Category Archives: Health Systems Strengthening

A Sick South Asia: The price of Corruption

Posted on June 5, 2024 by sunoor

Forget stock markets and GDP trends; there’s another annual report that genuinely reveals the health of a nation: Transparency International’s Corruption Perception Index (CPI). This year, the news for South Asia isn’t pretty. While the numbers don’t directly measure coughs or broken bones, they paint a chilling picture of a region struggling with a disease that eats away at its very well-being – corruption.

Across the board, South Asia scores below the global average, like a student consistently failing basic integrity tests. Only Bhutan and Maldives show signs of improvement, but what about the rest? Stagnant or slipping backwards. Afghanistan languishes at the bottom, Sri Lanka takes a worrying dip, and even giants like India and Pakistan fail to impress.

But why should we care about greased palms and shady deals when discussing health? Because corruption is a silent killer. It diverts lifesaving funds from hospitals, fuels the spread of counterfeit drugs, and silences voices that could expose public health failures. The lower the CPI score, the harder it becomes to guarantee equal access to quality healthcare, a fundamental human right that shouldn’t be a luxury. The CPI is a wake-up call that the fight for a healthier South Asia starts with tackling the rot at its core.

Consider how public health budgets for lifesaving medications and equipment are diverted to enrich corrupt individuals, a harsh reality in many South Asian countries. In 2022, Pakistan’s Anti-Corruption Establishment (ACE) registered a Rs 800 million embezzlement case against seven doctors and four other officials of the Mayo Hospital for a nefarious scheme, purchasing substandard items at inflated prices, effectively playing with people’s lives.

Meanwhile, a few days ago, in India, the Central Bureau of Investigation (CBI) arrested two of its own officers investigating alleged irregularities in Madhya Pradesh nursing colleges. These officers are accused of setting up a cartel that would collect bribes from college officials in exchange for overlooking issues and granting clean chits. The fake nursing college scandal in Madhya Pradesh, India, undermines public health by potentially graduating unqualified nurses who could put patients at risk, raising concerns about the broader prevalence of such institutions nationwide.

When COVID-19 first arrived in adjacent Bangladesh, doctors worried about the inadequate quality of personal protective equipment. There have also been instances of healthcare establishments providing fraudulent COVID-19 test results at a hefty cost. They went even further, charging a premium for Covid-19 treatment, which the hospital should have provided for free and reimbursed by the government. Instead, it did both.

Transparency International’s 2020 report on Pakistan paints a grim picture, highlighting the widespread practice of bribery for essential services like prenatal care and surgery. In this environment, the poor and marginalized, who are already struggling to make ends meet, are often left with no choice but to forego treatment, perpetuating a vicious cycle of illness and despair.

The Criminal Investigations Department (CID) arrested Sri Lanka’s former health minister and current environment minister in February 2024 for spending $465,00 on lifesaving medications that failed quality tests. Sri Lanka’s National Medicines Regulatory Authority (NMRA) claimed that falsified paperwork was utilized to get this batch of low-quality human immunoglobin, a lifesaving treatment for severe antibody deficiency. In the middle of last year, hospitals complained about patients’ drug reactions.

The ‘Pradhan Mantri Jan Arogya Yojana’ health insurance scheme, a source of hope for India’s low-income families, was rocked by allegations in 2021. Private hospitals entrusted with critical care have been accused of inflating bills, performing unnecessary surgeries, and even refusing to treat those who are eligible. This breach of trust may have diverted significant funds to provide a lifeline for the underprivileged. While investigations continue, the possibility of large-scale corruption casts a cloud of suspicion over this critical program.

Nepal’s Omni scandal during COVID-19 starkly illustrates the insidious reach of corruption in South Asian healthcare. Amidst the pandemic’s urgency, a dubious contract inflated prices and awarded medical supply procurement to a politically connected company (OBCI) lacking relevant experience. This case exposes the nexus between politics, business, and bureaucrats, where public health takes a backseat to self-interest, jeopardizing lives during a crisis.

Looking beyond our immediate borders, the Maldives, despite its idyllic image, is not immune to healthcare corruption. A 2019 Transparency Maldives report found evidence of bribery in procuring medical equipment and pharmaceuticals, raising concerns about the quality and accessibility of care. Similarly, Myanmar faces significant challenges. A United Nations report in 2021 highlighted inadequate healthcare infrastructure and a shortage of qualified personnel, exacerbated by potential systemic corruption.

In Ghana, over 80 children tragically lost their lives after consuming cough syrup imported from India, a grim result of systemic regulatory failures and corruption. This incident underscores the severe consequences of compromised safety standards in pharmaceutical exports, driven by the prioritization of profit over human lives. The Ghana scandal highlights the global ramifications of health sector corruption, demonstrating that lapses in regulatory oversight can have deadly international repercussions.

This discussion paints a bleak picture of how deeply corruption pervades South Asia’s health systems, with disastrous consequences for public health. This begs the question: can we remain silent in the face of such widespread suffering? Given the lacklustre and haphazard efforts of governments in this region to address corruption in meaningful ways, two key actors have a moral obligation to raise their voices and help tackle this issue head-on: WHO and UN agencies.

