset is particularly entrenched in southern Punjab where females are sometimes wedded to the Quran in order to keep property within the family.

Ironically, while we are being encouraged to embrace the ways of the 21st century, our regressive and patriarchal society is bent on pushing us into medieval times. The article about the honour killing in Italy validates this dichotomy. Despite living in the Western world, the primitive and bigoted outlook of some South Asians there is too deeply embedded to be uprooted easily.

Education, although it will alleviate the issue to a certain extent, is not the solution. Awareness and a conscious effort to bring about a shift in this way of thinking will serve as the magic bullet for the menace. As long as women are treated as second-class citizens and the ingrained hatred towards them remains deep-seated in our societal fabric, not a lot, I am afraid, can be achieved.

Endeavours like Ms Chinoy’s documentary on the issue are steps in the right direction. She was accused of giving her country a bad name on a global platform but at least she had the courage to depict realities which very few have the courage to even speak about. Honour killings, in any part of the world, should be denounced and condemned repeatedly and the documentary is only a drop in the ocean.

Attempting to bring about change is akin to attempting the impossible. However, small steps go a long way so even a dent is an achievement. More celebrities and public figures should espouse this cause and criticise the primitive and barbaric practice more vehemently. I am quite sure that plays and films on the subject will draw significant attention to the medieval ‘ritual’ that is gaining traction, rather than being curbed and controlled.

Pakistan is already viewed as a failed state where it has been proved time and again that women, comprising 51 per cent of the population, inevitably get the short end of the stick. Women must be respected, loved and treated as equals. The founder of this nation, Quaid-i-Azam Mohammad Ali Jinnah, made it abundantly clear that for this country to prosper and march ahead, the women have to play a significant role.

And increasingly, as they emerge as a force to be reckoned with, women are becoming hard to ignore and their voices and identities tough to quash. At a time when Pakistan is sinking into a political and economic quagmire and struggles to stay afloat, we need enlightened, educated and strong women to become a pivotal part of rehabilitative endeavours.

Social welfare for GB

Summary

  • Gilgit-Baltistan (GB) is a region with a disputed legal status.
    • It is not officially part of Pakistan, but is under Pakistan's control.
    • This has led to a lack of representation for GB in Pakistan's parliament and limited empowerment for local governments.
  • GB is rich in resources but faces energy deprivation and neglect.
    • The region has substantial mineral resources and hydropower potential, but its infrastructure development is focused on meeting the needs of Pakistan.
    • A top-heavy governance structure consumes most of GB's limited budget, leaving little for social welfare programs.
  • GB's people are resilient and have a strong sense of community.
    • They have a history of confronting harsh conditions and enduring limited resources.
    • GB's diaspora communities maintain strong ties with their homeland.
  • NGOs have played a key role in supporting GB's development.
    • The Aga Khan Foundation's Rural Support Programme has been a major success, providing education, healthcare, and other essential services.
    • The Marafie Foundation has also been instrumental in promoting education and healthcare, particularly for girls and women.
  • GB is pioneering a novel approach to social protection.
    • The government of GB has launched a Social Protection Fund (SPF) to address poverty and inequality in the region.
    • The SPF is modeled after an Initial Public Offering (IPO), inviting the public to invest in social welfare programs.
    • This approach aims to create a sustainable financial base for social protection and to empower communities.
  • The SPF is a call to action for social justice and equity.
    • It is an opportunity for individuals, businesses, and organizations to invest in the future of GB and its people.
    • The SPF represents a commitment to the idea that everyone deserves the opportunity to thrive.

Article

Every November, the people of Gilgit-Baltistan commemorate their freedom and accession to Pakistan. The Pakistani state actively promotes the region as the most beautiful part of the country, highlighting its unique and breathtaking landscape to encourage tourism.

However, when a student from Gilgit-Baltistan questions the denial of constitutional rights and the territory’s undefined legal status in conversation with the prime minister, the PM simply responds with the assertion that Gilgit-Baltistan is an integral part of Pakistan and will continue to be so.

A harsh reality emerges when the issue of this region’s representation in parliament is brought before the Supreme Court of Pakistan. The federal government challenges the court’s jurisdiction, asserting that the region is not part of Pakistan but a disputed territory of Kashmir under de facto control of Pakistan. Adding to the complexity, national political parties have extended their influence in this area through local chapters and dominated the limited empowerment granted to locally elected governments.

Despite possessing substantial mineral resources and the potential for hydropower energy, the region suffers from energy deprivation due to this imposed control. The development of infrastructure is solely focused on meeting the strategic needs of the federation. A top-heavy governance structure consumes most of its limited budget grants, exacerbating the neglect.

Amidst the prevailing gloom and adversity, the resilience of the people of Gilgit-Baltistan is a silver lining. They continue to exhibit a unique ability to confront the harshest forces of nature and endure punishing winters with their limited resources. GB’s diaspora communities not only thrive outside the region but consistently return, highlighting their unwavering bond with their homeland.

