1. Decentralization
In Pakistan

2. Historical Perspectives
1950 – 1960 General strategy for the provision of public services in Africa under Colonial Administration   
1970 – Under adoption of Rural Based Strategy by Donors & Governments, Decentralisation considered appropriate for effective Management, Planning and Community Participation
1980 – New-Right Thinking approach i.e.
Privatisation
Limitation of state role
Quasi- market in public sector
Decentralised service provision
Pakistan2011

3. Decentralization: Rationale-
A component of Development Sector Reforms programme
Low efficiency & quality of health and education
Political will
Pressure from donors
(Cont…)

4. Rationale for Decentralization: “Classical Agenda”
Decentralization is predicted to improve development sector performance:
Improve allocative efficiency
Improve production efficiency
Improve quality, transparency, accountability, legitimacy
Greater equity

5. Rationale for Decentralization: “Real Agenda”International
Attempts to keep country together by granting autonomy to all localities, by forging ‘asymmetrical’ federation- Uganda
Absence of any meaningful alternative governance structure to provide local government services- East Europe
Need to improve service delivery to large populations and the recognition of the limitations of central administration- East Asia
Pass on responsibility to carry out programs to the field because the central levels have run out of options to improve health services - Pakistan
Mostly motivated by political concerns:
Part of the democratisation process as discredited autocratic central regimes are replaced by elected ones under new constitution- Latin America
Spread of multi-party political systems is creating demand for more local voices in decision making- Africa
Pressures from regional & ethnic groups for more control & participation in the political process- Ethiopia

6. Elements of Decentralization
Decentralization inherently implies the expansion of choices at the local levelAmount of choice transferred from central level to institutions at periphery systems
What choices local officials make with their increased discretion; and
What effects these choices have on the performance of the development system
Prerequisites for Effective DecentralizationSystem of accountability that relies on transparent information, enabling community to monitor performance
Instruments for decentralization - constitutional, legal, institutional and regulatory framework that allow effective & equitable services in line with political objectives
Capacity building of local staff to undertake new responsibilities, and development of management & support systems

7. Rationale (Cont’d)
Key principle to implement in Pakistan because:
Management near to PHC and Education facilities
Less prior permission from central government
Increased Community Participation and resource mobilisation
Innovative approach could be adopted without involving whole country
Effective implementation in remote area
Inter-sectoral co-ordination
Committed & motivated workforce
Pass on responsibility to carry out programs to the field because the central levels have run out of options to improve health/eduation
services - Pakistan

8. Forms of Decentralization
Different forms are not mutually exclusive;any model have characteristics of different types superimposed upon one another
Deconcentration*
Functional
Prefectoral
Integrated
Un-integrated
Delegation* to semi-independent bodies
Devolution*
Decentralization to local bodies
Federalism
Public Sector Market
Fragmentation
CONTINUUM

9. Deconcentration
 “Transfer of functions with in the central government hierarchy through the shifting of workload from central ministries to field officers, the creation of field agencies or the shifting of responsibility to local administrative units that are part of the central government structure” (Collins, 1994)

10. Deconcentration: Salient Features
Shifting of power from the central offices to peripheral offices of the same administrative structure
Semi autonomy to field officers for routine decision-making
Some planning functions according to central government guidelines
Example: Many Developing Countries

11. A: Functional Deconcentration
Field officers directly linked & controlled by the ministry 
Resources, guidelines and decisions about recruitment, selection, transfer and promotions conveyed from vertical hierarchy 
Community need not well perceived 
Example: - Ex - District Health System in Punjab Health Department

12. B: Prefectoral Deconcentration
Field Officers are Sub-ordinate to Prefect
(Commissioner, Governor)  
Communication through Prefect.
Example:
British India before Independence
Where:
Collector/ District Commissioner exercised powers of Finance & Judiciary
Double Control system i.e.
a. Technical matters of field officers e.g. recruitment, pay, training, promotion, transfer controlled by the Ministry &
b. Performance accountability to the Prefect

13. Devolution
“Transfer of functions or decision-making authority to legally incorporated local governments, such as states, provinces, districts or municipalities”
(Collins, 1994)
  “Shifting of responsibility and authority from central offices of the ministry of health to separate administrative structures still within the public administration (provinces, states, municipalities)”
(Bossert, 1995) Cont….