As the world’s leading authority on public health, the World Health Organization (WHO) cannot ignore the insidious link between corruption and poor health outcomes. Its regional and country offices must become vocal supporters of clean and transparent healthcare systems. Issuing strong statements is a powerful way to effect change. The WHO Director-General and regional directors should publicly condemn corruption in health, emphasizing its negative impact on populations. They can set the tone for prioritizing integrity and accountability in healthcare systems by stating their position clearly. Since WHO leadership now makes statements on ongoing wars and conflicts, corruption should no longer be taboo.

WHO’s ambivalence on corruption and reluctance to highlight how privatization of health services harms public health outcomes has not helped either. The evidence for this correlation has long been available, but there has been no effective advocacy by the global custodian of health. South Asian lawmakers and their families frequently own private hospitals, medical colleges, nursing homes, and schools. It is clear where they would stand in the privatization of health debate. WHO should advocate, in particular, with those international finance institutions constantly pushing for lower public-sector health spending and see privatization as the first line of treatment for failing healthcare systems.WHO enters into three to five-year country cooperation agreements with host governments to outline the agreed-upon work plan. Corruption in the healthcare sector should be a vital component of this agreement with allocated funds. Without this, the WHO becomes an accomplice to local politicians who steal donated money.

Thorough country-focused research and reports showing the quantifiable effects of corruption on health outcomes are another essential strategy for fighting health corruption. Data encourages decision-makers to act, especially when it comes to citizen health. Rather than adding to its already overburdened issue list, the WHO should work closely with organizations like Transparency International and the Boston University School of Public Health, which have specialized expertise and credibility in this field. In such partnerships, the WHOcan help develop clear policies, implement effective oversight mechanisms, and promote transparency in health procurement and resource allocation.

Supporting whistleblower protection within WHO, specifically its regional and country offices worldwide, is a critical aspect of combating corruption in health. WHO employees and collaborators who witness corruption firsthand should have safe and confidential channels to report it without fear of retaliation. The WHO can help expose corruption, hold wrongdoers accountable, and improve healthcare delivery by creating an environment where whistleblowers feel empowered and protected.

Development agencies, the United Nations, and international donors are critical players because they provide the financial and technical support required to drive country-level development efforts. However, due to the pervasive influence of corruption, these organizations frequently face obstacles in their efforts. To effectively address this issue, they must take proactive measures and make more intentional decisions. First, they should include corruption assessments in their country reports. This allows them to understand better the scope and nature of corruption in each country, which is critical when developing effective anti-corruption strategies. Recent UN country reports rarely mention the words “corruption” and “misgovernance.” Second, donors should tie aid to demonstrable anti-corruption efforts. Third, they should help civil society organizations (CSOs) combat corruption. CSOs play an essential role in holding governments and other institutions accountable, and they require financial and technical resources to do so effectively.

Corruption is a human invention; it can be dealt with, even in South Asia!

Published in print on 05 June 2024 in The Annapurna Express

Dr Sunoor Verma is the President of The Himalayan Dialogues and an international leadership communication expert. More on www.sunoor.net

Hashtags

#Afghanistan #Bhutan #Bangladesh #Maldives #Myanmar #Nepal #Pakistan #SriLanka #India #Corruption #Health #WHO #UN #South Asia #Transparency #GobalHealth #GlobalHealthDiplomacy

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Seven Troubling Trends in Indian Elections 2024

Posted on May 29, 2024 by sunoor

As India votes in the 2024 elections, seven alarming trends that transcend party lines threaten the core of its democratic values and reflect systemic problems within the political sphere.

One of the most alarming tendencies in Indian politics today is accepting corruption as a necessary transaction cost.

Campaign conversations now revolve around the ‘decent’ per cent of kickbacks, indicating a broad acceptance of corruption. Across party lines, all major political parties have benefited from the electoral bonds system’s lack of transparency, which permits unlimited and anonymous donations, creating an environment conducive to corruption. Furthermore, recent corruption scandals involving officials from several political parties demonstrate the bipartisan nature of corruption.

Another alarming trend is the widespread acceptability of violence against women, both within and outside political parties. For example, India’s decorated female wrestlers protested harassment and sexual assault by a prominent politician by sitting on the pavements of Delhi for 4 months, 4 weeks and 1 day, before any serious inquiry was set up. Similarly, the tragic episode in Manipur in which women were paraded naked, as well as the big sex and video scandal in the opposition-ruled Karnataka state, highlight this troubling tendency. Furthermore, the current example of a female parliamentarian being allegedly abused at the home of Delhi’s Chief Minister, who also leads the country’s newest political party, highlights the rot. The absent or at best lethargic response of politicians to allegations of abuse by women showcases the systemic nature of the problem. Tragically this widespread acceptance of abuse stands in stark contrast to the hyper-targeted election campaigns by all parties vying for women’s votes.

It suggests a cynical belief among India’s politicians that women can be taken for granted, are oblivious to such contradictions, or are compliant and immune to abuse.

