New Local Government System: A Step Towards Community Empowerment?

Failure of the central/provincial governments to adequately capture local preferences and provide basic services strengthened the case for a new local government system for delivery of public services along with the authority to impose fees, taxes, user charges, etc. to finance these services. The new System aims at transferring political, administrative and fiscal powers1 from higher tiers of the government to lower tiers (Figure 1) in order to bring governments closer to common citizens for greater accountability and better understanding of the needs and preferences of people. National Reconstruction Bureau (NRB) was entrusted the task of designing a local government system which presented its first blue print in the form of “Devolution Plan 2000”. As a result of this exercise a new Local Government System has been installed in Pakistan on 14th August 2001 after the promulgation of Local Government Ordinance 2001 by all the four Provinces. The new System comprises a District Government or a City District Government and Zila Council in a district, Tehsil Municipal Administration and Tehsil Council in a tehsil (a Town Municipal Administration and Town Council in a town in a city district) and Union Administration and Union Council in a union. Village/Neighbourhood councils provide an interface with the lowest tier of the Local Government (Union Administration) with the community.

New Local Government System: A Step Towards Community Empowerment?

Failure of the central/provincial governments to adequately capture local preferences and provide basic services strengthened the case for a new local government system for delivery of public services along with the authority to impose fees, taxes, user charges, etc. to finance these services. The new System aims at transferring political, administrative and fiscal powers1 from higher tiers of the government to lower tiers (Figure 1) in order to bring governments closer to common citizens for greater accountability and better understanding of the needs and preferences of people. National Reconstruction Bureau (NRB) was entrusted the task of designing a local government system which presented its first blue print in the form of “Devolution Plan 2000”. As a result of this exercise a new Local Government System has been installed in Pakistan on 14th August 2001 after the promulgation of Local Government Ordinance 2001 by all the four Provinces. The new System comprises a District Government or a City District Government and Zila Council in a district, Tehsil Municipal Administration and Tehsil Council in a tehsil (a Town Municipal Administration and Town Council in a town in a city district) and Union Administration and Union Council in a union. Village/Neighbourhood councils provide an interface with the lowest tier of the Local Government (Union Administration) with the community

Self-reported health and smoking status, and body mass index: a case-control comparison based on GEN SCRIP (GENetics of SChizophRenia In Pakistan) data

Introduction Individuals with schizophrenia are at a high risk of physical health comorbidities and premature mortality. Cardiovascular and metabolic causes are an important contributor. There are gaps in monitoring, documenting and managing these physical health comorbidities. Because of their condition, patients themselves may not be aware of these comorbidities and may not be able to follow a lifestyle that prevents and manages the complications. In many low-income and middle-income countries including Pakistan, the bulk of the burden of care for those struggling with schizophrenia falls on the families.Objectives To determine the rate of self-reported physical health disorders and risk factors, like body mass index (BMI) and smoking, associated with cardiovascular and metabolic disorders in cases of schizophrenia compared with a group of mentally healthy controls.Design A case-controlled, cross-sectional multicentre study of patients with schizophrenia in Pakistan.Settings Multiple data collection sites across the country for patients, that is, public and private psychiatric OPDs (out patient departments), specialised psychiatric care facilities, and psychiatric wards of teaching and district level hospitals. Healthy controls were enrolled from the community.Participants We report a total of 6838 participants’ data with (N 3411 (49.9%)) cases of schizophrenia compared with a group of healthy controls (N 3427 (50.1%)).Results BMI (OR 0.98 (CI 0.97 to 0.99), p=0.0025), and the rate of smoking is higher in patients with schizophrenia than in controls. Problems with vision (OR 0.13 (0.08 to 0.2), joint pain (OR 0.18 (0.07 to 0.44)) and high cholesterol (OR 0.13 (0.05 to 0.35)) have higher reported prevalence in controls. The cases describe more physical health disorders in the category ‘other’ (OR 4.65 (3.01 to 7.18)). This captures residual disorders not listed in the questionnaire.Conclusions Participants with schizophrenia in comparison with controls report more disorders. The access in the ‘other’ category may be a reflection of undiagnosed disorders