The remarkable resilience of Gilgit-Baltistan’s people finds support in the NGO sector.

The remarkable resilience of these people, despite the denial of essential resources, finds support in the NGO sector. Over the past four decades, the Rural Support Programme initiated by the Aga Khan Foundation has emerged as a success story.

This visionary initiative, conceived and implemented by Shoaib Sultan, a forward-thinking civil servant, has not only flourished in the GB region but has been replicated nationwide, earning international acclaim and adoption in other countries.

Additionally, the Marafie family-funded NGO has played a pivotal role in the development of education, particularly for girls, and healthcare services, predominantly in the Baltistan division. Its impact has now expanded to encompass the entire region. The Marafie Foundation’s success is attributed to the active participation of the local community village and women groups organised by the Agha Khan Foundation, signifying a collaborative effort in promoting education and healthcare in the region.

The community’s notable achievements, facilitated by the support of these two NGOs, have served as a catalyst for the emergence of numerous NGOs initiated by the locals and comprised mostly of well-informed, educated youth.

This trend ensures sustained grassroots development of community projects, promising macroeconomic development for the region despite years of governmental neglect. This same spirit propels GB to explore innovative avenues for poverty alleviation.

Under social pressure from vocal and assertive local community organisations, GB has now embarked on a new and novel scheme for social protection for the vulnerable segments of society and the community at large.

In collaboration with Unicef Pakistan, the government of Gilgit-Baltistan has formulated a forward-thinking and comprehensive Social Protection Policy, whose most interesting aspect is that it expands the frontiers of social protection by pioneering a novel approach. It has adapted the Initial Public Offering (IPO) framework to create a Social Protection Fund (SPF).

As we well know, the concept of an IPO comes from the corporate world, where companies invite the public to buy equity shares in their future profits. However, through its novel approach, the GB government is proposing investments in human capital, social resilience, and the very fabric of our society, which may one day be found relevant to the whole of Pakistan.

The SPF is designed to address the systemic challenges of poverty and inequality in GB by providing a sustainable financial base for social protection programmes. The GB government agreed to seed this initiative with Rs100 million, demonstrating a strong commitment to social protection. Since this idea was germinated through an interactive process with Unicef, it may also consider contributing to the SPF as a pilot. SPF will eventually be linked with a provincial Social Registry.

The SPF IPO is an open invitation to every citizen, business, philanthropist, and international development partner to take a stake in the future of this region’s social welfare. Why is this important?

The SPF will stabilise social welfare funding, protecting it from political shifts and economic downturns. It will ensure that essential services — from childcare to education and emergency support — will always be available to those in need. Moreover, it will empower communities by providing the means for sustainable development, breaking the cycle of poverty and dependence.

But the SPF will do more than just provide services; it will engender a new philosophy of social welfare that is participatory, inclusive, and democratic. By buying into the SPF, investors are not just providing funds; they are taking ownership of the mission to protect and empower the most vulnerable members of society.

The SPF aims to leverage the spirit of public ownership to create a fund that is accountable to its stakeholders — the people. This is a call to action for all who share a commitment to social justice and equity.

This call to action resonates with the ethos of social justice and equity. It is an appeal to every individual and organisation that aligns with these values to join hands in this pivotal movement.

The SPF is not just a fund; it is a commitment to the idea that every individual deserves the opportunity to thrive — and that through collective investment, we can make this vision a reality for GB.

A pioneer

Summary

  • Dr. Tahira Kazmi, a gynecologist, is a pioneer in addressing female sexuality in the context of Pakistan's conservative environment.
    • She has faced criticism for her explicit blogs but has also garnered admiration for enlightening women about their bodies.
    • Dr. Tahira describes herself as a 'Gynae-Feminist' and has authored multiple collections of blogs covering various women's health topics.
  • Her writings discuss childbirth, labor pain, menstruation, menopause, incontinence, and prejudice against the girl child, bringing these issues into the public space.
  • Dr. Tahira highlights shocking crimes against women, such as the practice of putting a lock on a woman's vagina to control her fidelity.
  • She emphasizes the need to challenge traditional views that attach shame to women's reproductive organs, advocating for a more open and accepting discourse.
  • The blogs originated from personal experiences, with Dr. Tahira turning to gynecology blogging in 2021 after witnessing her daughter's severe menstrual agony.
  • Tahira criticizes the societal misogyny in Pakistan, pointing out the lack of outrage over crimes against women and the prevalent distortion that needs correction.

Article

The women’s movement in Pakistan has come a long way since its inception. It has assumed different forms and strategies during the course of its development while focusing on the fundamental human rights of women and their empowerment. What was noticeably missing was the female sexuality dimension in the discourse. It was too sensitive an issue to talk about in public in Pakistan’s conservative environment that was fraught with controversies.

