Archive for February 23rd, 2010

Telenovela Pakistan

Confrontation. Show-down. Crisis. Judicial coup.

Those were just some of the saucy terms used to describe Pakistan’s recent row last week, when President Asif Ali Zardari named judges to be appointed to Pakistan’s Supreme Court and Lahore High Court without first consulting Chief Justice Iftikhar Chaudhry. The Supreme Court called the move unconstitutional and blocked it, sparking conflict and rumors of impending “crisis” and instability. The row was cut short when Pakistan’s very own political magician PM Yousaf Raza Gilani came to the rescue, announcing the government “would go along” with the Supreme Court’s recommendations, assuring all of us, “It is completely over.”

Ha, that’s what you think, Jadoogar.

AP: "Mwahahaha." *Twirl, twirl.*

If there’s one thing about Pakistani politics, it’s that it’s anything but boring. In fact, the machismo-infused, handlebar-twirling scenarios are more comparable to a Mexican soap opera than a democratically elected government. Just when we think stability is restored, we tune into yet another episode of grown men screaming, cackling, switching alliances, and in some cases, crying. Because let’s face it. Zardari and Chaudhry are two burly moustached men who just can’t get along. As Dawn columnist Cyril Almeida noted last week, “The trend that the latest row fit into and the manner of the détente suggest that inevitably there will be another clash. The details of any given eruption or paroxysm aren’t all that important anymore.” The Chief Justice may have been the symbol of Pakistan’s judicial crisis, but his arguably politicized judgments and trump cards make him a far cry from a judiciary’s objective poster child. In fact, he is, according to some accounts, a key ally of Nawaz Sharif, who recently called Zardari “the biggest threat to democracy,” though the PML-N leader did tell reporters after a recent meeting with Gilani that this criticism wasn’t “personal.” Hmmm right.

In in the latest episode of Telenovela Pakistan, Finance Minister Shaukat Tarin resigned from his position “in order to focus on his business.” According to the Wall Street Journal, “Mr. Tarin said he will now work for Silkbank, a private bank in which he’s a major shareholder.” However, despite this statement, the development came on the heels of rumors that it was instead sparked by policy differences with the government. The Financial Times cited a source close to Tarin, who said his resignation “has to do with the government once again dragging its feet on a [tax] clampdown…They just don’t understand. You can’t allow tax dodgers to go free. This is a massive setback for Pakistan’s economy.”

As the drama continues, don’t forget about the figures on the sidelines. Because in every deliciously bad soap opera, exited characters are never gone forever. They are inevitably waiting in the wings, twirling their handlebar moustaches and cackling madly. Cue former President Pervez Musharraf, properly moustached out and undoubtedly smirking at the current state of affairs. In the below interview with CNN, he discusses his increasing Facebook stardom [see this former CHUP post], noting, “It is THE Facebook that provides the connectivity to collectivize all [my] support.” On the current situation and whether he’ll return to Pakistani politics, Mush vaguely responds, “At this moment, Pakistan is not doing well. So if I can contribute anything to the country and if the people want me to contribute, then I’d certainly like to look into that.”

Translation: THE Facebook. Take me home.

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In the United States, the debate over health care reform is still raging. In Pakistan, there are approximately 40 million low-income employees and family members. 99.3% of this population is uninsured and 97% of their health care expenses are out-of-pocket. Enter Naya Jeevan, (meaning “New Life” in Urdu), a social enterprise dedicated to providing urban low-income families affordable access to quality, catastrophic health care. Founded in October 2007, the organization utilizes an innovative micro insurance model to promote a vision of collective social responsibility, fostering “scalable partnerships with corporations, schools and individuals that employ low-income individuals, to leverage an existing, quality inpatient and ER-trauma health care delivery system.” Below, CHUP sits down with Naya Jeevan founder and CEO Asher Hasan:

Q: What is the current state of health care in Pakistan? What are the biggest obstacles facing low-income families in accessing health care?

There is a slow but emerging private health care system in Pakistan which is fairly high quality and meets international hospital standards (such as Shaukat Khanam in Lahore). Pakistan’s public health care sector, in comparison, is under resourced and overwhelmed. Most physicians in the public sector only show up at hospitals or clinics for one to two hours a day because of a lack of financial incentives and a lack of resources (in terms of medical equipment and auxiliary care).

The biggest issue for low-income families is affordability, particularly in terms of catastrophic health care (pertaining to large medical expenses for illnesses like cancer, pregnancy complications, etc.). Therefore, though families are conceptually entitled to free health care in the public sector, in practical terms they end up having to borrow money to take care of costs related to medical supplies, equipment, lab tests, and medicines. So their access to health care is subsequently impacted.

