Citizen Report Card Study · 2019. 12. 19. · DHQ District Headquarter hospitals EPI Expanded...

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Citizen Report Card Study Hyderabad & Matiari

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TRANSPARENCY INTERNATIONAL PAKISTAN

The Sustainable Goal 16 ‘Make Cities inclusive, safe, resilient and sustainable’ is a big challenge for the Government. For attaining this goal, public services, provided by the local government, need to be improved rapidly. Though the Government increases outlays each year, the public services in both the urban and rural areas do not seem to be moving in the right direction. The local governments need to be given more resources and authority to make a difference. The citizens have to be included in the decision making process so that they have a feeling of ownership. TI Pakistan undertook this research to report the strengths and weaknesses in the provision of public services including education, health, police and local government of the Hyderabad and Matiari Districts in Sindh. The objective of the study is to provide Sindh Government with an external review of the services offered to the general public with recommendations to address the gaps to provide relief to the citizens of the province. This research will also be disseminated amongst the civil society organizations, academia, media, public and other stakeholders. It is hoped that the Sindh Government will follow up on the recommendations provided in this report to improve performance of the service delivery at the district level. This research has been made possible due to a grant from Transparency International Secretariat. Saad Rashid Executive Director Transparency International Pakistan

© 2018 www.transparency.org.pk

http://www.transparency.org.pk/

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Ashfaque Ahmed & Saad Rashid

[email protected]@gmail.com

Transparency International Pakistan would like to thank Youth Development Forum (YDF) for collaboration in the study.

Every effort has been made to verify the accuracy of the information contained in this report. All information was believed to be correct as of December 2018 as per sources quoted in this report. Nevertheless, Transparency International Pakistan cannot guarantee the accuracy and completeness of the contents beyond the sources verified for the purpose of the study. Nor can Transparency International Pakistan accept responsibility for the consequences of its uses for other purposes or in other contexts. Contributions to this report by authors external to Transparency International Pakistan do not necessarily reflect the views of Transparency International Pakistan.

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http://www.transparency.org.pk/

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Table of Contents

1. Introduction ................................................................................................................................ 8

Police ........................................................................................................................................ 9

Health ........................................................................................................................................ 9

Education ................................................................................................................................ 10

Local Government .................................................................................................................. 11

1.2 Study Objectives .................................................................................................................. 12

1.3 Duration ............................................................................................................................... 12

1.4 Scope ................................................................................................................................... 12

2. Research Methods .................................................................................................................... 13

2.1 Research Design .................................................................................................................. 13

2.2 Sample Technique and Size ................................................................................................. 14

2.3 Instrument of Data Collection ............................................................................................. 14

3. Analysis and Results ................................................................................................................. 15

4. Recommendations ..................................................................................................................... 27

5. References and Bibliography .................................................................................................... 28

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List of Acronyms

BHU Basic Health Unit

CD Civil Dispensary

CH Civil Hospital

CRC Citizen Report Card

DHO District Health Officers

DHQ District Headquarter hospitals

EPI Expanded Program on Immunization

FP&PHC Family Planning and Primary Health Care

HFs Health Facilities

LC Leprosy Centre

LG Local Government

LGB Local Government Board

LGC Local Government Commission

LGO Local Government Ordinance

MCH Mother and Child Health Care Centre

MS Medical Superintendent

PPHI People’s Primary Healthcare Initiative

PPP Public Private Partnership

RHC Rural Health Center

SHC Secondary Health Center

SRSO Sindh Rural Support Organization

TBC Tuberculosis Centre

THQ Tehsil Headquarter hospitals

TI-P Transparency International Pakistan

VHP Vertical Health Programs

WHO World Health Organization

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List of Tables

Table 3. 1 Gender .......................................................................................................................... 15

Table 3. 2 Districts ........................................................................................................................ 15

Table 3. 3 Individual Attention ..................................................................................................... 15

Table 3. 4 Availability of Furniture ............................................................................................... 16

Table 3. 5 Cleanliness in Schools .................................................................................................. 16

Table 3. 6 Availability of drinking Water ..................................................................................... 16

Table 3. 7 Availability of clean toilets .......................................................................................... 17

Table 3. 8 Condition of School Building ....................................................................................... 17

Table 3. 9 Satisfaction with housekeeping .................................................................................... 17

Table 3.10 Availability of Medicines ............................................................................................ 18

Table 3. 11 Satisfaction with health facilities................................................................................ 18

Table 3. 12 Availability of doctors/staff during duty hours .......................................................... 18

Table 3. 13 Priority of the government in Health Sector ............................................................... 19

Table 3. 14 Foremost issues for Local Govt. to resolve. ............................................................... 19

Table 3. 15 Situation after LG election ......................................................................................... 20

Table 3. 16 Ways to improve LG system ...................................................................................... 20

Table 3. 17 Use of power delegated to LG rep. ............................................................................ 21

Table 3. 18 Effective use of allocated funds ................................................................................. 21

Table 3. 19 Ease in registering FIR ............................................................................................... 22

Table 3. 20 Satisfaction with police behavior ............................................................................... 22

Table 3. 21 How to improve police department ............................................................................ 22

