When I was doing research for my book that looked at the issue of counterfeit and substandard drugs, I kept coming across the term “trust”. For a purely technical topic, it was an intriguing and unusual concept that appeared in conversations, public sentiment, corporate strategy and even policy documents. A senior executive of a top American pharmaceutical company once told me, how he looks at the problem of quality of medical products. He said his strongest strategy against counterfeiting is not a technology, or some elaborate mechanism, it is simply, the name of the company, because people know (and expect) the products of this company to be good. A similar sentiment was echoed by a former CEO of another leading American pharma brand who famously remarked that the just the logo of the company is worth at least one-fourth of the entire company (valued in tens of billions). As I did interviews, looked at archives and did field work, I found that this concept of trust, while nearly impossible to measure quantitatively, is intimately connected to our behaviour and ultimately to our health. Trust, it turns out, is not in the product, but ultimately in the institution that produces that product.

This concept of trust, in the institutions, is what we need in post-elections Pakistan. Whether it is the government, judiciary or the ECP, the distrust in institutions compromises the products that they produce and ultimately that leads to poor acceptance of those products. The new government has to rebuild that trust and not just in the election process but across the government sector. In my work on drug quality and pharma, I found that building and sustaining trust rests on three pillars. First, gradual growth from a small set of products and initiatives. Second, consistency across the product line, and third, consistency across time. Let us evaluate these in the context of institutional performance and what lessons it may have for the new government.

Growth from a small set of initiatives means that choosing a few things and delivering an outstanding product in those. This means avoiding making bombastic and unrealistic claims, but instead focusing on a few key things and doing everything to make sure that they are of the highest quality. This may be in education or health, electricity or hygiene, police reforms or infrastructure, but it has to be focused and measurable. Trying to do too much, and doing so with abstract indicators does not build broad trust.

Second, consistency across product line means that every initiative that the government undertakes has to have the same high quality. This is connected to the first point that as the set of initiatives grows, the quality and performance of those should be held constant. This is one of the most difficult challenges for any institution, but central to building trust in that institution. Thus, a reform in health, environment, education or the police should be held to the same standard of quality, transparency and delivery.

Third, and perhaps the single most important factor in building trust in an institution is consistency across time. Over the course of the next five years, any new initiative or reform, any rebuilding or restructuring that impacts the public has to remain constant in its high quality. Trust maintenance, therefore, requires both quality assurance and quality control, it needs internal and external checks, and demands continuous investment. This is where institutions in Pakistan (public and private) tend to suffer the most. They start off strong, with a bang, eg, a new judicial reform, a new government initiative, etc, and deteriorate rapidly, therefore eroding the general trust in the institution.

Building and maintaining trust is expensive, but ultimately the single biggest metric of long-term success and sustainability. If the new government is able to build trust, it would create lasting institutions that are able to withstand the political tremors of vested interests.

Published in The Express Tribune, July 31st, 2018.

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