Ours is a society that is so prudish that an article I wrote on breast cancer in 1978 had prompted a horde of bearded gentlemen claiming to be the guardians of our morality to crash into the editor’s office to denounce the fahaashi (vulgarity) the paper was publishing. Being progressive and a feminist himself, the editor had shooed them away saying that breast cancer was a life or death issue for women.

In such a society, it needs guts to write about the female reproductive organs in explicit terms. There are far too many readers whose thinking is misogynistic and patriarchal. Even an innocuous piece of writing becomes pornography for them. Their anger stems from the belief that women are sex objects created to give satisfaction to man’s desires.

That would explain why Dr Tahira Kazmi’s blogs on the social media have invited the wrath of her critics who are in abundance. Mercifully, the doctor, a gynaecologist by profession, also has admirers. She has brought enlightenment to many female readers who feel after reading her blogs that they understand their bodies better. Being highly qualified — MBBS from Fatima Jinnah Medical University Lahore (1990) followed by a train of higher foreign degrees — Dr Tahira knows what she is writing. She holds prestigious positions in Oman’s Ministry of Health and the Sultan Qaboos University.

Our society’s misogyny is sickening.

Four collections of her blogs have already appeared while the fifth is under publication. A fair-minded reader would take them as a scientific piece of prose written in the social context with a strong underpinning of feminism. She describes herself as a ‘Gynae-Feminist’.

All the subjects covered are familiar to women reading English-language newspapers but no one has written on them in Urdu so frankly. Childbirth, labour pain, menstruation, menopause, incontinence and prejudice against the girl child have been covered in different social contexts. If the frankness is shocking it is because these issues have been kept under wraps. It is time they were brought into the public space to make them socially acceptable.

But what will continue to shock are the horrendous crimes against women Dr Tahira exposes. How else would one describe the practice of putting a lock on a woman’s vagina with the key kept in the husband’s pocket for safekeeping to ensure that the wife is not unfaithful to him.

It is the feminist in Tahira that is most striking. She is quick to note an injustice done to a woman. She recalls how observant and curious she was as a child and still is. “You have to convince me with solid arguments if you think I am wrong. If you force me I will hit back. I am not afraid of what people say,” she says boldly. She also has the discretion to know when silence is a befitting way to snub an obnoxious critic.

Her greatest assets have been her medical knowledge and her writing skills that helped her produce blogs with literary elegance. It was motherhood that led her on the road to self-discovery of her latent talent. She wrote her first blog on the night of her mother’s death. She was suffering from Alzheimer’s. Grief drove Tahira to write, “I saw my mother melt drop by drop” and the blog went viral. That was 2019. She turned to gynae blogging in 2021 when she saw her daughter in severe menstrual agony. It prompted her to write to explain how the female anatomy makes pain a handicap for a woman needing male understanding. Pain also makes a person creative, with reference to Faiz’s verse on his heart attack and the pain he suffered, Tahira wrote, “Kash Faiz ko mahwari aati”.

What angers Tahira is the traditional view that women carry the honour of the family — meaning the man’s. Hence shame is attached to the woman’s reproductive organs that are given derogatory names. Why can’t the spade be called a spade one may ask.

Our society’s misogyny is sickening. Pakistan is a place where men fight and attack each others’ women to take revenge. Where were these critics when women were paraded naked in the streets of Nawabpur (1984) and when Mukhtaran Mai was gang-raped on the orders of a male jirga (2002)? Presently, 30,000 girls are trafficked every year to be sold into prostitution to satisfy men’s lust and not a voice is raised. It is this distortion the good doctor blogger is trying to correct.

Essential health services

Summary

  • Healthcare systems have 3 main roles: preventing diseases, providing curative services, and addressing health determinants.
  • They deliver 5 kinds of services: preventive, promotive, curative, rehabilitative, and palliative.
  • These services are delivered at 5 levels: community, primary healthcare facility, first-level hospital, tertiary-level hospital, and population.
  • In low-resource settings, policymakers must prioritize services to ensure the most efficient use of resources.
  • Disease Control Priorities (DCP) is a project that identifies cost-effective health interventions for low- and middle-income countries.
  • DCP3 recommends a package of 218 essential health services, with a prioritized subset of 108 services for low-resource settings.
  • 70% of these services should be delivered at the primary healthcare level, and 90% at primary healthcare or first-level hospitals.
  • Governments should finance this minimum package of essential health services.
  • Pakistan has developed its own Essential Health Services Package (EHSP) based on DCP3, costing around $13 per person annually.
  • Effective implementation of EHSPs can advance countries towards universal health coverage.

Article

I received a lot of feedback on my article ‘Robotic priorities’, including some from defensive robotic surgeons! Some readers have asked about the essential health services package I referred to. Allow me to elaborate.