Perhaps the most depressing trend is omitting critical nation-building issues like education, healthcare, and employment from the current election discourse. These fundamental issues are overlooked mainly by divisive rhetoric and populist promises. For example, in areas such as Uttar Pradesh and Bihar, political campaigns usually centre on caste and religion rather than tackling severe deficiencies in educational facilities and healthcare services. Similarly, in Maharashtra, while political disputes frequently revolve around regional identity and linguistic issues, the state continues to face farmer suicides and rural unemployment.

Political parties’ lack of transparency and internal democracy is also glaringly visible this election cycle. Most parties have opaque decision-making processes and centralised power structures, limiting democratic participation and internal criticism. This internal authoritarianism fosters impunity and detachment from grassroots issues, undermining democracy. The BJP’s top-down decision-making has been challenged. Indian National Congress (INC) dynasty politics have long been suspected. Regional parties are similarly affected. Mamata Banerjee’s West Bengal Trinamool Congress (TMC) has been criticised for centralising authority and stifling opposition. The Aam Aadmi Party (AAP), which promised openness and grassroots democracy, has also been accused of autocracy and lack of internal democracy, particularly in removing founding members who questioned the leadership.

Nepotism, which prioritises family over talent and ability, is another worrying trend in Indian political parties.

Despite electoral losses, Rahul Gandhi and Priyanka Gandhi Vadra remain influential in the Indian National Congress (INC). Regional dynastic politics is seen in Uttar Pradesh’s Samajwadi Party (SP), led by Mulayam Singh Yadav’s son Akhilesh. The Karunanidhi family controls Tamil Nadu’s Dravida Munnetra Kazhagam (DMK), with M.K. Stalin ruling after his father.

Not only established parties are affected. The Maharashtra Shiv Sena is likewise a family affair, with Uddhav Thackeray succeeding his father, Balasaheb Thackeray, and now his son, Aaditya. In Andhra Pradesh, the Reddy family dominates the Yuvajana Sramika Rythu Congress Party (YSRCP), with Y.S. Jagan Mohan Reddy trying to emulate his father. While the BJP has often criticized other parties, particularly the Congress, for dynastic politics, it has not been immune to the same practices. Nepotism within the BJP can be seen as a strategic move to consolidate power and ensure loyalty within the party ranks.

Indian politicians in power and opposition, frequently seek endorsements from abroad to validate their actions and ideas. This craving for international approval is evident in their eagerness to speak at prestigious universities and their emphasis on statements by world leaders that praise their initiatives. These are then highlighted in domestic media, projecting an image of global respect and intellectual recognition. However, this pursuit of international validation can obscure pressing domestic issues. Indian politicians’ reliance on foreign endorsements can divert attention from the critical issues that require urgent and sustained focus.

Finally, the death of ideology across the Indian political spectrum is exemplified by politicians’ frequent party switching, which is motivated more by convenience, opportunity, and the seduction of power or money than by any firm commitment to principles or policies.

MLAs’ repeated floor-crossing has caused substantial political instability and governance issues in some states. This erosion of ideological loyalty erodes public trust and threatens the integrity of democratic institutions as voters increasingly struggle to rely on their elected leaders’ professed ideals.

The Sanskrit term Ātmānaṃ viddhi, or ‘Know thyself’, highlights the significance of deep self-awareness and introspection. It encourages a journey inside to find one’s actual nature and purpose. Perhaps Ātmānaṃ viddhi should be the united minimum programme of all political parties in India.

Dr Sunoor Verma is the President of The Himalayan Dialogues and an international leadership communication expert. More on www.sunoor.net

Published in The Himalayan Times in print on 29 May 2024

Tags

#Elections #India #Leadership #Corruption #Gender #Women #Nepotism #Idelogy #Election2024

Learning from Rwanda’s Rise: Insights from the Kigali Global Dialogue Forum 2023

Posted on August 18, 2023 by sunoor

Interview with Dr Sunoor Varma

Global Development Strategist and Leadership Communication expert

The developmental experiences of Rwanda and their applicability to countries such as Nepal are explored in an interview with Dr Sunoor Verma.

The Kigali Global Dialogue Forum is a one-of-a-kind forum that brings together representatives from developing countries to discuss major global issues. It is organised by India’s Observer Research Foundation (ORF) and the Rwanda Governance Board. Set against Rwanda’s incredible growth and development, this selected event focuses on inclusive conversation, bringing varied perspectives, and supporting gender equity. The critical findings are the importance of open discussions, regional alliances, and issue-based collaborations among developing nations.

Welcome to Nepal News Agency. Dr Sunoor Verma will be with us today to discuss developing countries such as Nepal and Rwanda. You were recently invited to speak at the Kigali Global Dialogue; please explain your personal experience and impressions of participating in this unique event in Rwanda.

Dr Sunoor Verma: The Kigali Global Dialogue is a truly unique platform for debate that is convened by two highly credible organisations, the Observer Research Foundation, India and the Rwanda Governance Board, and it brings together a diverse range of voices from developing countries. This dialogue is known for ensuringa significant presence of women speakers, which is not always the case at international events.”

Another thing that makes the Kigali Global Dialogue special is that it’s held in Rwanda, one of Africa’s fastest-growing economies. It’s an inspiring place to be, giving us a glimpse of what’s possible for developing countries.

