CCBs Contribution in Health Sector to the People of Sindh: Mirpurkhas & Hyderabad

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INTERDISCIPLINARY JOURNAL OF CONTEMPORARY RESEARCH IN BUSINESS

COPY RIGHT © 2012 Institute of Interdisciplinary Business Research 968

AUGUST 2012

VOL 4, NO 4

CCBs Contribution in Health Sector to the People of Sindh:

Mirpurkhas & Hyderabad

Dr. Mustaghiz-ur-Rehman, Vishnu Parmar and

Rizwan Raheem Ahmed

SZABIST - Karachi

Abstract

The main objective of the study was to identify the awareness and effectiveness of CCBs in

health sector in two districts in Sindh, namely, Hyderabad and Mirpurkhas Elected

representatives, Government functionaries, Beneficiaries of CCBs, Body of CCBs, as well as

Common People were obtained thru a questionnaire and personal interviews. Convenience

sampling was used in obtaining the data.

This is exploratory-cum-descriptive research based upon both primary and secondary data.

Descriptive statistics as well as qualitative analysis was utilized to analyze the data. Secondary

data has obtained mainly from the publications of National Reconstruction Bureau, Devolution

Trust for Community Empowerment (DTCE), Newspapers, existing research publications and

internet as well. The primary data has been gathered through the personal interviews from the

respondents based upon semi-structured questionnaires.

The main finding of the study was that the awareness level is high in district Mirpurkhas than

Hyderabad. The major reason was the role of DTCE. District Mirpurkhas is one among the five

selected districts of Sindh selected by DTCE. The awareness level has increased among the

people of Mirpurkhas through a mass awareness campaign by DTCE and Local District

Government of Mirpurkhas. The effectiveness of CCBs in the health sector is more significant in

Mirpurkhas as compared to Hyderabad. The available health facilities in rural constituencies of

both districts are very poor. The death rate is enough high due to unavailability of dispensaries

and medicines over there. Poor people cannot afford the expensive private clinics and hospitals

in urban areas while the pathetic conditions of government hospitals in main cities do not

provide any relief to them.

Key Words: Citizen Community Boards (CCBs), Contribution in Health Sector, and

Community Empowerment

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1. Introduction

The present global changes are affecting everyone. The new scientific technologies and social

theories have changed the human life in a big way. Researches in Management Sciences, social

sciences and economics have opened several new dimensions in social livings. The past forty

years have seen a significant improvement in quality of life especially among developing

countries: life expectancy has increased by 50%. Infant and child death rates have been cut by

half, the percentage of children starting school has risen from less than half to more than three

quarters, despite doubling of population and the percentage of rural families with access of safe

water has risen from less than 10% to almost 60%, and the per capita income has doubled in the

last 25 years [1]. Besides these human victories, the existing problems of developing countries

are alarming the prosperity of the future. The essentials of life are much beyond from several

people in the developing world. Poverty is a big challenge today, in 2000; an estimated 113

million children worldwide between the ages of 6 and 11 did not attend the school. More than a

billion people still struggle to survive on less than a dollar a day. Child mortality rates in

developing countries are still ten times higher than in the developed countries. Seven million

people still die every year from easily preventable diseases, incomes in the countries with the

riches 20 per cent of world population grew nearly three times faster than in those countries with

the poorest 20 per cent [2] Families around the world are under sustained and tremendous stress.

Economic and political transformations in many parts of the globe, disease, war, poverty, famine

and other such forces are taxing them, often beyond their ability to cope. Such pressures are

clearly not confined to the developing world as seen by the pressures generated in families by

unemployment, drugs, crime, and AIDS [3]

All the development practitioners, government officials and international donors that local

authorities play an increasingly proactive role in participatory development agree it. The “World

Bank Report (2003)[4] strongly supports devolution for ‘making service delivery work for the

poor’. The outgrowth of decentralization literature has emphasized Local Government as a way

and vehicle for good governance and participatory development [5].

After independence, Government of Pakistan has stipulated three local government ordinances.

The concept of devolution of powers to the grass roots was promulgated by the Local

Government Ordinance 2001, which contemplated community participation mechanisms through

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multi-stage elections to multi-tiered local bodies. The new administrative reforms lead to the

creation of three levels of local government: unions, tehsils and districts, a chain of new offices

created mainly to facilitate “transparency” to and “participation” of the general public.

