Why officials who govern public hospitals, schools and transport should have a stake in their quality – and how Pakistan can get there without compulsion

A quiet but pointed question has entered Pakistan’s policy conversation in recent weeks: should the officials who run the country’s public hospitals, schools, universities and transport systems also be the ones who use them? Senator Pervaiz Rashid raised it on the floor of the Senate, arguing that anyone drawing a salary from the public exchequer – from the prime minister to a Grade-22 bureaucrat – should receive treatment in government hospitals rather than private ones. He extended the logic to schooling and daily commuting, and proposed that officials who opted out should face professional consequences, including the loss of their positions. It is a provocative proposal, and it touches a nerve because it names something citizens have long sensed but rarely heard said aloud in Parliament: that the people entrusted with building and overseeing public institutions are frequently the same people who have opted out of using them. When policymakers do not send their children to the schools they fund, or seek treatment in the hospitals they administer, the institutions lose their most attentive and most powerful potential advocates. Senator Rashid’s instinct – that skin in the game changes behaviour – is not a new one in political thought, but it lands with unusual force in Pakistan’s present moment, when public frustration with service delivery runs deep, and trust in state institutions is fragile.

Senior officials who choose, without compulsion, to send a child to a public school or seek routine treatment at a government hospital send a signal that no legislation can replicate: that they trust what they administer.

Senior officials who choose, without compulsion, to send a child to a public school or seek routine treatment at a government hospital send a signal that no legislation can replicate: that they trust what they administer.

Strip away the headlines, and the proposal rests on a simple accountability logic: officials who set the budgets, appoint the staff and design the policies for public hospitals, schools and transport are also the ones........

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