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Understanding the Roots of Poor Social Development in Sindh, Pakistan And Development, Disease, and Democracy: Understanding the Roots of Poor Social Development in Sindh, Pakistan and Outlining The Possibilities for Reform An Essay Presented by Kamran Mujahid Jamil to The Committee on Degrees in Social Studies in partial fulfillment of the requirements for a degree with honors of Bachelor of Arts Harvard College March 2018 1 Table of Contents Chapter 1 The Ideas of Development and the Example of Pakistan p. 2 Chapter 2 The Historical Saga of the Wadero-System p. 20 Chapter 3 The Subjects of History: The Impact of the Wadero-System on Social Development and on Public Healthcare in Karachi p. 72 Conclusion p. 130 Appendices p. 134 References p. 141 2 Chapter 1: The Ideas of Development and the Example of Pakistan Introduction Since the 1700s, the Sindh province of modern-day Pakistan has had one of South Asia’s highest per-capita income levels, but today has one of Pakistan’s highest income and social inequality levels (Ghaus et al., 1996 and Pasha, 2015). Against the classical development hypotheses of some scholars, which posit high income levels as determinants for such things like the healthiness and literacy of a population (Filmer, 2003), the Sindh province of Pakistan supports an alternate theory: despite the fact that Sindh has consistently been at the top of Pakistan’s per-capita GDP levels by province and has led Pakistan’s per-capita income levels, Sindh is currently the only province in Pakistan with a district experiencing rapid declines in life expectancy levels and literacy rates (Jamal et al., 2007 and Pasha, 2015). A neighboring province, Punjab—which has not had such a strong, modern- sector economy and which exists as a largely agrarian economy—has been called the agricultural “backwater” of Pakistan (Crompton, 2006, p. 31), by contrast, tells a surprisingly different story. The Punjab province of Pakistan has lower poverty rates, higher literacy rates, and lower infant mortality rates across both its rural and urban settings when compared to Sindh (Ghaus et al., 1996). Whereas Sindh is home to “modern” industrial economies and to 50 million citizens, it is 3 unable to provide a decent level of social development across its province, Punjab, which is home to largely “traditional” agrarian economies and to 100 million citizens, is able to provide a higher level of development to its citizens. What is the narrative of social development—or the development of social infrastructures that support such things as health, education, and sanitation works—between these two provinces, and where can modern efforts to improve such trajectories locate themselves? The onus on the provinces of Pakistan to lead social development projects has only become more pressing: Pakistan’s Local Government Ordinance of 2001 has completely shifted the responsibility of health and education to provincial legislatures and policy-makers, and the dissolution of Pakistan’s Ministry of Health in 2011, in favor of giving the provinces greater autonomy on health policy, has made Pakistan the only modern-day federal, democratic republic without a national-level health services body (Anjum, 2001, Dawn, 2011, and Nishtar, 2013). Understanding the discrepancies, between two neighboring provinces in Pakistan, in terms of their institutions, governance, and historical trends that may be driving such differences in the lived-conditions of people on the ground, can offer insights into how social development happens and can offer insights towards how we can better understand global development needs. But such a lens—of looking at development and its divergences within Pakistan—is widely unacknowledged in the prominent development literature surrounding Pakistan (McCartney, 1974, Easterly, 2012, and World Bank, 2017). In one example, William Easterly, a scholar of development, writes: 4 “Pakistan is a poster child for the hypothesis that a society polarized by class, gender, and ethnic group does poorly at providing public services” (p. 465, 2012). This statement, I argue, casts far too wide of a net: such a blinding nationalization of Pakistan’s state of development fails to realize the productive heterogeneities in social development that exist within Pakistan. Such universalizing views of development, present throughout this literature, subscribe (intentionally or not) to Euro-centric notions of the homogenized nation-state, to simplify complex issues into intelligible arguments that fit our current worldview, and fail to account for Pakistan’s indigenous heterogeneity that spans from its social development levels to its various languages. Stating that “Pakistan (as a whole) is a poster child for the hypothesis that a society polarized by class, gender, and ethnic