1.1 Background of the Study

Decentralization refers to the structuring or reorganization of authority so that there is a system

of co-responsibility between institutions of governance at the central, regional and local levels

according to the principle of subsidiarity (i.e. the local authorities will have the authority and

responsibility to address all problems that are, in their determination, with their ability of solve),

thus increasing the overall quality and effectiveness of the system of governance, while

increasing the authority and capacities of sub-national levels [6].

Devolution is the transfer of resources and power to lower level authorities, which are largely or

wholly independent of higher levels of government [7]. The present devolution plan in Pakistan

is a result of global trend. Several developing countries of Latin America, Europe or East Asia

have introduced this plan [8]. It serves the basic need of political stability-decentralization by

delegating the political powers from federal to local elected politicians. Political scientists

suggest that this is an outcome of the declining credibility of the centralized state.

Decentralization is expected to achieve higher economic efficiency, better accountability large

resource mobilization, and lower cost of service provisions and higher satisfaction of local

preferences. This devolving plan improves the match between the mix of services produced by

the public sector and the preferences of the local population. It transfers the fiscal resources from

richer to poorer areas and leads to an increase in the quantity and quality of expenditures in these

areas [9].

1.2 Problem Statement

For the last six years, the newly established local government system is in operation, which

provides the services to the community at the doorstep through power devolution from top to

bottom. It is now right time to evaluate the performance of CCB’s (one of the community’s

participation constitution in local development) in health sector in two districts of Sindh:

Hyderabad and Mirpurkhas.

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1.3 Focus of the Research

This study is focused on the performance of CCB’s in health sector in two districts of Sindh

province: Hyderabad and Mirpurkhas. This research paper has evaluated the awareness of CCBs

among people, effectiveness of CCB's, participation of local people, and functioning areas of

CCBs in health sector.

2. Previous Research

2.1 Historical Perspective of Local Government

Local governments have existed in the Indian subcontinent for many centuries, with the first

municipal corporation set-up in Madras in 1688 by the East India Company. In 1842, the

Conservancy Act, which leads to the formation of sanitary committees for garbage disposal,

became the first formal measure of municipal organization, which applied to the Bengal

Presidency. In Karachi, the Board of Conservancy was established in 1846, while in Lahore and

Rawalpindi; the Municipal Act was passed in 1867. Subsequent important events were Lord

Ripon's Resolution on local self-government in 1882, which allowed for the provision of some

elected members in municipal committees and proposed the establishment of rural local

governments. The 1907 Decentralization Commission recommended the appointment of non-

official Chairmen of municipal committees, a recommendation which was endorsed and

extended further by the 1925 Simon Commission set up to assess the performance of local self-

government. The 1935 Government of India Act allowed provincial autonomy and permitted

provinces to frame legislation on local government systems [10].

In 1947 the areas that constituted Pakistan had few developed systems of local government and

they were confined mainly to Punjab. The period 1958 to 1969 saw the development of an

extensive elected system of local government by the first military government of Pakistan. The

military government gave rise to the Basic Democracies System providing for a new local

government system across the country through which members were elected. Under the Basic

Democracies Ordinance of 1959 Town committees were expected to perform 37 functions

ranging from measures for promotion of social welfare and health to the maintenance of

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infrastructural facilities. Urban areas consisted of union committees that had six to ten elected

members. The Chairman of the union committee was elected as an ex-officio member of the

municipal committee. Union committees were deprived of fiscal powers of any sort. While all

the Chairmen of union committees were members of the municipal committee, Commissioners

appointed by the provincial government or the Chairman of the municipal committee itself. In

rural areas, the first tier of government was the Union Council that consisted of a group of

villages. Like urban areas, each Council elected a Chairman from amongst its members who

served as the executive head of the committee. Like town committees, Union Councils also had

37 functions assigned to them. The Chairmen of the Union Councils in an area constituted

collectively a higher Council, the Tehsil Council, which did not perform any executive functions.

Its main function was to coordinate the activities of Union Councils and Union Committees in its

jurisdiction.

The Basic Democracies system closed with the fall Ayub Khan’s regime. The first Martial Law

Government was the pioneer in devising an extensive system of local government it was the

second Martial Law Regime of General Zia that implemented elected local governments. These

were revived in 1979 under the provincial local government ordinances, which, with

amendments, was in operation till 14th August 2001 in Pakistan. Under this ordinance, there

were four levels of municipal government in the urban areas: town committees, municipal

committees, municipal corporations and metropolitan corporations. Members of the council elect

the senior officers of these councils and the controlling authority was the elected house. There

was a three-tier system of local government in operation in Pakistan in the rural areas, where

Union Councils, Tehsil or Taluka Councils and District Councils were supposed to exist [11].

