1. Pakistani Healthcare in a poor form
Sifarish
Pakistani Healthcare in a poor form

2. Scope
Case Study of North West Frontier Province, Pakistan (Khyber Pakhtunkhwa)
Health Services Quality
Contextual factors that influence mechanisms for quality improvement

3. Nurses situation in district hospitals
Dust at base of tap
No soap
No hand towels
No guideline for washing hands
No water
Not separated indicting poor
hygiene

6. Key Health System Issues
Critical shortage of health service providers
But not sure of the numbers (3 doctors/1 nurse)
External and internal brain drain (rural & donor)
Urban/rural discrepancies
Increasing reliance on paramedical and ‚ward boys‘
Weak regulatory framework
Limited registration of health facilities and providers with lack of regulatory mechanisms
Professional groups weak influence on members
Corruption
Political interference in transfers and postings
Private medical schools proliferating without transparent processes

8. Corruption Routes
Uncertainty about what services should be delivered and at what level of quality
Involvement of private and public actors like payers, providers, suppliers, consumers, and regulators
Asymmetric information among different actors and their individual interests
Extent to which private providers are entrusted with important public roles

9. Corruption
The abuse of entrusted power for private gain (Transparency International)
According to rule- corruption where payments/bribe is paid to receive preferential treatment for something that the bribe receiver is required to do by law.
Against the rule: Where a bribe is paid to obtain services that the bribe receiver is prohibited from providing.
IMF and World Bank define corruption as misuse or abuse of public force (office) for private gain

10. Sifarish
There is consistency in the practice of Sifarish (patronage, nepotism, favouritism)
It was identified as a system, with specific practices which are not described or prescribed
Those who reported on Sifarish usually described harmful results of the practice

11. Culture and Corruption
Variations of levels of Corruption may be due in part to variations in the social norms and preferences that have been internalized by the citizens of that country
( Barr & Serra 2006)
Barr A. & Serra D Culture and Corruption. Global Poverty Research Group accessed on 21 June, 2010

12. Sifarish – a moral system?
It is a moral system which is accepted and those participating are often not aware of the practice
Morality can be defined as: a system of rules for guiding human conduct, and principles for evaluating those rules
Individual acts within a cultural and social system

13. Sifarish implications
If Sifarish is not recognized as part of the moral fabric of the cultural system and understood as such then, how can we develop tools which will maximize accountability and transparency?

14. What can we do?
Recognize that it is a social norm, a pattern in society and not simply an individual act
Include transparent discussion of the different kinds of acts and their results
Discuss the concept of harm to society and encourage research on not only corruption but also related topics such as Sifarish