14. Devolution Cont…. Conducive to Community Participation
A Devolved Unit has
Budgetary allocation
Freedom of Revenue generation & Expenditure
Elected members
Conducive to Community Participation 
More Accountability to people
Example:  
LGP 2000 in Pakistan
Cont….

15. Example: National Health Service In UK Public Sector Market
Federalism
Decentralised units receive powers from national government & constitution 
Example:
States in USA & India
Market mechanisms are introduced in the health care delivery  
Purchase & Providers have decision-making authority
 Example: National Health Service In UK
Public Sector Market

16. Decentralization: Problems & Issues
Weak Local Management
Lack of Skilled Staff
Weakening of the Ministry
Planning Implementation Problems
Equity in the delivery of services
Unequal Resources
Political domination
Local Elites Control

17. Decentralization: Conclusions
Inherently implies expansion of choices at the local level
Is predicted to improve health sector performance through increased efficiency, quality of services, accountability, equity
Could be political, administrative, fiscal, market - major overlaps

18. Conclusions: Cont….
Is not a single transfer of a block of authority & responsibility, but a set of functions that pertain to finance, service organisation, human resources, access, governance
Preliminary data indicates that results have been mixed at best
Issue at hand is how to better adopt decentralization policies to achieve national health policy objectives

19. Decentralization: ‘Not a Magic Bullet’
 Benefits: Improved delivery & utilisation of services; enhanced capacity for district health planning, increased funds etc
 Constraints: Conflict between civil servants & politicians, procedures not streamlined; retrenchment of staff undermines performance; resistance of health personnel; problem of defining role of DoH vis-à-vis local government

20. NGOs Codes
& Registrations

21. History of NGOs in Pakistan
Origin goes back to 1947
Many formed for humanitarian and relief for refugees
Initially for many years the work was on rehabilitation etc
1970s martial Law promoted philosophy of welfare and social work
1980s many NGOs emerged.
1990 an upsurge to take advantage of available funding

22. History of NGOs in Pakistan
According to UNDP the number is upto to
If un-registered NGOs and CBOs are added it would be
Only few have comparable credentials, sufficient resources, coverage, linkages, delivery mechanism and documentation system
According to CIDA (DFATD)100 effective NGOs in Pakistan

23. Laws Governing NGOs 6 Laws
Socities Registration Act 1882 (for professional, cultural and education bodies)
The Trust Act 1882 (Provides legal cover for private acts of Charity)
The Voluntary Social Welfare Agencies (Registration and Control) Ordinance 1961: To regulate and assist the development of NGOs undertaking Welfare work
The Companies Ordinance 1984 (Allows NGOs to set themselves as non-profit companies)
Income Tax Ordinance 2001 (sets oyt the Tax Exemption which NGOs are eligible for)
The Foreign NGOs and those in receipt of government funding are required to register with the EAD and CBR

24. Regulatory Framework
The Ministry of Social Welfare and Special Education and the Provincial Welfare Departments are responsible for registering and monitoring organizations under the Voluntary Social Welfare Agencies (Registeration and Control) Ordinance
The District Offices and Industry Department are responsible for registering organization under the Societies Act 1860
The Income tax exemption are granted by the Ministry of Finance and these are not automatically granted. NGOs can apply for exemptions if they are registered with the CBR

25. Reporting Requirements
Organazinzations registered under the Voluntary Social Welfare Agencies Ordinance 1961 are required to maintain accounts and submit an annual report and audit report to District Officers
Registered Societies must submit a copy of the membership annually.
Not for profit companies must submit annaul returns, audited accounts and other documentation for examination. Accounts are open for Public Scrutiny.
The EAD asks INGOs to explain their plans. EAD role is strategic to coordinate activities of Government and NGOs so as to minimize duplication of effort and focus on unmet needs,
NGOs which benefit from Tax exemptions are required to submit annual audited accounts, a lost of donors and benefeciaries and other financial information of the CBR