Table 3. 22 Citizens feel secure in presence of police ................................................................... 23

Table 3. 23 Can a common man make a difference ...................................................................... 23

Table 3. 24 Most corrupt department ............................................................................................ 24

Table 3. 25 Departments where respondents paid bribe ................................................................ 25

Table 3. 26 Reasons of not reporting corruption ........................................................................... 26

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List of Figures

Figure 1. 1 Data gathering in Matiari .............................................................................................. 8

Figure 1. 2 A ward of Government Hospital in Sindh ................................................................... 10

Figure 1. 3 CRC Survey, Hyderabad ............................................................................................. 12

Figure 3. 1 Gender ......................................................................................................................... 15

Figure 3. 2 Districts ....................................................................................................................... 15

Figure 3. 3 Individual Attention .................................................................................................... 15

Figure 3. 4 Availability of Furniture ............................................................................................. 16

Figure 3. 5 Cleanliness in schools ................................................................................................. 16

Figure 3. 6 Availability of drinking Water .................................................................................... 16

Figure 3. 7 Availability of Clean Toilets ....................................................................................... 17

Figure 3. 8 Condition of School Building ..................................................................................... 17

Figure 3. 9 Satisfaction with housekeeping ................................................................................... 17

Figure 3. 10 Availability of Medicines .......................................................................................... 18

Figure 3. 11 Satisfaction with Health facility ................................................................................ 18

Figure 3. 12 Availability of doctors/staff during huty hours ......................................................... 18

Figure 3. 13 Priority of the government in Health Sector ............................................................. 19

Figure 3. 14 Foremost issues for Local Govt. to resolve ............................................................... 19

Figure 3. 15 Situation after LG election ........................................................................................ 20

Figure 3. 16 Ways to improve LG system ..................................................................................... 20

Figure 3. 17 Use of power delegated to LG rep. ........................................................................... 21

Figure 3. 18 Effective use of allocated funds ................................................................................ 21

Figure 3. 19 Ease in registering FIR .............................................................................................. 22

Figure 3. 20 Satisfaction with police behavior .............................................................................. 22

Figure 3. 21 How to improve police department ........................................................................... 23

Figure 3. 22 Citizens feel secure in presence of police ................................................................. 23

Figure 3. 23 Can a common man make a difference ..................................................................... 23

Figure 3. 24 Most corrupt departments ......................................................................................... 24

Figure 3. 25 Departments where respondents paid bribe .............................................................. 25

Figure 3. 26 Reasons of not reporting corruption .......................................................................... 26

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Figure 1. 1 Data gathering in Matiari

1. Introduction

Social Accountability plays an important role in the development of essential

structural reforms for accountability and good governance in the country. Through

this process, a productive engagement between citizens and government is

established, which helps to evaluate the performance of public officials, politicians,

and service providers as these are the entities that use public resources.1 As a result

of this accountability process, the public service delivery is improved and public

money is spent in a more transparent manner benefiting citizens at large.

Citizen report card is a tool

of social accountability

for the provision of public

service delivery to the

masses. 2 It can be used to

solicit user feedback on

service provider

performance. In developing

countries, the delivery of

public services is often

inefficient and inadequate

due to corrupt practices,

poor management, and lack

of transparency and

accountability. During the

CRC process, quantitative

feedback of the services

provided to the users, is

taken scientifically. This

feedback is analyzed

statistically and presented

with recommendations and

suggestions to improve the

public service quality.

This CRC study has been conducted in Hyderabad and Matiari, two districts of the

Sindh Province. Police, Education, Local Government and Health are the four basic

services which have been evaluated in this study. A brief overview of these services in

the province is described below.

1 http://www.ansa-eap.net/about-us/who-we-are/the-four-pillars-of-social-accountability/

2 https://www.sdpi.org/media/media_details179-press-2011.html

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Police

Modern police may be described as an organized body of personnel assigned to preserve

law, order, prevent and detect crime.3 They need to work in close coordination with

citizens. As an institution, it requires constant reforms and up gradation, inevitable for

better performance. Traditionally in the Sindh Province, reforms were a result of mutual

understanding between ruling classes and police top officials. The public was given the

least importance. In May 2018, the then Chief Justice of the Supreme Court of Pakistan,

constituted a Police Reform Committee (PRC). Prior to this, there were some 21 reports

on police reforms, whose recommendations were barely implemented.4 In January 2019,

the Law and Justice Commission of Pakistan launched the PRC report in which the need

to redress public complaints against police was given the highest priority. This was

necessary if meaningful reforms in the criminal justice system were to be achieved.5 The

recommendation to give public complaints a priority becomes more important in the

backdrop of the perception that the majority of Pakistanis believe that police as the most

corrupt department.6 The citizens’ perception about the police needs to be changed for

citizens to interact and assist the police for crime prevention/control and maintaining

social order. Due to the lack of trust in the police this interaction becomes difficult.

Among many methods of citizens’ involvement in this reform process, one is a

systematic feedback on the services through citizen report card. Therefore, in this CRC,

we asked citizens questions about police services as well as the amount of difficulties

citizens face in registering a FIR, behavior of police with citizens, and citizens feedback

on how to improve police force. The respondents replied these questions based on their

past experience with police.