The topics discussed at the Kigali Global Dialogue are also very bold. They don’t shy away from complex issues; participants can express their views without worrying about pleasing donors or funding sources. This makes for a candid exchange of ideas essential for developing countries.

The Kigali Global Dialogue is an invaluable platform for developing countries to come together, discuss critical issues, and learn from each other’s experiences. I’m grateful for the opportunity to participate in this year’s event, and I look forward to returning.

Can you share some insights that you gained from participating in the dialogue?

Dr Sunoor Verma: One of the most significant insights I gained from the dialogue was the continued relevanceof dialogue between developing countries. Too often, the conversation about development is dominated by developed countries, who may not always understand the unique challenges and opportunities facing developing countries. The Kigali Global Dialogue was a refreshing change of pace, as it was a platform for developing countries to come together and share their experiences. This was incredibly valuable; we could learn from each other and build relationships. Another insight I gained was the importance of regional alliances and issue-based alliances. In today’s world, it is no longer enough to focus on national development simply. We need to work with our neighbours and countries facing similar challenges. This is the only way to achieve sustainable development. The Kigali Global Dialogue was a wake-up call for many. It is a sobering reminderthat developing countries have the power to shape their destiny. We must continue coming together, sharing our experiences, and building alliances. Together, we can create a better future for all as long as there are credible hosts, such as the Observer Research Foundation and the Rwanda Governance Board, whose intentions are trusted.

So the dialogue was held in Rwanda, and its Kigali Global Dialogue and such dialogues have helped the country garner international attention; so can you elaborate on how these dialogues have effectively promoted Rwanda’s achievements and helped foster global engagement?

Dr Sunoor Verma: The Kigali Global Dialogue is a powerful asset for Rwanda to showcase its achievements to the world without being a pony show. It brings together a wide range of influential people from all over the world who get to see firsthand Rwanda’s progress in recent years. This year’s dialogue, for example, brought together people from over 70 countries. They had the opportunity to learn about Rwanda’s economic growth, its commitment to good governance, and its progress in education and healthcare. They also had the chance to meet with Rwandan policymakers and business leaders and discuss ways to collaborate on future projects.

However, The Kigali Global Dialogue is not just about promoting Rwanda’s achievements. It is also about fostering global engagement. When policymakers and business leaders worldwide come together in Kigali, they can build relationships and share ideas. This can lead to new partnerships and new development opportunities.

Rwanda has made some significant improvement in development despite the genocide that occurred not long ago, so what are the factors or strategies that do you believe contributed to Rwanda’s transformation into current Africa’s fastest developing nation?

Dr Sunoor Verma: Rwanda’s transformation always inspires me; it is a remarkable story of how a country can overcome a horrific past and build a brighter future. Many factors have contributed to Rwanda’s success, but I believe the most important ones are visionary leadership, good governance, and investment in human capital.

President Paul Kagame has been a visionary leader for Rwanda. He has articulated a clear vision for the country’s future and has been committed to implementing it. He has also created a robust, stable government focused on good governance and transparency. This has created an environment where businesses can thrive, and people can live in peace and security.

Rwanda has also invested heavily in education and healthcare. This has led to a significant improvement in the quality of life for its citizens. The country now has one of the highest literacy rates in Africa and is also making progress in reducing poverty and malnutrition. Rwanda is also a leader in gender equality, with women making up more than half of the parliament. I am confident that Rwanda will continue to thrive in the future.

I speak passionately about Rwanda’s transformation because it is a model for other developing countries. The principles of visionary leadership, good governance, gender equity and investment in human capital are the same principles that I believe can be applied to other developing countries.

As you said, the society was torn from violence and ethnicity, and now it is embracing its unity; that transition is indeed remarkable for a landlocked country or small country like Rwanda, so what do you believe are the key factors that enable this transition and how can other countries with a similar situation, similar socio-economic problems can learn from Rwanda’s experience.

Dr Sunoor Verma: Rwanda’s transition from a country torn by violence and ethnicity to embracing unity is remarkable. It is a story of how a country can overcome a complicated past and build a brighter future. Many factors have contributed to Rwanda’s success, but the most important ones are leadership, reconciliation and gender equality.

Leadership is essential for any country that wants to achieve its goals. President Paul Kagame has understood the importance of Reconciliation in Rwanda and has taken steps to promote it. He has also committed to gender equality, and women now play a leading role in all aspects of Rwandan society.

Reconciliation is another essential ingredient for peace and unity. Rwanda has taken several steps to promote Reconciliation, including creating a system of local courts and local bodies to help people reconcile with each other. The country has also integrated the issue of Reconciliation into its school curriculums.

Gender equality is also essential for peace and unity. When women are empowered, they are more likely to be involved in decision-making and promote peace. Rwanda has made significant progress in gender equality; women now comprise more than half of the parliament.

Reconciliation is a difficult process, but it is critical in countries that have suffered genocide or other mass tragedies. It is the only way to fully move past the past and create a better future for everyone. Reconciliation does not imply ignoring the past. It is about remembering the past in order to create a better future. It is about acknowledging the grief and suffering inflicted and working together to find a way forward. It is a matter of forgiveness, not forgetting. It is about justice, but not about vengeance. It is a process of healing, not forgetting.

