The history of policy

Not far from the offices of the Pakistan Secretariat in Islamabad and from the new offices of the Ministry of Health, is a dilapidated building. The architecture is intriguing and perhaps in years gone by it would have been a place to visit. Not anymore. The windows are shattered, the roof ready to cave in, the bird droppings and nests are aplenty, and the overall feel brings it closer to a Halloween haunted house than a state institution. The building of the national archives is in shambles and the condition of the institution is shameful. The inside paints an equally eerie picture of neglect and disdain. I have worked in state and national archives in a dozen or so countries for my work studying access to health, and how policy is crafted, but never have I seen anything like this. It should trouble us but it does not. Perhaps it is not surprising given how much we value our history.

Our relationship with our own history is fragmented and curated. Plenty of redlines around. Scholars and citizens are unable to write much on one of the most defining moments of our history, the 1971 war and its aftermath, as the documents remain inaccessible. What little sanitised version is available in the national archives is housed in a place that is anything but sanitary.

The problem is not just with the national archives or material considered sensitive related to national security. It is with the attitude of the public-office holders, and our public, towards history. In the last seven years, I have had numerous conversations with officials at various levels of federal and provincial health ministries, trying to figure out the history of our health policy. It was for a broader understanding of how we decided on a certain framework of our health system, determined which drugs to import and when and how we chose certain companies to work with. What I often found from bureaucrats was rumours, gossip and conspiracy theories with no documentation to back up. I was also given leads which were dead-ends and often non-sense. Worst, I was told that my quest was futile. The message was: why does it matter how we did things in the past? What matters, I was told, is what we do in the future. In a paternalistic tone, senior officers told me that as a scientist I was wasting my time and theirs, asking about things that were done in the past. The verdict on my quest was that the world has moved on, so should I.

The field of history of health and science and associated policies does not exist in the country. There is little interest in analysing science and health policy with a historical lens. Reflection on health policy requires historical records that do not exist, and an attitude that is looked down upon. Science and health are viewed as disciplines of the future, not areas influenced by prior decisions. Policies of the past are viewed not from a historical lens, but an ideological one. The future planning is, therefore, impulsive and subjective, not based on a rigorous analysis. There is little reason to believe that this is going to change anytime soon.

Some may ask why the history of policy matters when there is inflation, shortage of flour and sky high prices of sugar. All these issues are acute, but unfortunately we have seen this horror movie of assault on the poor before. A reading of history should tell us what not to do. It is however unlikely. A quick trip to the national archives will tell what we think of history, and why it is impossible to learn from it.

Published in The Express Tribune, February 11^th, 2020.

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