Q: What has the journey been to forming Naya Jeevan? What have been your biggest challenges and successes?

I was trained in surgery before I began working in biotechnology. I kept coming back to Pakistan on a yearly basis, and it struck me that we had to do something that was institutionally transformational in Pakistan. At the time I was thinking about Naya Jeevan, I serendipitously met Irum Musharraf and Saad Tabani who came to form the founding team of Naya Jeevan. Our ideas gelled and we set up a social enterprise that tried to attack the problem of affordability and quality health care in Pakistan for low-income families.

Our biggest challenge has been the restrained access to the kind of capital we need to become truly have a social impact. We would ideally like to raise much more growth capital. Another challenge has been establishing trust and credibility, since in Pakistan you’re often guilty until proven innocent. In the beginning, a lot of our potential clients engaged in watchful waiting. We are now beginning to see the results of patience, with our involvement rate accelerating significantly this year.

Naya Jeevan has been successful at adapting quickly to changes in the global economy, especially given that investor appetite has changed. Our visibility has been great and we have been invited to forums like the Clinton Global Initiative and received recognition like the TED fellowship. Moreover, our low-income beneficiaries feel that we are making a difference in their lives, which has been incredibly rewarding.

Q: According to your website, Naya Jeevan “offers its insurance program at subsidized rates under a novel national group health insurance model (underwritten by Allianz-EFU and IGI Insurance).” Could you tell us a bit more about this innovative approach to health insurance? How do you market these rates to urban low-income families?

One of our biggest innovations has been the structure and introduction of an HMO [Health Maintenance Organization] for the marginalized in Pakistan. We leveraged what was already on the ground and what was working for 600,000 lives in the private corporate sector, and expanded it to include a much wider potential target market of 40 million Pakistanis in the urban sector.

Naya Jeevan approached Pakistan’s major underwriters with a proposal that took what they were doing and customized a health plan that targeted a much larger group of low-income individuals who have historically been ignored by health insurance companies – including domestic household staff, contract workers, low-income workers in corporations and their families. In the past, companies have focused on the top of the pyramid, the corporate elite. We inverted that pyramid and told them to focus on the base because it is a much larger population. As long as costs are shared, it is a win-win for all stakeholders.

Another one of our innovations is our distribution system. Instead of going door-to-door to individuals, we are going to their employers, taking a more centralized approach and leveraging these organizations as distribution networks to reduce cost of collection and cost of distribution. Because employers do have an understanding of what health insurance is and their benefits,  it is much easier to convince them to purchase health insurance on behalf of their employees. In comparison, employees may not have as much of a comprehensive understanding. Naya Jeevan can therefore access low-income people through this distribution network.

Naya Jeevan’s fundamental premise is that a critical mass of employers in Pakistan (at an individual or institutional level) are philanthropic.  We discovered that many corporations either through CSR initiatives or through employee funds, pay for the healthcare, education, wedding, funeral expenses of the low-income staff affiliated with these organizations.  We sit with HR and finance managers, open their books and work out current health care cost as compared with the umbrella protection of health insurance coverage.  Such encounters drive our sales.

Q: Where do you see Naya Jeevan in the next year, five years, and ten years? Is it a model that you hope can be replicated in other developing countries?

We designed our organization to be scalable, sustainable, replicable and globalizable. Naya Jeevan is a social enterprise meant to be sustainable once it hits 100,000 insured lives. That has always been part of the philosophy  – to expand aggressively to other emerging markets. So many emerging countries have social hierarchical systems and health care issues similar to Pakistan, such as Brazil, South Africa, and the Palestinian Territories. We plan to expand this model to other countries. India is next up on the cards,  and we have already had discussions and done market research. That is our next target country and we hope to expand Naya Jeevan there by 2011 or early 2012.

In the next five years, we hope to expand to five continents – North (Mexico) and South America, Africa, Asia, and Europe. And in the next five to ten years, we hope to hybridize into a two-tier model consisting of a non-profit wing focused on low-income families and a for-profit arm targeting the upper class and the “missing middle,” individuals who are vulnerable but still have a purchasing capacity. There is a healthy opportunity for a for-profit enterprise that could enhance the non-profit side.

To learn how to get involved or donate to Naya Jeevan, click here. Below is Asher’s presentation at TEDIndia 2009, where  he relayed a message of peace from Pakistan:

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