Rwanda has focused a lot on agricultural development to progress since the genocide. Nepal is also an agro-based country, so what methods used by the people of Rwanda can be applicable for Nepal to develop agriculturally?

Dr Sunoor Verma: Rwanda is a remarkable example of a country that has transformed itself from a low-income, post-conflict country to a high-performing economy in just two decades. One of the key drivers of this transformation has been Rwanda’s focus on agricultural development.

Rwanda has invested heavily in agriculture, both in terms of infrastructure and technology. The country has built a network of irrigation canals and dams and introduced new technologies such as drip irrigation and solar-powered pumps. This has helped to increase agricultural productivity and reduce vulnerability to drought.Rwanda has also invested in agricultural research and development. The country has established several agricultural research centres and partnered with international organisations such as the International Maize and Wheat Improvement Center (CIMMYT) to develop new varieties of crops resistant to pests and diseases.

In addition to infrastructure and technology, Rwanda has also focused on good governance and gender equity in agriculture. The government has put in place many policies to promote women’s participation in agriculture and has also made efforts to reduce corruption in the agricultural sector.

As a result of these investments, Rwanda has achieved significant progress in agricultural development. The country’s agricultural output has doubled in the past two decades, and poverty has been reduced by half.

Nepal can learn a great deal from Rwanda’s experience in agricultural development. Nepal is also agro-based, facing many of the same challenges as Rwanda. However, Nepal has the potential to achieve similar results if it invests in infrastructure, technology, good governance, and gender equity in agriculture. I am confident that Nepal can follow in Rwanda’s footsteps and transform into a high-performing economy. It is only a matter of commitment and determination.

For a country like Nepal which is quite similar to Rwanda as it has faced many transitions in the political system, it is now a democratic country experiencing several changes in the political system. So in your view, what aspects of Rwanda’s governance leadership and policies can benefit countries like Nepal facing similar political changes

Dr Sunoor Verma: I have been impressed by Rwanda’s progress in recent years, and I believe that the country has much to offer other developing countries facing similar political changes.

One of the most striking things about Rwanda is its political vision. The government has a clear and long-term plan for the country and has been able to implement this plan effectively. This is in contrast to many other developing countries, which often have frequent changes of government and lack a clear vision for the future.

Another critical aspect of Rwanda’s governance is its political stewardship. The government has channelled international support and technical assistance in a way that has benefited the country as a whole. This contrasts with many other developing countries, where international aid is often fragmented and does not reach the people who need it most.

Finally, Rwanda has made significant progress in gender equality. This contrasts with many other developing countries, where women, including Nepal, are still underrepresented in decision-making roles.

I believe these three aspects of Rwanda’s governance can benefit other developing countries facing similar political changes. If these countries can create a clear vision for the future, channel international support effectively, and promote gender equality, they can achieve significant progress in their development.

I am particularly passionate about the issue of gender equality. I believe that when women are empowered, they can make a real difference in the development of their countries. Rwanda is an excellent example of a country that has benefited from gender equality. I hope other developing countries will follow Rwanda’s example and allow women to lead their societies.

As you said before, Rwanda has garnered a lot of tourist attention. Nepal is also a little bit inclined towards tourism development. It is trying to develop more tourism in the country. It has more tourist attractions than Rwanda, but still, it is not as successful as Rwanda. So what could be the cause behind it and what steps can Rwanda take, and what methods that Rwanda has applied can be applicable in Nepal in developing the tourism sector?

Dr Sunoor Verma: Nepal is a beautiful country with a lot to offer tourists, but it has not been as successful as Rwanda in attracting tourists. If we analyse how Rwanda has achieved this feat of attracting high-value, high, spending tourists, we will find that the answers lie in good governance, branding, and infrastructure.

Good governance: Rwanda has a reputation for being a well-governed country with low levels of corruption. This is important for tourism, as tourists want to feel safe and secure when they travel. Lesson number one- Corruption deters high-spending tourists from visiting a country.

Branding: Rwanda has done an outstanding job branding itself as a tourist destination. The country is known for its gorillas, beautiful scenery, and friendly people. The lesson, Two: Political and economic instability is not conducive to solid branding.

Infrastructure: Rwanda has invested heavily in infrastructure, such as roads, airports, and hotels. This makes it easy for tourists to get around the country and enjoy their visit. Lesson, Three: infrastructure for safe connectivity and secure accommodation is critical.

In addition to these three areas, Nepal can also improve its tourism sector by addressing the following issues:

Gender equality: Nepal has a long history of gender inequality. This can deter female tourists from visiting the country. Nepal needs to do more to promote gender equality and to create a more welcoming environment for female tourists.

Tourism education: Nepal needs to invest in tourism education. This will help to create a more skilled workforce in the tourism sector and will also help to raise awareness of the importance of tourism.

Sustainable tourism: Nepal needs to develop sustainable tourism practices. This will help to protect the environment and to ensure that tourism benefits the local community.