Health

Education and health conditions are the main parameters against which the status of

human capital of any economy is gauged. Numerous studies validate the significant

positive relationship between health indicators and economic growth.7 Better health

indicators, especially in childhood, such as good nutrition for infants and toddler and less

exposure to infectious disease may improve their productivity in future and develop a

strong foundation for sustainable economic growth.8 But if we consider the health

situation in the country, Pakistan ranked 149th

towards its progress to achieve United

3 https://www.thebalancecareers.com/the-history-of-modern-policing-974587

4 https://www.dawn.com/news/1410471

5 https://tribune.com.pk/story/1887648/1-law-justice-commission-set-launch-police-reforms-report-today/

6 6 http://gallup.com.pk/2013-2016-majority-urban-pakistanis-view-police-as-the-most-corrupt-authority-

judges-and-magistrates-are-perceived-to-be-the-least-corrupt-world-justice-project-and-gallup-pakistan/ 7 Currie, J. (2009). Healthy, Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital

Development. Journal of economic literature, 47(1), 87-122. 8 Schultz, T. P. (2010). Health Human Capital and Economic Development. Journal of African Economies, 19(3), 12-

80.

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Figure 1. 2 A ward of Government Hospital in Sindh

Nations’ health-related Sustainable Development Goals (SDGs)9 and scored just 38 out

of 100.

One can question the

government’s huge budget

spending on health which is yet

to deliver benefits properly. The

most common challenges being

faced in the health care system

in Pakistan are: shortage of

hospitals, doctors and

specialists in remote areas, poor

management, inadequate

resources, scarcity of drugs,

untrained staff, unavailability of

female staff, absenteeism, and

private practice of many

doctors.10 In Sindh province, majority of Tehsil Headquarters hospitals are in urban areas.

People in distant villages, due to lack of transportation/ambulances, have avail the

services of BHUs and RHCs which provide only basic treatment. In these primary health

centers, people often complain about the poor quality of facilities and shortage of staff,

doctors, diagnostic equipment and laboratories.11 The government of Sindh is supposed to

consider citizens’ feedback about the services they are providing in these government run

hospitals, but with the absence of any well-defined mechanism or complaint management

system it is difficult. In this CRC, we included some basic questions about health services

with a provision that it will assist the policy makers to improve health services.

Education

According to the Constitution of Pakistan, the government is responsible to provide free

and compulsory education to all children between the age of 5 and 16 years. Before the

18th

amendment in 2010, education was a federal issue, but it has now been transferred

to the provinces.12 It is now the responsibility of the provincial government to focus on

education and fulfill the constitutional obligation towards its citizens13.

Comparing the attendance rates of the four provinces, Sindh, has 67 percent attendance rates

while other provinces attendance is around 80 percent.14 Student’s performance are a

9 https://www.dawn.com/news/1285528

10 https://www.ncbi.nlm.nih.gov/pubmed/28712245 11

https://www.pakistantoday.com.pk/2017/06/07/poor-functioning-at-government-hospitals/ 12

http://www.ipripak.org/education-system-of-pakistan-issues-problems-and-solutions/ 13

https://www.dawn.com/news/570524 14

http://dailytimes.com.pk/sindh/28-May-16/sindh-secures-6th-position-in-education-ranking

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good gauge to know how well the education system is working. The standard of

education in the government schools in Rural Sindh is so poor; it is estimated that in

grade 5, 77 percent students in schools are not able to read Urdu/Sindh sentences and 75

percent are not able to read sentences in English.15 According to the Annual State of

Education Report (ASER), private school students’ are performing better than those

students who are studying in government run schools.16

The condition of basic facilities available in school is also very poor. According to a

report, out of 42,383 schools, 4,910 do not have buildings, 4,810 of which are primary

schools.17

23,235 schools do not have electricity18

, 18,128 do not have drinking water19

,

15,478 schools do not have washrooms20

and 16,359 do not have boundary wall. Lack of

basic facilities is also a reason why there is a low enrollment in these government run

schools. In order to provide and improve basic facilities in schools, citizens’ feedback can

play an important role along with improved transparency and accountability mechanism.

Questions have therefore been included in this CRC to get citizens feedback on education

services.

Local Government

In Pakistan there are three levels of government: local, provincial and federal. The local

government which is the essence of democracy is the first level of government and

primarily responsible for matters close to local communities such as public

health, local roads and footpaths, parks and playing fields, libraries, local environmental

issues, waste disposal, and many community services institutions provide various public

services to citizens. In the presence of a strong local government system, citizens easily

receive basic public services and can improve their standard of living. They can also have

easy access to their local government representatives and hold them accountable.

