Pakistan: Growth Set Back by Structural Rigidities

This article has five parts. The first provides an overview of major structural weaknesses in the Pakistani economy—I call them faultlines. The following three parts describe the programme of stabilisation and structural reform introduced by the caretaker administration of Prime Minister Meraj Khalid. This government was in office for 104 days, from November 5, 1996 to February 17, 1997. On February 17, the government headed by Prime Minister Mian Nawaz Sharif took office. The fifth part provides a brief assessment of what lies in Pakistan’s future if the problems created by delayed structural reforms are not addressed adequately and on time.

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Development Strategies for Poverty Alleviation

Whereas in the 1970s, there may have been grounds for cautious optimism with respect to poverty alleviation, welfare and redistributive policies were severely battered by macroeconomic conditions in the first half of the 1980s. In many, perhaps the majority of less-developed countries, modest gains in improving income distribution or containing poverty slipped away, and there is little evidence that the ground has been retrieved over the past four years

Employment Creating Urban Public Works Programmes: Outline of a Strategy

The principal concern of this paper is to examine the feasibility of using Public Works Programmes (PWPs) as a strategy for solving the problem of under-utilisation of labour in the urban sector. A number of hypotheses are implicit in this analysis and it would be appropriate to list them here. First, despite fairly large investment in family planning programmes, we do not expect any reduction in the rate of growth of population in most countries of the developing world in the foreseeable future; at any rate, not in the next two to three decades. Second, we do not expect any major structural changes in their economies—changes that would permit the solution of the problem by shifting the surplus labour from the rural to the urban sector. This implies that efforts to solve the problem would have to be made primarily in the rural areas. Third, recent developments in agricultural technology notwithstanding, it does not seem possible that the problem can be solved simply by reordering production relation¬ships in the rural areas. Some investment in short term employment generating programmes seems necessary. Fourth, even when new production relationships in agriculture are supplemented with public works programmes, the problem of enemployment cannot be solved. This is because of the spill-over of the unem¬ployed from the rural to the urban areas. Fifth, the urban sector is even less ready to tackle the problem of unemployment than the rural sector. In this sector, reordering of production relationships to accommodate more fully the relatively more abundant factor (labour) is considerably more difficult. There¬fore, there is some need for investment in Urban Public Works Programmes (UPWPs). Finally, while it is feasible to use PWPs in the urban sector for solving the problem of unemployment, their effectiveness is limited to a few areas and they can provide benefit to only a few socio-economic groups

Pakistan: Growth Set Back by Structural Rigidities (The Quaid-i-Azam Memorial Lecture)

This article has five parts. The first provides an overview of major structural weaknesses in the Pakistani economy—I call them faultlines. The following three parts describe the programme of stabilisation and structural reform introduced by the caretaker administration of Prime Minister Meraj Khalid. This government was in office for 104 days, from November 5, 1996 to February 17, 1997. On February 17, the government headed by Prime Minister Mian Nawaz Sharif took office. The fifth part provides a brief assessment of what lies in Pakistan’s future if the problems created by delayed structural reforms are not addressed adequately and on time