2.2 The New Local Government System 2001

The present government of Pakistan, sensing the obvious shortcomings of local government

system under Ordinance of 1979 and putting the country on the road of democracy came up with

a new local government plan. The plan integrates the rural with the urban local governments on

one hand and bureaucracy with the local government on the other. In this system district

administration and police are answerable to the elected Chief Executive of the district. Citizen

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monitoring of the affairs of governance through elected representatives, the civil society's

involvement with development activities and system of effective check & balances.

Local governments are formed on three levels District, Tehsil & Union Council level. They are

based on five fundamentals devolution of political power, decentralization of administrative

authority, decentralization of management functions, and diffusion of power authority nexus and

distribution of resources at different levels. Elections were held in August 2001 under the new

local government Ordinance. Elected Local governments have been successfully setup at all tiers

and devolution of administrative, bureaucratic and financial resources one at the final stages. The

Local Governments have successfully completed their tenure and new elections of Local

Governments were held in year 2005. A major paradigm in shift has taken place after devolution

plan 2001. Powers have been decentralized at grass roots level, which enhanced efficiency and

effectiveness.

Today 96 District Councils have vertical linkage with 342 Tehsil/Towns Councils and 6,022

Union Councils. At every tier of the LG women have been guaranteed at least 33%

representation. Peasants and minorities have 5% reserved seats [12]. This new system, which may

be best, described through the following 5Ds Local Government System 2001

1. Devolution of Political Power

2. Distribution of Resources to the districts

3. Diffusion of the Power Authority Nexus

4. Decentralization of Management Functions

5. Decentralization of Administrative Authority

The essence of this system is that the local governments are accountable to citizens for all their

decisions. It enables the proactive elements of society to participate in community work and

development related activities. It has also removed rural-urban divide.

2.3 Citizen Community Board (CCBs)

The word CCB stands for Citizen Community Board. Under LGO 2001, twenty-five or more

persons can join together to form a community organization called CCB. After a CCB is

registered, it is eligible to execute various development projects with the approval of respective

councils. There is no restriction on the number of CCBs, which might be registered in union

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council local area. The CCBs can be registered only with the office of EDO (CD) at the District

level. The office of the CCB shall be established in the Union at the address mentioned in the

Registration Certificate issued by the office of EDO (CD). The registered CCBs can work at any

level i.e. District/Tehsil/Union within the District in which CCBs is registered. An NGO can be

registered as a CCB by fulfilling the registration formalities as stipulated in the law. NGO has to

add the word of CCB with its name and the name/number of Union Council in which its office is

located e.g., XYZ NGO can be named as ‘XYZ CCB (Name/number of Union Council)'. There

is no provision of membership fee for a CCB. However, donations/contributions required for

particular CCBs activity are allowed. The priorities for CCBs projects are to be set by the local

governments on the basis of the number of projects submitted by the CCBs/ communities.

2.4 (DTCE) as a Capacity Building Organization for CCBs

The Devolution Trust for Community Empowerment (DTCE) is a “not-for-profit” non-

governmental organization registered with Securities and Exchange Commission of Government

of Pakistan, under Section 42 of the Companies Ordinance 1984. Its aim is to build a support

system by mobilizing all segments of the society through networking and public/private

partnerships to empower local communities and ensure their participation in the development

process by facilitating the formation of Citizen Community Boards (CCBs) and building their

capacity to identify and implement development projects as envisaged in Local Government

Ordinance 2001 [14]

3. Research Methodology

3.1 Type of Research

This is exploratory-cum-descriptive research based upon both primary and secondary data.

Secondary data have obtained mainly from the publications of National Reconstruction Bureau,

Devolution Trust for Community Empowerment (DTCE), Newspapers, existing research

publications and Internet as well. The primary data has been gathered through the personal

interviews from the respondents based upon semi-structured questionnaires (see annexure-II)

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3.2 Target Population

This research has conducted in Hyderabad and Mirpurkhas districts. Both are thickly populated

districts of Sindh Province and covered up large area. The total population of this research is

very large. There is 730 registered CCBs are in Mirpurkhas and 47 are in Hyderabad, but the

funds that have been disbursed are as follows: 38 in Mirpurkhas and 5 in Hyderabad. Using the

convenience sampling method from those functioning CCBs to whom funds have been disbursed

has collected data. Further the target population is divided into five stakeholders: government

functionaries; elected members of local government; beneficiaries of CCBs; body of CCBs; and

common people. The detail is as under:

3.3 Methods of Sampling

Due to the diversified nature of target population, convenience and stratified sampling methods

are used for this research paper. By random sampling the probability of unaware respondents

would have been increased as majority of respondent in district Hyderabad were unaware about

CCBs and were reluctant to respond, so they were contacted through personal references.