group” (parenthetical added by the author) serves to homogenize the wealth and breadth of distinct societies found across Pakistan into ‘one society,’ and further serves to infantilize Pakistan as a ‘lost-cause’ to be showcased to the world. Such statements service outdated development ideals that attempt to nationalize, internationalize, and export vocabularies that have worked within a Western context to other, non-Western settings often times without an interest in or an understanding of local conditions as they actually exist (Marglin, 1987, J. and J. Comaroff, 1991, Marglin 1992, Escobar, 1995). Instead of accounting for Pakistan’s deep pre-colonial, colonial, and post- colonial histories of autonomy and difference within the provinces, and the incredibly devolved nature of national governmental responsibilities to the purview of the provinces (clearly seen today through the 18th amendment and 5 Local Governance Ordinance of 2001), much of the theoretical scholarship on Pakistan and its development has resulted in broad and generalized characterizations of Pakistan’s constitutive communities, economies, and polities writ large. The Failures of Classical Economic Development Theories The classical economic development scholarship has also failed, not just in failing to recognize important differences that exist within local contexts, but in providing shaky justifications for direct economic intervention in countries.1 Specifically, it is clear that the development paradigms of the 1980s—that of neoliberal economics—have largely failed in attaining global development efforts to improve access to education, healthcare, and general livelihood.2 The case of Zimbabwe, in 1984, proves illustrative: from an economic growth level of 4% per year and infant mortality rates at its historic low, Zimbabwe represented a strong state with a commitment to social development (World Bank Performance Audit Report, 1995, and Ismi, 2004). But after signing into the Structural Adjustment Program (SAP) of the World Bank and as a result of the SAP-required cuts to government spending on healthcare and education (in order to promote the private 1 Classical development economics can be best encapsulated by priorities given to free- markets, encouraging private economy and its subsequent growth through private consumption, a shift in ‘type’ of economy from traditional sectors (like agriculture) to modern sectors (like manufacturing) to encourage greater GDP-levels and exports, to name a few (Engel, 2010). 2 The development theories of neoliberal thinkers centered around the privatization of the economy, encouraging foreign corporate and direct investments, and cutting government spending (Engel, 2010). 6 economy), Zimbabwe rapidly witnessed declines in education and health (maternal mortality in one city had doubled by 1999), and spiraled into a manufactured economic crisis. The privatization and liberalization of Zimbabwe’s economy, promoted by the ‘rule-of-thumb’ development theories the World Bank employed across the world, led, by 1994, to the reversal of Zimbabwe’s encouraging 1980 health trends (Performance Audit Report, World Bank, 1995, and Ismi, 2004). 3 We cannot use simple ‘rules-of-thumb’ like the complete privatization of the economy or the transfer of the labor force from ‘traditional’ agricultural activity to ‘modern’ manufacturing sector jobs to predict how well a society will do. In the case of Sindh, a bustling ‘modern’ economy exists side-by-side poor living conditions across the province’s urban and rural populations (Jamal et al., 2007). The fact that Sindh is the heart of Pakistan’s modern economy (46.5% of Pakistan’s manufacturing sector is located in Sindh) has done little, historically, to improve social development in Sindh’s rural areas, whereas Punjab’s agrarian economies have brought greater social development to both urban and rural conditions (Ghaus et al., 1996). Further ‘fixes’ to the private economy present little structural change for unjust institutional arrangements, like this thesis’s study of feudalism, that perpetuate and foster poverty. There is a need for a model of development that goes beyond economic development ideals towards social development programs. Further, the development scholarship—just like 3 Further research on the failures of neoliberalism to address social development needs exist in “Blind Spot: How Neoliberalism Infiltrated Global Health” (Keshavjee, 2014) 7 development interventions—cannot be homogenizing or universalizing, or else be doomed to repeat the severe mistakes of previous development efforts. Defining Social Development In understanding the development theories that form the foundations of this thesis, I turn to the idea of analyzing development through the lens of social development. Social development has
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