I believe that Nepal has the potential to become a significant tourist destination. However, it needs to address its challenges to realise its full potential.

Lastly, what do you think, methods or formulas Rwanda used to be this successful within two decades? And how would you compare their political system and their development with Nepal’s development?

Dr Sunoor Verma: I have been working in international development for over 20 years and have seen many countries progress, but Rwanda is one of the most impressive success stories. In just two decades, Rwanda has transformed from a country ravaged by genocide to a thriving and prosperous nation.

Many factors have contributed to Rwanda’s success, but I believe that the following are the most important:

Evidence-based decision-making: Rwandan leaders have committed to using evidence to guide their decisions. This means that they have invested in research and analysis and are willing to change course if the evidence shows that they are on the wrong track.

Political will: Rwandan leaders have shown a strong commitment to development. They have made it a priority to improve the lives of their citizens, and they have been willing to make difficult decisions to achieve their goals. There appears to be an agreement among the politicians of Rwanda on a common minimum national interest agenda.

Gender equality: Rwanda has made significant progress in gender equality. Women comprise more than half of the parliament, leading in all aspects of society. This has helped to create a more just and equitable society, and it has also contributed to economic growth.

Public participation: Rwandan leaders have committed to public involvement. They consult with citizens regularly, and they are responsive to their feedback. This has helped build trust between the government and the people, making it easier to implement reforms.

Finally, the Rwandan leadership has maintained stewardship of its National Development agenda and has not allowed foreign interference while being open to considering global best practices.

Published in Polar News, Nepal on 17 August 2023

Dr Sunoor Verma speaking at the Kigali Global Dialogue 2023

Public Health debates we can ignore at our own peril

Posted on June 30, 2022 by sunoor

public health

Global lessons learnt are not as valuable as we might think!

Having lived and worked in low-, middle- and high-income countries, I do not like sweeping ‘global lessons learnt’. The situational, cultural, and operational contexts based on countries’ income levels vary hugely. Moreover, the reports and recommendations from global apex bodies are often drafted by people from primarily high-income country experiences. Many of them may have never actually worked at the country level. Often their lexica are so watered down in assessments of low-income countries that severe reprimand ends up sounding like applause by publication. Without a scorecard system where each country would know where they need to improve to achieve standards, it is difficult to get a reality check. We, the low-income countries, have a choice to make. We can believe that we are high performers or quench our vanity, critically examine our performance, and take corrective measures.

The glaring gaps in public health that COVID-19 exposed

COVID-19 has exposed critical societal gaps across the globe. In the case of high-income-developed democracies, this means adjustments and fine-tuning. In the case of low-income countries, this has meant seeing a horrid picture in the mirror and the need for transformational change. So a natural enquiry would be-what has been happening in the business of Health Systems Strengthening over the years and billions of donated dollars later? We would have thought that SARS, Ebola, MERS, and ZIKA emergencies would have better prepared our health systems, but here we are.

This pandemic has opened some chronic societal wounds, especially in low-income countries. The top issue that warrants an urgent societal debate is what services are essential and must remain in the public domain and how we regulate the private sector. Many proponents for the rapid privatisation of public services in low-income countries are foreign experts. Their countries have achieved an equilibrium between top-notch public services and effective private-sector regulation.

Public Health, Corruption & Transparency

Corruption, lack of transparency, power asymmetry, and invisibility of women in decision-making all contribute to the complexity of public versus private debate in low-income countries. When lawmakers overtly or by proxy own significant numbers of private hospitals, mainstream media, and educational institutions, it becomes difficult to have an objective national debate. The COVID-19 pandemic has allowed us to rethink and reboot societal contracts. The pandemic struck when public trust in institutions- governmental, civil society, private sector, media, academia, and the judiciary was at the lowest after years of steady decline globally.

Public sector- the saviour during COVID-19

Suppose we reflect on the past two years of the pandemic in low-income countries. In that case, we will note that we turned to either the public sector organisation or the defence forces whenever we needed a timely nationwide response. For example, when students needed to be brought back from abroad in India, the then-national carrier Air India stepped up. When stranded migrant workers needed to return home, it was the Indian Railways that rose to the occasion. When liquid oxygen had to be mobilised, the public sector was at work again. Working around the clock to secure scarce supplies from other countries and securing evacuation permissions were diplomats who are public servants. On the borders, facilitating the movement of people, supporting testing, quarantine etc., were members of the border police, armed forces, and the police. Similar was the case with many countries in South and Southeast Asia.

Other rich countries, such as Germany and South Korea, responded robustly. Attribution to the ability of their governments to manage private-sector activity and essentially public ownership of critical health system elements. Their impressive testing capacity was thanks to public laboratories and the presence of industries that could supply the required safety equipment and chemicals.