Therefore convenience sampling method was adopted. Further there were five main stakeholders

of target population so they were first grouped through stratified sampling and than data obtained

through convenience sampling. The groups of target population for this study are as under:

1. Government functionaries

2. Elected members of local government

3. Beneficiaries of CCBs

4. Body of CCBs, and

5. Common People

The samples size for the subject study was 121. The breakdown of the sample size is as under:

Table 1 Sample Size of the Study

No. Stakeholders Target Pop. Hyd MPK Total

01 ER 20 05 07 12

02 BEN CCBs 1000 8 17 25

03 B. CCBs 100 2 18 20

04 GF 22 04 10 14

05 CP 1000 20 30 50

Total 1167 41 80 121

Source: Author’s research

One CCB consist on at least 25 members so one member selected from one CCB

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3.4 Method of Data Collection

The Primary Data has been collected through personal interviews and questionnaire (enclosed in

annexure) from the selected samples. While secondary data has obtained from the Websites and

printed literature of Devolution Trust for Community Empowerment (DTCE) and National

Reconstruction Bureau (NRB), Newspapers, and past empirical studies.

4. Data Analysis

Seven general and health related questions are answered in this study. These questions are

designed on likert scale from 5 to 1 (5 means strongly agree, 4 means agree, 3 means do not

know, 2 means disagree, and 1 means strongly disagree). This is an exploratory research so

through descriptive statistics the Mean, Median and Mode have calculated from mega state

excel. The base data (enclosed in annexure) has developed on five main questions according to

the response of selected samples. Question wise data analysis and interpretation is as under:

4.1 Awareness of CCBs in Both Districts

Awareness of CCBs among all stakeholders’ means that the people are familiar with the term

CCBs, they know how CCBs work? How to register the CCBs? What are the functional areas of

CCBs? What is the procedure to formulate a CCB? The relevant question is as under:

Q: Local people aware to participate and form CCBs for development projects in their

constituencies? (5 4 3 2 1)

Table 7

Awareness of CCBs Among Common People

Mirpurkhas Hyderabad Both

3.99 2.23 3.42 Source: This Study

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GRAPH 1

People awareness & Participation in CCBs Projects

3.99

2.23

3.42

-

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

4.50

1

Mirpurkhas Hyderabad Both Districts

Above table and graph show that there is high awareness about CCBs in Mirpurkhas district than

Hyderabad. In Mirpurkhas, 63 respondents out of 82 were agreed or strongly agree (on likert

scale 5 to 1) that people are aware about CCBs. While in Hyderabad only 9 respondents out of

39 were agree that people are aware in their surrounding about CCBs even the literate people

were not well aware about CCBs in Hyderabad. This major difference is due to the intervention

of DTCE. Mirpurkhas is one among the five districts of Sindh province the rest are: Badin,

Thatta, TandoAllahyar, and district Khairpur.

4.2 System Improvement

In this study the system Improvement means that the existing system regarding disseminating of

information about CCBs among common people, registration process of CCBs, funds

disbursement procedure, proper guidance by government functionaries, and elected members of

local government, to increase the peoples’ participation in social development projects of their

constituencies. The related question was formulated as under:

Q The existing system of peoples’ participation in social development projects by CCBs

need to be further improved (5 4 3 2 1)

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Table 8

System Improvement in Both Districts


4.32 4.26 4.30 Source: This Study

GRAPH 2

System Improvement in CCBs in all the districts

4.32

4.26

4.30

4.22

4.24

4.26

4.28

4.30

4.32

4.34

1

Mirpurkhas Hyderabad Both Districts

All the five category of respondents unanimously agreed that the system of CCBs needs to be

improved. The author observed some good facilities in Mirpurkhas district for the registration of

CCBs, proper guidance and support by the government functionaries, and elected members of

local government, published literature is available in related offices. Local government has

started the campaign of awareness through lectures, seminars, and Khuli Kuchairees. As a result

the registration process has speed up and people specially women are registering their CCBs

rapidly. Until the last day of compiling the report there was 730 CCBs are registered and

approximately 50% are of them are of women. But this rapid change occurred after intervention

of DTCE. This is the main difference between the both districts. CCBs but still there are

bottlenecks of documentation, long wait for funds disbursement

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4.3 Health Facilities in Mirpurkhas and Hyderabad

Available Health Facilities means availability of govt. hospitals, dispensaries, medicines, and

doctors for the masses, where people can get relief from health complications. The question

relevant, the mean of respondents and graphical presentations of the same are as under:

Q There are sufficient health facilities are available in Hyderabad and Mirpurkhas (5 4 3 2 1)

Table 09

Health Facilities in Hyd. & MPK.


