OVER the years, billions of dollars in foreign aid have been poured into Pakistan’s social sector. Nevertheless, literacy remains stubbornly below 50 per cent, and life expectancy at birth is at 66 years, 164th lowest in the world.

So why this abysmal and sustained failure by successive Pakistani governments and international donors in solving these perennial problems? After all, other similarly placed countries have made great strides in both critical areas. Sri Lanka, to name one, has long had a literacy rate of over 90 per cent, and life expectancy there is above 75.

One reason is our prodigious birth rate: Pakistan’s population has grown around six times since Partition, climbing exponentially from around 32 million in 1947 to close to 190 million now. But planned parenthood is another issue the donor community as well as a few Pakistani governments have tried to address, to little avail.

Despite the fact that none of our religious texts bans family planning, many of our reactionary politicians have opposed such programmes tooth and nail.

Much literature has been produced by social scientists to explain these failures, but few writers, to my knowledge at least, have succeeded in getting to the heart of the matter. It has taken a medical doctor to produce a nuanced understanding of the dynamics of social-sector programmes, and the reasons why they have been such dismal failures.

In her book So Much Aid, So Little Development, Dr Samia Waheed Altaf has delved deeply into her personal experience based on years working for the Pakistan government, as well as for donor agencies. Thus, she has been able to give readers an insight into the inner working of both bureaucracies. And as a medical practitioner, she has observed at firsthand the poorly designed programmes that foreign ‘experts’ push.

As her template, Dr Altaf uses our Social Action Programme or SAP (does anybody remember that ill-fated attempt at poverty alleviation?). But her book is not just another academic exercise: rather, it’s a lucid, sardonic look at why things are in such a mess.

At the centre of the book is ‘Lucymemsahib’, a composite ‘development expert’ based on other well-meaning foreigners who travel the world, trying to devise and implement programmes in societies where they don’t speak the language, and don’t understand the customs.

In my many years as a civil servant, I have observed the interaction between various government departments and donor agencies at close quarters. For our government, grants and loans from overseas represent a much-needed boost to our foreign-exchange reserves. Thus, these inflows are courted and welcomed, irrespective of the nature of the projects.

For donors, there is normally a budget for sectors and countries, so there is pressure on agency bureaucrats to disburse these funds before they lapse. Usually, they are judged not by the end result of long-gestation projects, but by their efficiency in doing the paperwork, and signing agreements.

Thus, neither Pakistani civil servants nor their foreign counterparts are accountable for where the money went, and whether it did what it was supposed to in terms of impact.

The first thing written into a project proposal is transport for the team leader and his staff. Next comes foreign training and visits to the headquarters of the donor agency for meetings and discussions.

A big chunk of the budget goes towards the salaries and allowances of foreign experts who can easily command a consultancy fee of $2,000 a day. What’s left is then divided up between local staff.

One problem Dr Altaf highlights is what happens when medical technicians are trained to work in, say, maternal and child health centres of provincial governments. Because there is no clearly defined career path for them, they mostly go abroad or work for themselves. In the rural areas, they can easily get away with styling themselves as doctors.

In her book, Dr Altaf skewers the many bureaucrats she comes across in Pakistan, and recounts hilarious encounters and discussions. Poor Lucymemsahib misses much of what’s going on around her, maintaining a constantly bewildered air while delegating the actual work to her associate, Dr Altaf. Here is one project director instructing his staff on his priorities for a new social-sector project:

“Vehicles, make sure you put in vehicles. Four-wheel-drives, vans, jeeps, pickups, even motorcycles and scooters. You never know what the project might need.”

One underling points out that POL (petrol, oil, lubricants) might be a problem because running costs and maintenance have to be covered by provincial governments. A colleague suggests a way around: these people are old hands at working the system.

Although Dr Altaf uses wit liberally throughout her book, her anger over what’s wrong with the whole international aid racket bursts out now and then. Here, she vents her rage with the so-called development experts who flit around the world, dispensing half-baked nostrums:

“You call yourself an expert, you go halfway around the world at enormous financial cost to the country you are sent out to help. (World Bank experts do not come cheap. All the cost of their technical input, including premium air travel, five-star hotel accommodations, any other related expenses, are part of the loan to the developing country.) You give expert advice to national governments on a sensitive and crucial technical issue that has far-reaching economic consequences. You know your advice will be taken seriously, and you know very well that it is half-baked…”

Due to the gender-oriented projects on which Dr Altaf has worked in Pakistan, she has dealt with many professional women in offices and in the field.

Almost invariably, she finds that their effectiveness is reduced because of the male-dominated environment in which they work. Her view of Pakistani male civil servants, with their patronising attitude towards women (unless they are, like Lucymemsahib, foreigners), is severely jaundiced.

When SAP was finally shut down in 2003, there were few tangible results from this costly exercise. Generations of Pakistanis will have to repay the loans obtained from sundry countries and institutions whose ‘experts’ profited mightily from the ill-fated programme.

Given the fact that Pakistani resources met 80 per cent of SAP’s huge costs, citizens have the right to demand a proper accounting. Who did the money help, apart from those directly involved with the programme? What, if any, lessons were learned? I’m sure Lucymemsahib and her tribe won’t care for the answers, but Dr Samia Altaf does.

The writer is the author of Fatal Faultlines: Pakistan, Islam and the West.

irfan.husain@gmail.com