The South and Southeast Asia neighbourhood

Some governments in Southeast Asia have managed to build public health systems that learn. So, lessons from SARS and Tsunami have fed into their preparedness systems, allowing them to respond efficiently and effectively. The city-state of Singapore has traditionally shown a proactive approach based on solid scenario planning and proactive public health communication. Within India, the response of the southern state of Kerala has stood out. Over the decades, Kerala has invested in health, education, and women’s empowerment. It has consistently adopted an evidence-based approach to decision-making on health matters. Theirs is a learning system that drew heavily on lessons from the NIPAH virus emergency not too long ago. Kerala has also avoided the black-and-white notion of Public or Private and established a successful public-private partnership model. The government of Vietnam efficiently diagnosed the regional situation and closed its borders. Similarly, they were swift in developing low-cost test kits.

Public Health and the private vs public discourse- an axis of national security too

The considerations that need to be at the centre of this post-COVID-19 public-private discourse are:

Re-evaluate and reign in the privatisation spree of health-related assets and services. Nurture back to health underperforming units through quick and transparent reform.
Two, Reboot and relaunch sensible and practical national health policies that serve the objective of achieving universal health coverage. These should not be a copy-paste of what middle- or high-income countries are doing but should be rooted in the realities of poverty, patriarchy, and emerging democracy.
Three, While the issue may appear to be of health, the scope of solution searching is well beyond the expertise or experience of health actors. The complexity of this matter warrants the leadership of the Ministries of Finance, Law, Commerce and Home. For example, supply chains, the rule of law during the lockdown, transportation of people, and labour issues related to health workers have solutions outside of health agencies’ remit.
Four, Governments must take the lead and regulate the private sector more effectively and transparently. While governing the somewhat more streamlined public sector may be more satisfying, the rapidly and wildly growing private sector needs aggressive regulation. In many low-income countries, this means enforcing the existing fantastic on-paper rules and not drafting new ones. Moreover, the hopelessness of data collection from private sector health providers, whether on testing, bed occupancy, oxygen availability, or mortality during COVID-19, has hampered many low-income countries’ effective and timely response.

Refocusing on the Health for All agenda

This public discourse requires us to open our eyes to what we witnessed in the last two years and set aside our ambition and vanity. Let us acknowledge the actual situation in our countries and not artificially push ourselves into a higher boxing category for mere prestige. Organic, home-grown solutions are needed now, not a collage of random international best practices. Instead of drawing lessons from countries in the region, we need to study states and provinces with similar challenges and partner with them. Cross-border areas should be of interest in standard solution searching.

Many glorious careers are built worldwide in the name of Health Systems Strengthening. However, COVID-19 has shown that not much strengthening may have happened. WHO’s “Health for All” agenda ought to remain our focus. However, the tools, processes and commitment need to be indigenous. Countries must bring their sharpest, most independent, and most fearless minds to this debate.

Let us not forget that health, education, and security are nation-building tools. Taxpayers will have little incentive to contribute their fair share if all these continue being disproportionately privatised. One can only imagine the threat to democracy this will pose.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He is credited with setting up WHO’s communication portfolio from scratch in Nepal in the midst of COVID-19. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.

Published in Nepal’s national daily Kantipur on 30 June 2022 in Nepali language. This is a translation with some additional text.

An urgent and critical re-think of global health governance and mandates is warranted!

Posted on April 22, 2022 by sunoor

Dr Sunoor Verma’s interview Face to Face with The Himalayan Times. Published on 22^nd April 2022

The Himalayan Times (THT) Question: In an interview with THT in March 2020, your predictions on how COVID-19 will play out came true. So, what has changed in the global health business in these two years?

Dr Sunoor: It seems to me that COVID-19 has shown countries, policymakers, technocrats, businesspersons, and the media the mirror. And the picture in the mirror was far from pretty. Years of under-investment in health as public service and health professionals have brought us to despair. We also saw that when there is strong cooperation between high-income countries and multilateral agencies like WHO, there can be accelerated solution-finding, as with vaccine development. At the same time, we saw that not much has changed on the axis- rich and poor. The rich controlled the allocation of essential Covid19 supplies. The helplessness of the poor, both as individuals and as countries and their dependency on acts of charity by rich countries is one strong memory of the last two years. I believe that what has also changed over the previous two years is the frivolous questioning of WHO‘s relevance. The UN’s health agency has long been the favourite punching bag of health stakeholders. With all the shortcomings of any membership organisation, WHO has shown that it is more than a normative and standards body. Its power of convening health actors has been hugely visible and effective these past two COVID-19 years. Low-income countries often vent on UN agencies for their miseries, especially the WHO. This is because they cannot box donor countries as they welcome the bilateral money that flows from them. Many member states ask WHO to be stronger, wiser, braver, etc. They must realise that WHO is the sum of the strength of its member states. Low-income countries can only contribute to WHO’s strengthening by making their health systems solid and practical for the commoner. All said and done; global health governance needs a rethink and recalibration. India, Brazil, Thailand and many others who until now were regarded at the periphery of global health governance architecture have unequivocally demonstrated their strength.

THT: What are the lessons for low-income countries from the last two years of COVID-19?