In Sindh, the LG system which was introduced in 2013 was implemented in 201621

. The

step although delayed but was important towards enhancing the quality of local service

delivery in the province. A strong local government system is needed to redress

grievances of all the citizens. However, the LG system is yet to deliver what it was

established for. According to a study, political, social, administrative and

mismanagement of resources and rampant corruption are the many causes which have

severely paralyzed the governance system at local government level of Pakistan.22

The

15

Annual Status of Education Report, ASER Pakistan 2018, p-199 16

https://www.thenews.com.pk/print/123008-In-a-shambles-is-what-education-is-in-Sindh 17

Table 5.1.2, Pakistan Education Statistics 2016-17 18




Undermining Local Governance, A Review of the Sindh Local Government System, 2013 22 Local Government System in Pakistan: Causes of bad Governance of Local Government System, Journal of Social and Administrative Sciences, vol2, issue 2

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Figure 1. 3 CRC Survey, Hyderabad

allocated funds to each of the districts

are so insufficient that elected

councilors are unable to address

public issues which are of utmost

importance to the citizens.

1.2 Study Objectives

The main objectives of the research

were:

To evaluate police, education,

health and local government

services from the end-user’s

perspective.

To identify gaps in service

delivery processes and appraise

the good practices.

To provide a quantitative

feedback to all the stakeholders,

particularly the Sindh government

about the service quality while

pointing out weak areas for future planning and budgeting.

To provide a basis for future research in the same area.

1.3 Duration

The duration of the study was three months. It started from November 2018, ended in

February, 2019. During this period, all work of research design, data collection, and

analysis was carried out.

1.4 Scope

The data collected during this study was based on the sample taken from district

Hyderabad and Matiari. Due to time and resource constraints, the data was only taken

from this district whereas other districts were excluded from the study. Hence its findings

can only be generalized to these two districts.

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2. Research Methods

2.1 Research Design

A research design can be defined as an objective, systematic plan to gather data that has

application to other situations/ populations.23

It directly addresses the goals and questions

of research24

, gives a structure to the scientific work and provides a basis for its direction

and organization.25

The selection of a particular design depends on research objectives

and the overall conditions under which a particular research is carried out. It involves

decisions about target population, development of a questionnaire, sample size, sampling

technique, data collection method and the selection of analysis technique.

This Citizen Report Card (CRC) study was conducted in two districts Hyderabad and

Mitiari. Studies like Citizen Report Card (CRC) use a survey method in which a

respondent chooses from a set of options against a statement or a question about the

services they receive from government departments. These questions designed carefully

considering their relevance and consistency with the problems or issues relevant for the

citizens. In the questionnnare design it was made sure that the questions should be

consistent with the objectives of the study.

Another issue was defining the survey population and collecting data from it through a

proper sampling technique. According to the objectives of the study, the target population

of this study should be the users of health, education, police and local government

services provided by the provincial government. Users of these services are easily

available in public places like; markets or parks etc; however, defining the purpose of the

study and taking data from them require skilled enumerators with relevant experience.

These enumerators should have a familiarity with local language, culture and geography.

For this reason, a local NGO, Youth Development Forum (YDF), was contacted which

had the past experience of conducting such surveys and had access at the grassroot level

in the district necessary for data collection. They were also in contact with local

authorities.

Before the study, the enumerators were given a briefing about the purpose of study,

questions of the survey and respondents’ eligibility. The respondents for this study were

the user of the public services. In the selected tehsils, the data was collected from places

like markets and parks where people from nearby areas gathered in large numbers,

making it easy to collect the data that represent the entire population. A total of 400

responses were gathered from the entire district. The local NGO provided basic

information about the district and key problems faced by its inhabitants to access public 23

Introduction to Nursing Research: Incorporating Evidence Based Practice by Carol Boswell, Sharon Cannon Jones & Bartlett Learning, 2011 24

Participant Observation: A Guide for Fieldworkers by Kathleen Musante (DeWalt), Billie R. DeWalt AltaMira Press, 2010 ⦁ 25

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808761/

https://books.google.com/books?id=R69bnmpadeIC&source=ttbhttps://books.google.com/books?id=ymJJUkR7s3UC&source=ttb

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services. The first draft of the questionnaire was designed after thorough research of

available literature, newspaper articles, experts’ opinion and previous CRC studies

conducted by TI Pakistan. It was finalized after consultation and discussion with the local

NGO.

The collected data was analyzed on IBM SPSS software. The results were compiled and

presented in a tabular form with a graphical representation for easy understanding.

2.2 Sample Technique and Size

A sample of 400 respondents was taken for the study using non-probability convenience

sampling technique. It was used because of time and financial constraints; however, it

was made sure that the sample should be a good representation of the entire district. This

approach is not new, as majority of survey researchs follow the same sampling technique.

2.3 Instrument of Data Collection

The instrument of data collection for this CRC was a questionnaire which consisted of 24

questions. These questions were divided among four services; health, education, police

and local government in such a way that six questions were asked to evaluate education

service, five questions were asked to evaluate health service, five questions were asked to

evaluate local government, and four questions were asked to evaluate police service. In

addition to this, four questions were asked to get a general feedback of citizens about

corruption perception. The questionnaire also included questions about respondent’s

demographic and personal information. The questions were participant friendly, simple

and carefully designed matching the objectives of the study and the analysis plan.

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Yes 67%

No 17%

To some extent

16%

Male 89%

Female 11%

Figure 3. 1 Gender

Matiari 46%

Hyderabad 54%

3. Analysis and Results

The data of this study was collected from 400 respondents, 183 from Matiari and 217

from Hyderabad. 89 percent of the total respondents were male while 11 percent were

female. No gender was particularly targeted; however, the reason that male respondents

are more in number is because of cultural issues and also they are more familiar with the

services in question, and available in large number in public places where the survey was

conducted.