26. NGO Types
Advocacy and Lobbying: include organizations focused on legal rights, literacy, women’s issues, Human Rights, Minorities etc.
Policy Advocacy : Relatively new in Pakistan. Purpose is to participate in Policy issues be it the Government or other NGOs.
Emergency Rehabilitation and Relief Organizations: Majority in Pakistan
Implementation of Development projects and Programs.
/Service Delivery and CBOs

27. Role of GOP GOP has been positive about it
First five years ( ) a permanent Social Welfare Section was created which now a part of Planning Commission
Income Tax Ordinance exempts NGOs from income Tax which helped NGOs in sustainability and resources
Many Govt. sponsored institutions provide financial grants to NGOs (Zakat Council, SAP, National and Prov Health Council, National and Prov Education Council, TVO, National Trust for Population Welfare.

28. Role of Donor Support in NGOs in Pakistan
The term donor is used to bilateral and multilateral funding agencies in Pakistan
Does not include Pakistani Philanthropies
Funding agencies typically provide funds for economic and public sector development, particularly for large scale infra structure development.
In the absence of internal resources bilateral and multilateral funding agencies have received an important role in social development and support to NGOs

29. Role of Donor Support in NGOs in Pakistan
Multilateral agencies include UN agencies
Focusing on MCH, WATSAN, RH, Gender and Health etc.
Bilateral sources are JICA, CIDA, DFID Norwegian AID etc
There are also several INGOs active in Pakistan : OXFAM, STC, Asia Foundation, Action Aid etc
Since NGOs are often not a part of the Planning phase, there are always problems in implementation.

30. Impact of Ngos on Poverty in Pakistan
Give the Fish ?
Mix record
Relations betrween NGOs and the government have at times marked by tension
NGOs are reported to have not moed forward to address fundamental in-equity issues that create the problems in the first place
NGOs prefer to work on relief work rather than focusing on problems or poverty and in equity.

31. Problems of NGOs in Pakistan
Registeration process in complex
Bureaucratic procedures and red tapism causes delays
Funding problems by withdrawl of INGOs
Restriction to work in specific areas.
Corruption of politicians and bureaucrats
Security
Failure to meet the legal obligations. Also, sources of funding and amounts produces environment of suspicion.
NGOs vested interests

32. Registration
For those NGOs that do choose to register, the benefits, although not necessarily enjoyed by every registered NGO, include: 1. the ability to enforce by-laws; 2. statutory requirements that force an NGO to become organized; 3. legal status “at the official level and among donors;” 4. the ability to open a bank account; 5. the ability to sign contracts; 6. the ability to indemnify employees; and 7. the ability to qualify for financial assistance and tax exemption

33. Registration Process There are four main registration laws:
1. the Societies Registration Act of 1860,
2. the Trusts Act, 1882,
3. The Voluntary Social Welfare Agencies (Registration and Control) (VSWA)
Ordinance, 1961, and
4. The Companies Ordinance, 1984

34. Socities
Societies are composed of a governing body and members. The governing body is the groups of governors, council, directors, commission trustees, or other body entrusted with the management of the affairs of the society and must consist of at least three members. Basic Requirements to Establish a Society
At least seven founders,
A signed Memorandum of Association,
A copy of the society’s rules and regulations, A fee of 50 Pakistan rupees, and
An application submitted to the Registrar of Joint Stock Companies in the province in
which the NGO is located.
The Memorandum of Association must include:
1. the name of the NGO;
2. the province in which it is located;
3. the objects for which it is established;
4. names, addresses, and descriptions of the members of the governing body; and
5. the signatures of those members.
The rules and regulations must contain:
1. membership requirements,
2. the makeup of the governing body,
3. meeting and quorum requirements,
5. procedures for the election and removal of officers, and
6. accounting and audit procedures