Dr Sunoor: Negotiation from a position of poverty is a non-starter. Least so during a global health crisis. While globalisation has been much celebrated, the poor have not benefitted proportionately. I hope that developing countries learn that health must transcend nationalism and regional alliances must be made as disease crosses borders quickly. Instead of each country reinventing institutions, regional health resources must be shared. They should be recognised and shared regionally by setting up laboratories, training facilities, stockpiling drug testing, and registration. It is a pity that regional fora such as SAARC have not developed to their potential and around the topic of health remain rudderless. Once again, with the facilitation of bodies like WHO, there was support for utilising the capacities of member states during COVID-19. However, these should be a reflex of countries and not the cajoling of international bodies. Regional global health alliances need to be forged now. These need to be regional in operations and financing yet learning from global systems.

Another vital lesson is the importance of activating existing emergency and disaster mechanisms over inventing new structures on the go. Some countries learned that emergencies are not the best time for adventure but rather for tested mechanisms.

THT: As you work closely with leaders and elected officials on strategy and leadership communication around the globe, what lessons are there from COVID-19 for leaders?

Dr Sunoor: COVID-19 has shown the importance of leaders exercising leadership. Occupying a leadership position is no guarantee of leadership. There is ample evidence and peer-reviewed research that countries where women have been in leadership positions on COVID-19, have fared better in their response. Power asymmetry against women in our countries in South Asia is a barrier to our emergency response, development, and prosperity. Excluding women from top-tier decision-making has been a blunder that should be corrected for future emergencies. An important message for leaders is that excluding women from decision-making is foolish and expensive. Donors should make grants available only subject to at least a fifty per cent representation of women in the steering committees of any project they fund in recipient countries.

Second, leaders have seen that undisciplined, unplanned, and unverified communication during health crises leads to the death of people. Third, communicating science and scientific messages to a broad and diverse audience is challenging and beyond the scope of many politicians and leaders. Either they should follow advice and scripts prepared by experts or appoint their own “Faucis” and let them do their job without interference. The top communicators on COVID-19 among leaders have been the former Chancellor of Germany and the Prime Minister of New Zealand. While Mrs Angela Merkel, a scientist, simplified complex data for her citizens in direct telecasts, Ms Jacinda Ardern showed unprecedented transparency in decision-making. If you don’t understand science, don’t deny it or twist it but appoint experts to communicate it and let them do their job.

Another lesson for leaders, I hope, is that they must be unifiers and not dividers in crisis. When people suffer, the last thing they want to see is their leaders’ bickering. The ability to transcend petty politics and create an environment of a unified national response is critical. Unfortunately, few leaders around the world have achieved this feat during COVID-19.

THT: In the post, COVID-19 world order, are multilateral agencies like WHO still relevant? Does their role need to evolve?

Dr Sunoor: Close your eyes for thirty seconds and visualize COVID-19 without WHO.

The question of relevance arises only if there is an alternative. In a world divided along the axis of income, gender, faith, ethnicity etc., the importance of a convener and facilitator is critical. WHO has outstandingly supported countries in their COVID-19 response, especially for an underfunded organisation. Do such agencies need to evolve or transform? Yes, of course, we all need to evolve constantly. High-income countries that fund much of the budget of WHO should want a transformed organisation and support that journey consistently and systematically. Low-income countries should better appreciate the rich-poor power asymmetry more realistically and temper their expectations accordingly.

I also feel that a new kind of expertise is needed in the global health arena. While countries need the norms and standards-setting from an apex body; however, their country-level implementation requires more than technical expertise. It requires coalition-building and diplomacy talent to help countries navigate their factions and mazes. Twenty years ago, people expected disease elimination from WHO; today, they expect WHO also to deliver health and well-being. This warrants an ability to look beyond WHO’s traditional matrimony to government health agencies and forge partnerships with national finance, policy planning, youth, education, and technology custodians. Finally, for any international agency, it is crucial to set clear criteria on when to exit a country, announce it, and adhere to that handover. How many flags you can pin on the world map should not matter in a Zoom world.

THT: Lastly, what conversations are essential now, drawing from the COVID-19 experiences as a society or global community?

Dr Sunoor: A core question that societies need to debate is what should remain in the public sphere and what in private? We have seen that countries with a robust public system of services have done much better in their emergency COVID-19 response. This is an important question, especially for low- and middle-income countries with an urgency to privatise public institutions and services in a call for greater efficiency. Some countries that advocate privatisation in aid-recipient countries have maintained solid public service systems in their own countries. So, this needs to be an organic debate in situ.

At the citizen level, I hope we will appreciate that Health is Politics. Voters would need to demand of their politicians the fundamental right to good quality health, education, and nutrition. And hopefully, this is what the ballot would be cast on in future.

About the Author

Dr Sunoor Verma is a global health practitioner. He has advised WHO, UNICEF, UNHCR, HUG-Geneva and Cambridge University on Strategy, Leadership Communication, Advocacy and Resource Mobilization. He has set up and led the country and regional operations for the European Centre for Minority Issues in the Balkans. He has supported track two peace processes in Macedonia, Kosovo and Sri Lanka and emergency response to the Tsunami, Avian Influenza and COVID-19. He has taught Global Health at Boston University. He has curated partnership initiatives with Macedonia, Kosovo, Germany, Switzerland, Australia, and Nepal parliamentarians. He divides his time between the foothills of the Jura Mountains in France and Buddhanilkantha in Nepal.