Table 3. 1 Gender

Table 3. 2 Districts

3.1 Analysis of Questions

Q.1 Do the teachers give individual attention to the students?

According to the results most of the respondents, 67 percent, responded Yes that the

teacher gave individual attention to students, while 17 percent responded No and 16

percent responded that teachers pay individual attention on students up to some extent.

Table 3. 3 Individual Attention

Frequency Percent

Yes 269 67

No 68 17

To some extent 63 16

Total 400 100

Frequency Percent

Male 358 89

Female 42 11

Total 400 100

Frequency Percent

Matiari 183 46

Hyderabad 217 54

Total 400 100

Figure 3. 3 Individual Attention

Figure 3. 2 Districts

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Yes 70%

No 30%

Yes 52%

No 22%

To some extent 26%

Yes 57%

No 43%

Figure 3. 4 Availability of Furniture

Figure 3. 6 Availability of drinking Water

Q.2 Is required furniture available in schools?

According to the results, 70 percent responded that the required furniture is available

while 30 percent responded it is not available.

Table 3. 4 Availability of Furniture

Frequency Percent

Yes 281 70

No 119 30

Total 400 100

Q.3 Is cleanliness satisfactory in the schools?

According to this CRC results, 52 percent respondents were satisfied with the cleanliness

in the schools, while 22 percent were not. The other 26 percent responded that they were

satisfied ‘to some extent’.

Table 3. 5 Cleanliness in Schools

Frequency Percent

Yes 209 52

No 86 22


Total 400 100

Q.4 Is drinking water available in schools?

Drinking water is a basic necessity. Safe drinking water prevents many stomach diseases.

When asked whether drinking water is available in school, 57 percent responded ‘Yes’

and 43 percent responded ‘No’.

Table 3. 6 Availability of drinking Water

Q.5 Are toilets cleaned regularly in schools?

Clean toilets are basic necessity and should be available in all public schools. Students

particularly females suffer badly if they are not available. When we asked this question,

40 percent responded that the toilets are not clean, while 35 percent responded ‘Yes’. The

other 25 percent were satisfied with cleanliness ‘to some extent’.

Frequency Percent

Yes 228 57

No 172 43

Total 400 100

Figure 3. 5 Cleanliness in schools

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Yes 35%

No 40%

To some extent 25%

Yes 61%

No 15%

To some extent 24%

Yes 32%

No 28%

To some extent 40%

Figure 3. 7 Availability of clean toilets

Figure 3. 8 Condition of School Building

Figure 3. 9 Satisfaction with housekeeping

Table 3. 7 Availability of clean toilets

Q.6 Is the school building in good condition?

According to the result of this CRC, 61 percent responded that the school building were

in good condition; however, 15 percent responded ‘No’ while 24 percent responded they

were satisfied with the condition of school building 'to some extent’.

Table 3. 8 Condition of School Building

Q. 7 Are you satisfied with the house-keeping in the health facilities?

In response to this question, 32 percent responded ‘Yes’ and 28 percent responded ‘No’

while 40 percent responded ‘To some extent’.

Table 3. 9 Satisfaction with housekeeping

Q.8 Are medicines easily available in the hospital?

Inadequate access to essential medicines is a common issue in developing

countries. According to this CRC, 27.5 percent responded ‘Yes’ however 35 percent

responded ‘No’. The other 37 percent are satisfied with the availability of medicines up

to some extent.

Frequency Percent

Yes 140 35

No 160 40


Total 400 100

Frequency Percent

Yes 243 61

No 59 15


Total 400 100

Frequency Percent

Yes 129 32

No 110 28


Total 400 100

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Yes 27%

No 35%

To some extent 38%

Yes 25%

No 37%

To some extent 38%

Yes 47%

No 21%

To some extent 32%

Figure 3. 10 Availability of Medicines

Figure 3. 11 Satisfaction with health facilities

Table 3.10 Availability of Medicines

Frequency Percent

Yes 110 27

No 140 35


Total 400 100.0

Q.9 Are you satisfied with the facilities available in hospitals?

In response to this question, 37 percent respondents were not satisfied about the facilities

available in the hospital, while 38 percent were satisfied to some extent. The other 25

percent respondents were satisfied with the available facilities.

Table 3. 11 Satisfaction with health facilities

Q.10 Are doctors and other staff available during duty hours?

47 percent responded that the doctors and other staff were available during duty hours;

however, 21 percent responded to this question with No. 32 percent responded that up to

some extent doctors and other staff are available in their duty hours.

Table 3. 12 Availability of doctors/staff during Duty Hours

Q.11 What should be the priority of the government in health sector?

The respondents were provided with five options. Among them, 38 percent of the

respondent said that government should curb corruption in hospitals, 26 percent said that

free checkup with latest technology, 17 percent said availability of doctors, 15 percent

said availability of medicines and 4 percent said cleanliness should be their top priority.