35. Trusts
A trust is a “’gift’ of property to a person or institution providing benefit to both parties,” and
may be either a public trust, which benefits the public at large, or a private trust, which
benefits individuals.
The advantages to registering as a trust under the Trusts Act include:
1. a high level of control over the administration and management of the NGO - there is
a succession in place and there are no members;
2. little to no interference from the outside;
3. a simple registration procedure;
4. irrevocability; and
5. eligibility for income tax exemption

36. VSWA
A voluntary social welfare agency (agency) is “an organization, association or undertaking established by persons of their own free will for the purpose of rendering welfare services in any one or more of [the proscribed] fields … and depending for its resources on public subscription, donations or Government aid.” The proscribed fields • child welfare • welfare and rehabilitation of released prisoners, • youth welfare • welfare of juvenile delinquents, • women’s welfare • welfare of the beggars and destitutes, • training in social work • welfare and rehabilitation of patients, • family planning • welfare of aged and infirm, • welfare of the physically and mentally handicapped, and • social education • coordination of social welfare agencies

37. VSWA
Unlike the other registration acts, the VSWA Ordinance contains a penalty provision for
noncompliance. Any person involved with an agency that contravenes the provisions of the
VSWA Ordinance or makes false statements can be punished with up to six months in jail and a fine of 2,000 Pakistan rupees. Every director or officer of the agency “unless he proves
that the offense was committed without his knowledge or consent [is] deemed to be guilty of such offense.” Nonprofit Companies

38. Companies Act
NGOs may register as nonprofit companies under § 42 of The Companies Ordinance, 1984,
“for promoting commerce, art, science, religion, sports, social services, charity or any other
useful object.
” A nonprofit company must direct its profits to achieving its objectives and not return any to its members.
Registering as a company requires more documents and greater
costs than for other types of NGOs. The Companies Act, like the VSWA Ordinance,
also
specifies “stringent accounting, audit and reporting requirements.”

39. Companies Act Two steps: 1. At the SECP
2. The NGO must then register at the Registrar, Joint Stock Companies at the Directorate of Industries in the provincial office where the company is located.

40. NGOs Conduct
- Charter
Regulatory framework
Network

41. NGO-Code of Conduct
Offer guidance on how International NGOs can work in host countries by respecting and supporting the primacy of the Govt. responsibility for organizing HSD
A response to the recent growth in the number of international non-governmental organizations (NGOs) associated with increase in aid flows to the devlopment sector- Particularly Health.
It serves as a tool for service organizations , and eventually, funders and host governments
This code serves as a guide to encourage NGO practices that contribute to building public health systems and discourage those that are harmful. 
Drafted by HAI, Action Aid, Oxfam etc

42. NGO-Code of Conduct
Last decade has shown growth in Political will , funding support and Organizational Structures to improve devlopment work.
Although gains in HIV/AIDs etc but basic primary Health Care and MCH lost ?
It is now clear that NGO’s if not careful and vigilant can undermine the Public Sector and even Health Systems a whole by diverting Health Workers,, Managers and Leaders into privatized operations that create parallel structures and worsen the isolation of communities from Formal Systems
This code is intended specifically to address INGOs and their roles in trainings, securing and deploying HR in the countries where they work.

43. . There are six areas where NGOs can do better
This code offers sustainable practices in each of these areas of concern.
:1) hiring policies;
2) compensation schemes;
3) training and support;
4) minimizing the management burden on governments due to multiple NGO projects in their countries;
5) helping governments connect communities to the formal health systems; and
6) providing better support to government systems through policy advocacy

44. Code of Conduct
Signatories to this code recognize the role of Voluntary ethical codes and country based codes.
-Codes like IRC and Red Crescent Movement and NGOs in disaster relief (1992), offer practical ethical standards for NGOs and donors engaged in development work.
- These standards aim to improve the quality and impact of work

45. 1. Hiring practices Ensure long term sustainability of system
The role of international NGOs is to supplement — not supplant — the public policy role of host country governments and local institutions to strengthen and expand systems.
The NGO role is to provide research, support and expertise to strengthen civil society and local academic and research institutions in informing public health policy development.
The signatories to this code, view their role as time-limited; that is, as communities, local institutions and Ministries of Health become stronger and build capacity, the role of the NGO should diminish or evolve

