The article wants to pose a teaser for the readers: Why, even in areas where we are already good, have we not been able to create global enterprises or enterprises whose ambitions are global.
There are doctors, working especially in the English speaking countries, who are Pakistani or of Pakistani origin. England has many as do the United States and Canada, and I am sure there must be some in Australia. And there are quite a few working in the Gulf. Amongst them there are doctors who have graduated from excellent medical programmes, work in some of the best hospitals, have solid reputations and some even stellar ones, and there are quite a few who are considered to be the leading lights in the areas they work in. Though I do not know the field very well but still I know of at least 3 world class oncologists, a couple of brilliant orthopedic surgeons, some brilliant cardiologists and some very accomplished internal medicine physicians.
Many of the senior doctors working in Pakistan have also come back after their studies from abroad or after working in places such as the UK and USA. Many even continue to maintain their outside connections and go every summer to work in hospitals abroad.
Some of these doctors have even opened up hospitals in Pakistan. But here is the intriguing part. Though these doctors come with all of the qualifications and accolades mentioned above, they have nonetheless chosen to open hospitals that might be considered to be good in Pakistan but are not of top international standards.
To put it another way, if Singapore, Malaysia and India can develop an international clientele for health services, why, despite our impressive stock of doctors, are we unable to do that? Or why are we unwilling to aim big and think of global markets?
It is convenient nowadays to blame everything on law and order conditions in the country and say who would want to come to Pakistan. But where this might have validity for tourism, it does not apply as readily to healthcare. If treatment was of high quality, but service prices were at Pakistani levels, people are likely to find it attractive enough. Many come from the Gulf for hunting and some come for kidneys. If the services are good value for money, people will come. So why dont we have a health city outside Lahore or near Islamabad?
Even the best for-profit hospitals in Pakistan have far from stellar reputations. In some cases, they have a very uneven reputation and there are too many allegations of being mercenaries on them. Apart from that, hospital care is not anything to write home about. In my few visits there I found cleanliness standards to be poor and uneven and emergency room standards to be poor; the bedside manners of the doctors I met were quite ordinary and the general attitude of the staff was also average. There is too much emphasis on billing and not enough on looking after the best interest of the patient. And friends tell me that the standard of post-operative care is also not good. If this is the condition of the best the private sector has to offer, how can we expect to win international clients who have many competing options?
Why are doctors at this level not aiming higher? And the medical profession is not the only example we have or could think of. Pakistan, supposedly, grows some of the best citrus fruits in the world. And the world demand for oranges and orange juice and concentrate is substantial. And yet we do not have a presence on the international level. Even though we have the Shezans and Mitchells, local companies who have been in the juice business for more than a few decades, they are not international brand names. Why are they happy with being local players? And even if they are, why has it not been possible for other local players to enter the market. Shezan was set up as a joint-venture between a Pakistani and a US firm, and one of the aims was to look at exports. But the Pakistani owner bought all the shares from the US partner and it became a Pakistani firm and now exports is not the driving force of the vision or mission of the company.
Clearly there are some barriers here that we have not been able to surmount. Are these the barriers that investment climate and business climate reports talk about: high cost of inputs, poor legal structure, uncertainty, law and order, corruption and such issues. Or are these barriers different. Are there limits to our imagination and limits to what we want to achieve? Some of the most successful entrepreneurs across history did not just want to make money, they loved what they were trying to do; they loved ideas and the thrill of putting them into action, and wanted to do something worthwhile. They had objectives other than money. Are our issues related to our culture and limited vision?
Successful survival in a global world requires us to be competitive. Even if globalisation is not the driving force, if we want to export we have to become competitive internationally. But it seems our businesses tend to focus on local markets and aim for meeting local demand only. Some industries of course thrive on exports: textiles. Here one can understand that making it big requires building brand names and that is costly. Even China has had problems with that. But areas where we have large advantages, and where we could go global, we are not exploring these. We need to better understand why.
The writer is an Associate Professor of Economics at LUMS (currently on leave) and a Senior Advisor at Open Society Foundation (OSF). He can be reached at fbari@sorosny.org