Frequency Percent

Yes 102 25

No 146 37


Total 400 100

Frequency Percent

Yes 190 47.5

No 82 20.5

To some extent 128 32.0

Total 400 100

Figure 3. 12 Availability of doctors/staff during Duty Hours

19


Drinking water 43%

Sewage 24%

Maintenance of roads

19%

Cleanliness 14%

0 20 40 60 80 100 120 140 160

Corruption in Hospitals

Free checkup with latest technology

Availability of Doctors

Availability of Medicines

Cleaniliness

Figure 3. 14 Foremost issues for Local Govt.to resolve

Table 3. 13 Priority of the government in Health

Q.12 What problem should the local government address foremost?

The respondents were given four basic problems which are usually dealt by the local

government. These options were derived through a systematic process of research

explained in the previous chapters. 43 percent responded drinking water should be

addressed first by the local government. 24.8 and 20.8 percent responded sewage system

and maintenance of roads should be the local government priority. The results show that

providing safe water for drinking is the main problem people of the district are facing.

They also desired that the local government improved the sewage system and road

maintenance.

Table 3. 14 Foremost issues for Local Govt.to resolve

Frequency Percent

Corruption in Hospitals 151 38

Free checkup with latest technology 104 26

Availability of Doctors 68 17

Availability of Medicines 61 15

Cleanliness 16 4

Total 400 100

Frequency Percent

Drinking water 173 43

Sewage 94 24

Maintenance of roads 76 19

Cleanliness 57 14

Total 400 100

Figure 3. 13 Priority of the government in Health

20


Yes 20%

No 41%

To some extent 39%

Figure 3. 15 Situation after LG election

Figure 3. 16 Ways to improve LG system

Q.13 Has the administrative situation improved after the Local Government

election?

This question was asked about the improvement in the administrative situation in the

district after the LG elections. In response, 41 percent responded that there was No

improvement while only 7 percent responded ‘Yes’, there was an improvement. The

result shows that majority of the respondents are not satisfied with the administration of

local government.

Table 3. 15 Situation after LG election

Frequency Percent

Yes 81 20

No 164 41


Total 400 100

Q.14 In your opinion how can the local government system be improved?

To improve the service delivery of LG, citizens play an important role by providing their

feedback about the services received and also suggest ways to improve them further. In

this study, we have provided them with four strategies which can possibly improve the

LG system. Among them, 35 percent responded that by inserting a minimum level of

education for the members the LG system can be improved. 29 percent responded in

favor of having a better accountability mechanism while 26 percent said that by

increasing the powers of LG members. 10 percent were of the view that by increasing the

funds given to LG members, the system of LG can be improved.

Table 3. 16 Ways to improve LG system

0 50 100 150

By inserting a minimum level of…

Better accountability

To increase the authority

dissemination of more funds

Frequency Percent

By inserting a minimum level of education 141 35

Better accountability 116 29

To increase the authority 103 26

Dissemination of more funds 40 10

Total 400 100

35%

29%

26%

10%

21


Yes 24%

No 33%

To some extent 43%

Figure 3. 17 Use of power delegated to LG rep.

Yes 22%

No 34%

To some extent 44%

Figure 3. 18 Effective use of Allocated funds

Q.15 Do the local government representatives making the best use of the powers

delegated to them?

There has been a constant debate on the powers given to the local government. The

Mayor Karachi has attributed the LG government toothless. In his opinion that is the

reason for people not getting good services through their elected representatives.26

However, the respondents were asked whether the powers given to the elected LG

representatives were being utilized effectively. In response to this question, majority of

the respondents, 43 percent said ‘To some Extent’, while 33 percent responded ‘No’. 24

percent responded that they are effectively using the powers delegated to them.

Table 3. 17 Use of power delegated to LG rep.

Frequency Percent

Yes 98 24

No 131 33


Total 400 100.0

Q.16 Do you think LG representatives make effective use of the allocated funds?

In response to this question, only 22 percent responded ‘Yes’, while 34 percent

responded No. The other 44 percent according to this survey were of the opinion that

funds allocated to LG representatives are not being utilized effectively. The other 39

percent of the respondents said the funds are being used effectively to a certain extent.

Table 3. 18 Effective use of Allocated funds

Q.17 Is it easy to register an FIR with the Police?

First Information Reports (FIR) are registered to report a crime. The process of

registering FIR should be simple to encourage citizens to give the first information report

to the concerned police station. However, it is also reported that the registering process

has its flaws which effects prosecution and investigation27

. Non-registration of FIR is an

offense and can be a ground for disciplinary action against the concerned police officer.

26

https://pakobserver.net/lb-representatives-not-given-power-by-sindh-govt-waseem/ 27

https://tribune.com.pk/story/974777/fir-registration-process-replete-with-flaws-cops-say/

Frequency Percent

Yes 87 22

No 135 34


Total 400 100

22


Yes 55%

No 45%

Figure 3. 19 Ease in registering FIR

In this CRC, we asked respondents whether FIRs can be easily registered easily. In

response to this question, 55 percent responded that it was easy to register a FIRs while

the other 45 percent responded No.

Table 3. 19 Ease in registering FIR

Frequency Percent

Yes 221 55

No 179 45

Total 400 100

Q.18 Are you satisfied with the behavior of police with common people?

