September 5, 2011
at the grassroots
A few weeks ago I had the opportunity of facilitating a workshop on decentralization of health services in Maldives. This is a decision the Maldivian government recently took to bring public decision-making closer to the community. Laudable is this move, and I must say is the essence of democracy. People must be the deciders of their fate in the ultimate analysis. That is what we understand by the concept of democratic governance. Hopefully, this will be the first step to our local voices being heard in the mainstream of public decision making. As a nation that has espoused full fledged democratic governance only just about three years or so ago (with the separation of powers etc.), this decision must necessaritly go with an understanding of the power of our voices to shape the future. This is what democratic governance claims to bring in. But it must also be said that much of our past Maldives history is crowded with top-down approachs to public decision making and so to get voices to emerge from these layers of public silence will take a lot of doing. Especially at the island level to which this devolution has taken place, needs a lot of coaching and coaxing to bring the leadership there to both understand this sea change in the way we would now help people lead their lives, and change their style to truly seek the voice of the people. "To each one a voice" is the drive that is needed for a refreshing beginning that must lay aside the centuries old silent and passive generations.
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First of all, the decision to bring public decision-making closer to the community is not a decision of the Government alone. It is enshrined in our new constitution. If you may recall, the new Law on Decentralization was passed in a Majlis (Parliament) which had an opposition majority. In fact, the law on Decentralization gives much more powers to the city, atoll and island councils than the Government wanted. If this is laudable, the credit must go to both sides of political spectrum. I would leave for the readers to judge on how democratically this nation is governed. Actions speak louder than words!
As for the privatization of key sectors which have a very high impact on the health of the people; viz; access to public health and water and sanitation services, we all know very well, that the private-sector involvement in infrastructure was vigorously promoted by development agencies and international institutions in the 1990s and early 2000s. The proponents of the privatization policy expected such a move would facilitate injection of both investment and efficiency into these sectors in developing countries, replacing traditional public-sector systems suffering from under-investment and inefficiency due to excessive political interference and by vested interests including bureaucracies and labour. It was assumed that this extension of private-sector involvement would be economically successful and generally welcomed, except by those who are losing out as a result of the reform process. Unfortunately, in these sectors, these expectations have not been fulfilled. A literature review will show you that the private-sector investment in developing countries has been falling since its peak in the 1990s. Not only that. Even multinational companies have failed to make sustainable returns on their investments, and the process of privatisation in these sectors has proved widely unpopular and encountered strong political opposition. In many developing countries which pursued this policy, this resistance is now generally recognised by supporters and critics of privatisation alike as an important factor in the failure of private investment in these sectors,.
For Maldives, which has a small and scattered population, the small size of their individual markets, the inadequate socio-economic infrastructure and the high per capita cost of providing the infrastructure as well as their low-income base has made it difficult for these communities to individually attract or maintain the necessary investments for their sustained development. Therefore, it is imperative that the choice between private or public management of health, electricity and water and sanitation services should be based within the general framework of public economics. The decision should be based on which form of enterprise has absolute efficiency advantage. Finally, studies conducted in the United Kingdom and France does not support the case that the private sector had absolute efficiency advantage in drinking water production. As for the privatization of health services, the case studies conducted in UK and USA is worth giving a thought.
Interestingly, one of the benefits of privatization most cited by public officials after privatization is peace-of-mind from no longer having to worry about day-to-day issues at the hospitals, health centres and utilities and the costs of operating them. Have rushed in making this decision? Only time will tell.
Good point Mr Farooq, this is the way of democratic decision making; however, given the onus of responsibility vested in public leaders/officials in democratic governance, policies when enacted have to be systematically followed up by commitment and accountability. At least that's what the public expects as a duty. Failed policies of one era may succeed in another; lets see what the future holds for Maldives and pray for success for the sake our small and captive community.
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