Healthcare systems principally act in three ways: by preventing diseases and promoting health at population and individual levels; by providing curative health services at an individual level; and through intersectoral action addressing determinants of health.

These three aspects of healthcare systems are translated into five kinds of health services: preventive, promotive, curative, rehabilitative, and palliative.

Healthcare systems deliver various combinations of these five kinds of services through five levels of the healthcare system (also called delivery platforms): community level (individual household); first-level PHC facility; first-level hospital; tertiary-level hospital; and population level (eg awareness-raising media campaigns).

With this conceptualisation, in low-resource settings, policymakers must make difficult choices. The right health services must be selected for the right levels to ensure the most efficient and effective use of limited resources to maximally benefit the people. Appropriately addressing the burden of various diseases and health risks is key. From here we enter the realm of “disease control priorities (DCP).”

The principle of prioritising health services applies to all healthcare organisations.

A story spanning 30 years, beginning with DCP1, which fed the World Bank annual flagship development report themed Investing in Health in 1993. It was the first time a proper attempt was made to assess the value for money (cost-effectiveness) of health interventions that would address the major sources of disease burden in low- and middle-income countries (L&MICs).

DCP2 came in 2006 with a focus on delivery platforms, with special attention to community-based PHC. A major global effort followed and the launch of DCP3 — which I happened to attend — took place in London, December 2017. This was a major joint effort by the World Bank, the Bill & Melinda Gates Foundation (BMGF) and WHO, housed in the Department of Global Health at the University of Washington, Seattle.

DCP3 took more than five years of analysis involving more than 500 leading global medical experts and 33 editors who produced 172 chapters in nine volumes on health services related to: Essential Surgery (Vol 1); Reproductive, Maternal, Newborn and Child Health (Vol 2); Cancer (Vol 3); Mental, Neurological, and Substance Abuse Disorder (Vol 4); Cardiovascular, Respiratory, and Related Disorders (Vol 5); Major Infectious Diseases (Vol 6); Injury Prevention and Environmental Health (Vol 7); Child and Adolescent Health and Development (Vol 8); and Disease Control Priorities: Improving Health and Reducing Poverty (Vol 9).

This work is a magnum opus on health services — an evidence-based descriptive analysis of the situation in L&MICs, detailing why and which proven cost-effective health services should be provided as a priority. DCP-3.org makes all these volumes freely available.

The ninth volume is a synthesis of the preceding eight. The basic idea is that if countries must achieve universal health care (UHC) by 2030, which health services should be provided to the people. Health services are costed and classified in 21 groups. Systematically sifting and selecting through the maze, DCP3 ultimately proposes a package of only 218 essential health services. If resources are too low then a highly prioritised sub-set package of 108 services is recommended. It was estimated that to provide these packages to a whole population, governments would have to double or triple their current level of health financing.

Two very important conclusions of this colossal work are: out of 218 health services 70 per cent are to be delivered at the PHC level and if we also include first-level hospitals then it comes to 90pc, and secondly, this minimum package must be financed by governments.

The principle of health service prioritisation however, applies to all healthcare organisations. I have noticed that most well-meaning service oriented not-for-profit organisations don’t bother to systematically invest in developing their health services package. This is the centrepiece of healthcare, and once defined, guides everything from human resource needs and training, financing, medicines and diagnostics etc.

The translational phase of this work is L&MICs developing their own packages using DCP3 as a model. As part of UHC-related assistance, WHO has been urging the development of national packages of essential services. As Director of Health System Development in WHO EMRO, I started promoting this idea to Pakistan. Eventually, with the help of DCP3, WHO, BMGF, AKU, HSA and some other partners we started developing the National EHSP.

When I assumed the office of Special Assistant to the Prime Minister, I made this a priority and finally we became the first country to systematically develop an EHSP following DCP3 and even got it costed. I had a wonderful team of young researchers at the Health Planning, System Strengthening, and Information Analysis Unit (HPSIU) in the ministry who managed this work.

Pakistan EHSP was launched in October 2020. It is the result of wide-ranging national consultations with health specialists in the country from public and private sectors. Our analysis showed that only 42 — ie less than one-fifth of the 218 interventions — were available in Pakistan’s public sector facilities, and these gaps were pronounced at the PHC level.

A highly prioritised package was ultimately developed consisting of 170 health services to be delivered at all five levels. Out of this a district-level package consisting of 88 services to be provided at community level, first-level PHC facility and first-level hospital was separated. The costing came to around $13 per person annually.

HPSIU has since worked with provincial health departments and today all provinces have developed their own packages with minor differences. All of these are available online under ‘Knowledge Hub’ on the Ministry of National Health Services, Regulation and Coordination website.

Effective implementation of these packages would effectively advance Pakistan towards universal health coverage.

More on intersectoral service packages next time.

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