In response to this question, 36 percent respondents that they are satisfied with the

behavior of police with citizens, while 33 percent responded No. The other 31 percent

respondents were satisfied to some extent.

Table 3. 20 Satisfaction with police behavior

Frequency Percent

Yes 146 36

No 130 33


Total 400 100

Q.19 In your opinion how can police department be improved?

Citizens can suggest various steps which can improve the performance of police

department. The respondents were given six options as shown in Table 3.21. According

to their replies, induction on merit is the most popular option opted by 33 percent of the

respondents, while political interference and police reforms were the second and the third

highest chosen options.

Table 3. 21 How to improve police department

Frequency Percent

Induction on merit 133 33

End political interference 96 24

Police reforms 87 22

Independent & Autonomous Police 39 10

Need better training 34 8

Need more facilities 11 3

Total 400 100

Yes 36%

No 33%

To some extent 31%

Figure 3. 20 Satisfaction with police behavior

23


Yes 36%

No 24%

To some extent 40%

Figure 3. 22 Citizens feel secure in presence of police

Q.20 Do the citizens feel secure in presence of police?

It is the responsibility of police to maintain law and order which results in the safety and

security of its citizens. The citizens were asked if they felt secure in the presence of

police. In response to this question, 36 percent respondents said that they felt secure, and

24 percent said ‘No’. While 40 percent responded that they feel secure ‘to some extent’.

Table 3. 22 Citizens feel secure in presence of police

The next four questions were added to get citizens feedback on corruption and corrupt

practices.

Q.21 Do you agree that a common man can make a difference in the fight against

corruption?

This question was added to know how a respondent perceives his capacity in the fight

against corruption. In its response, 46 percent said ‘No’ that a common man can’t make a

difference while 32 percent responded ‘Yes’. The other 22 percent responded ‘to some

Extent’.

Table 3. 23 Can a common man make a difference in the fight against corruption

Frequency Percent

Yes 128 32

No 183 46


Total 400 100

Frequency Percent

Yes 144 36

No 95 24


Total 400 100

Yes 32%

No 46%

To some extent 22%

Figure 3. 23 Can a common man make a difference in the fight against corruption

Figure 3. 21 How to improve police department

0 20 40 60 80 100 120 140

Induction on merit

End political interference

Police reforms

Independent & Autonomous Police

Need better training

Need more facilities

Frequency

3%

8%

10%

22%

24%

33%

24


Q.22 Based on your previous experience, which public department is most corrupt?

According to our results, Police department is perceived to be the most corrupt while

Education is the least corrupt department. The second most corrupt department is

Revenue department, while Local Government is at third number. The rest of the details

is shown in table 3.24.

Table 3. 24 Most corrupt departments

Frequency Percent

Police 113 28

Revenue Department 97 24

Local Government 86 22

Health department 41 10

Judiciary 32 8

Education Department 31 8

Total 400 100

Figure 3. 24 Most corrupt departments

Q.23 In which department were you compelled to give a bribe in getting public

services?

The respondents were given six different options. The options included Police, Revenue,

Local Govt., Education, Health and Judiciary department. The result is shown in the

following table.

The department where most of the people had to pay bribe is Police which is mentioned

by 21 percent of the respondents, 20 percent mentioned Local Government Department,

and 19 percent mentioned Revenue Department. The findings suggest that the Education

department is the least corrupt. The findings are consistent with the responses of previous

question.

0 20 40 60 80 100 120

Police

Revenue Department

Local Government

Health department

Judiciary

Education Department

Frequency

8%

8%

10%

22%

24%

28%

25


Table 3. 25 Departments where respondents paid bribe

Frequency Percent

Police 85 21

Local Government 82 20

Revenue Department 77 19

Health Department 59 15

Judiciary 55 14

Education Department 42 11

Total 400 100

Figure 3. 25 Departments where respondents paid bribe

Q.24 According to some people, corruption is not reported. Based on your

experience what is the most common reason?

According to this survey, the most common reason for not reporting corruption is that

citizens think that the complaint receivers are themselves involved in corruption. The

next 31 percent respondents think that there is no use of reporting corruption. 15 percent

respondents do not know whom to report corruption, and 12 percent respondents do not

know where to report corruption.

0 10 20 30 40 50 60 70 80 90

Police

Local Government

Revenue Department

Health Department

Judicary

Education Department

26


Table 3. 26 Reasons of not reporting corruption

Frequency Percent

The complaint receivers are themselves involved in corruption 171 43

There is no benefit to report 86 22

People don't know to whom to report the complaint 46 11

People don't know where to report 40 10

Don't have time to report the corruption complain 33 8

This is public money not government, so it our duty to report 24 6

Total 400 100

Figure 3. 26 Reasons for not reporting corruption

43%

22%

11% 10% 8%

6%

The complaintreceivers are

themselves involvedin corruption

There is no benefit toreport

People don't know towhom to report the

complaint

People don't knowwhere to report

Don't have time toreport the corruption

complain

This is public moneynot government, so it

our duty to report

27


4. Recommendations

Education

1. According to this study, 30 percent respondents said that adequate furniture is not available

in schools. The government should ensure its availability. The school administration should

be responsible and accountable for these assets.