46. Hiring practices
1. In areas where trained personnel are scarce, NGOs will make every effort to refrain from hiring health or managerial professional staff away from the public sector, thus depleting ministries and their clinical operations of talent
2. When hiring staff, NGOs will make every effort to employ available national expertise, particularly where unemployment of highly qualified nationals abounds. Where qualified nationals are available, volunteer labor will not be used as a substitute for paid staf
3. In places of scarcity, on rare occasions when NGOs hire health staff already working in the public sector, NGOs pledge to do so in coordination and with the consent of local health authorities. This coordination will be accompanied by a commitment to expand overall human resource capacity in the public sector through pre-service training, salary support and/or other means. Governments and NGOs should work collaboratively to address the chronic underpayment of health workers in all sectors
4. NGOs recognize that they have had a historical role in creating conditions that lead trained and skilled personnel to work abroad in wealthy countries. NGOs commit to avoid creating incentives for health workers to leave their developing countries for work in international organizations or locations. Instead, NGOs will provide incentives to stay in the public sector, including better working conditions, and good compensation and benefit packages -

47. 2.Employee Compensation Practices
NGOs commit to advocate for fair monetary compensation for work done by all employees, across the health care system, including salaries for community health workers
NGOs that hire health workers, managers and other skilled personnel in the countries where they work will offer salaries that are “locally competitive,” striving for salaries that are not substantially more generous than the public sector while providing a fair and living wage to their employees.
NGOs sometimes pay “top-ups” (compensation payments that supplement public salaries) to public sector staff to secure their services for contract work. In general, NGOs will avoid this practice, as it creates inequities, increases burdens on existing staff and fails to add new workforce to the devlopment sector
NGOs will establish benefit structures that are based on the needs of employees and, at a minimum, match public sector practices, including retirement plans. Where public sector benefits or pay structures are inadequate, NGOs will collaborate with the public sector to improve them
Any privileges granted to expatriate employees will also be granted to national employees of similar qualification and responsibility, such as opportunity to work from home or access to personal transportation.

48. HR Training and Support Systems
NGOs will preferentially invest in long-term commitments to pre-service education and training.
In areas where professionals are scarce, INGOs will adopt measures that increase the number and capacity of professionals (PAIMAN/USAID MNCH)
NGOs will support training to support both the service and management capacity of Ministries (PHSR and Trips)

49. Minimize the NGO management burden for ministries.
NGOs recognize the burden on governments that have insufficient resources to organize
their own country’s affairs, while having to juggle the management burden of multiple
and sometimes-competing aid organizations from a variety of other countries.
Sector Wide Aproach (joint Planning, evaluation and Coordination within the Ministry’s own planning cycle.

50. Supporting Ministries to Engage Communities.
- NGOs can play an important role as a bridge between civil society organizations and government agencies, especially (but not exclusively) in nations where populations or sub-populations are actively oppressed by their governments - Strengthen capacity of communities to take ownership (Community Mobilization-PPAF) - Helping the oppressed communities to protect themselves.

51. NGOs will advocate for policies which promote and support the public sector.
NGOs will actively advocate with civil society, local institutions and donors for policies and programs that strengthen health systems overall. NGOs recognize that vertical programs and selective approaches exacerbate inequities in health systems and ignore underlying determinants of health.
We also recognize that funding conditionalities can limit or distort government expenditures and priorities.
These unnecessary limitations continue to create barriers to health and development and are unfair and inequitable.

52. NGOs will advocate for policies which promote and support the public sector
NGOs will work in solidarity with their Ministry of Health colleagues to oppose the detrimental policies of the International Monetary Fund, the World Bank and other lenders whose loan conditions limit government expenditures on health or education
NGOs will follow national labor laws and pay all
relevant taxes on their income and assets in the
countries where they work, just as any business
would

53. Thank you