2. The schools, along with the areas surrounding it, need to be kept clean. The administration

should have the budget to deploy proper house-keeping staff.

3. Another facility that schools are missing is availability of washrooms and clean drinking

water. 43 percent of the respondents said schools do not have drinking water facility, while

40 percent said toilets are available. These facilities should be available in all schools.

Health

4. Housekeeping of all health facilities need to be improved. Area around hospitals should be

kept clean at all times. Medical waste should be properly disposed of.

5. Important/necessary medicines/vaccines should be available at all health facilities.

6. Biometric devices and CCTV should be installed in all health facilities to address the issue

of punctuality and ghost employees.

7. Corruption in hospitals should be addressed at priority basis. Anti-Corruption mechanism

should be in place in the hospital for accountability and transparency.

8. Government should improve infrastructure, make available necessary equipment and

diagnostic laboratories at the hospitals, so as to improve the services offered to the citizens.

This will help doctors in the treatment of their patients.

Local Government

9. The local government should address three main problems faced by the citizens; providing

safe drinking water, improve sewage system and improving roads.

10. Reforms are needed to improve the administrative situation of Local Government. There is

also a need to keep a balance of power between provincial and local government.

11. To improve the performance of LG representatives, minimum qualifications of the

candidates should be set. They should also be provided training after the elections.

12. Measures should be taken to improve local government accountability system.

Police

13. The police department should facilitate complainants to register FIR. They should also

punish those officers who intentionally hinder the FIR registration process.

14. A proportion of respondents were not satisfied with the behavior of police with citizens. It

requires further investigation to know its reasons. The police should be trained to be

courteous at all times.

15. The police department should be independent and free from any political influence. The

department also needs a transparent hiring and promotion process.

28


5. References and Bibliography

1. http://www.ansa-eap.net/about-us/who-we-are/the-four-pillars-of-social-accountability/

2. https://www.sdpi.org/media/media_details179-press-2011.html

3. https://www.thebalancecareers.com/the-history-of-modern-policing-974587

4. https://www.dawn.com/news/1410471

5. https://tribune.com.pk/story/1887648/1-law-justice-commission-set-launch-police-reforms-report-today/

6. http://gallup.com.pk/2013-2016-majority-urban-pakistanis-view-police-as-the-most-corrupt-authority-judges-and-magistrates-are-perceived-to-be-the-least-corrupt-world-justice-project-and-gallup-

pakistan/

7. Currie, J. (2009). Healthy, Wealthy, and Wise: Socioeconomic Status, Poor Health in Childhood, and Human Capital Development. Journal of economic literature, 47(1), 87-122.

8. Schultz, T. P. (2010). Health Human Capital and Economic Development. Journal of African

Economies, 19(3), 12-80.


10. https://www.ncbi.nlm.nih.gov/pubmed/28712245

11. https://www.pakistantoday.com.pk/2017/06/07/poor-functioning-at-government-hospitals/

12. http://www.ipripak.org/education-system-of-pakistan-issues-problems-and-solutions/


14. http://dailytimes.com.pk/sindh/28-May-16/sindh-secures-6th-position-in-education-ranking

15. Annual Status of Education Report, ASER Pakistan 2018, p-199

16. https://www.thenews.com.pk/print/123008-In-a-shambles-is-what-education-is-in-Sindh

17. Table 5.1.2, Pakistan Education Statistics 2016-17




21. Undermining Local Governance, A Review of the Sindh Local Government System, 2013

22. Local Government System in Pakistan: Causes of bad Governance of Local Government System,

Journal of Social and Administrative Sciences, vol2, issue 2

23. Introduction to Nursing Research: Incorporating Evidence Based Practice by Carol Boswell, Sharon Cannon Jones & Bartlett Learning, 2011

24. Participant Observation: A Guide for Fieldworkers by Kathleen Musante (DeWalt), Billie R.

DeWalt AltaMira Press, 2010 ⦁

25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808761/

26. https://pakobserver.net/lb-representatives-not-given-power-by-sindh-govt-waseem/

27. https://tribune.com.pk/story/974777/fir-registration-process-replete-with-flaws-cops-say/

28. Annual Status of Education Report

29. Budgets and Fiscal Decentralization: A case study of Sindh

30. Community Policing in Pakistan

31. Factor Influencing Police Image in Public, Pakistan Journal of Criminology

32. Health Profile of Sindh, District Wise 2016

33. Pakistan Education Statistics 2016-17

34. Police Organization in Pakistan, HRCP 2010

35. Revisiting Police Reforms in Pakistan: A Critical Analysis

36. Role of Pakistan Police in Counterinsurgency

37. State of Health Sector in Pakistan 2018

38. Structural Organization of Police: Official Record of the Government of Pakistan Based on Cabinet

Division and Secretariat

39. The Definition and Importance of Local Governance

40. Undermining Local Governance: A Review of the Sindh LG System 2013

https://www.sdpi.org/media/media_details179-press-2011.htmlhttps://www.dawn.com/news/570524https://books.google.com/books?id=R69bnmpadeIC&source=ttbhttps://books.google.com/books?id=ymJJUkR7s3UC&source=ttbhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2808761/

29


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