Mean 1.77 1.96 1.91 Source: This Study

GRAPH 3

Health Facilities in Hyd & MPK

Comparatively Hyderabad has better health facilities than Mirpurkhas mainly due to the 2nd

biggest city of the province and 8th

of the country.

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4.4 Effectiveness of CCBs in Mirpurkhas

CCBs are very effective in health sector in district Mirpurkhas. All the respondents particularly

Government functionaries and Bodies of CCBs are very optimistic in this sector. People have

submitted several proposals to improve the health facilities. Here, the proper guidance by the

Government functionaries, elected members of local government and people’s personal interest

has highly motivated the people to participate in health projects. The women are also taking high

interest in health sector particularly, in the various types of vaccination programs like Hepatitis,

B, C, and labor room facilities for pregnant women. The following relevant question, table, and

graph shows the calculated mean of the respondents in district Mirpurkhas:

Q CCBs are playing effective role in health sector in your constituency

(5 4 3 2 1)

Table 10

Effectiveness of CCBs in Mirpurkhas

ER BEN CCB B. CCB GF CP

Mean 3.29 3.35 4.5 4.3 3.37

Source: This Study

GRAPH 4

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4.5 Effectiveness of CCBs in Hyderabad

In Hyderabad, the author did not find the working CCBs in health sector like other sectors. The

poor awareness among people is the main hurdle. Due to the same the peoples’ participation is

very poor. Government functionaries show their high interest to work in health sectors, while

common people also show their interest to work but they are not familiar with the procedure. The

following table and graph shows the calculated mean of the respondents.

Table 11

Effectiveness of CCBs in Hyderabad


Mean 2.4 3.12 2 4.25 3.8

Source: This Study

GRAPH 5

4.6 Effectiveness of CCBs in Both Districts

The effectiveness of CCBs in health sector is high in district Mirpurkhas than Hyderabad. There

is hope that this high peoples’ participation in health sector in Mirpurkhas will bring some relief

to the poor people. The comparison of both districts is presented below in Table 5 and graph 5:

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Table 12

Effectiveness of CCBs in Both Districts


MPK 3.29 3.35 4.5 4.3 3.37

HYD 2.4 3.12 2 4.25 3.8

Source: This Study

GRAPH 06

4.7 Working Areas of CCBs in Health Sector in Mirpurkhas

In Mirpurkhas districts people are enthusiastically participating in various health projects like

New and extension of existing dispensaries, mass vaccination program of Polio, Hepatitis B-C,

Vaccinations of Snake and Dog biting. Various proposals have submitted for X-Ray machines,

and ultra-sound centers. Schools are participating in vaccination program in their constituencies

in Mirpurkhas. The relevant research question, calculated mean, and graphical presentation are

given below:

Q. CCBs are effectively working in the following areas of health sector in your

constituencies

(a) Opening and expanding dispensaries (5 4 3 2 1)

(b) Vaccination program (5 4 3 2 1)

(c) Labor room facilities to pregnant women (5 4 3 2 1)

(d) X-ray machines (5 4 3 2 1)

(e) Ultra Sound machines (5 4 3 2 1)

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Table 13

Working Areas of CCBs in Mirpurkhas

DIS VAC LBR RM X-Ray ULT SND

Mean 4.35 4.43 4.20 2.26 3.85 Source: This Study

GRAPH 7

Working Areas of CCBs in MPK

4.8 Working Areas of in District Hyderabad

In Hyderabad district people are interested to work in the various sectors of health but the author

did not find any CCB active in health sector. The relevant question, calculated mean and

graphical presentation of the same is as under:

Q. CCBs are effectively working in the following areas of health sector in your

constituencies

(f) Opening and expanding dispensaries (5 4 3 2 1)

(g) Vaccination program (5 4 3 2 1)

(h) Labor room facilities to pregnant women (5 4 3 2 1)

(i) X-ray machines (5 4 3 2 1)

(j) Ultra Sound machines (5 4 3 2 1)

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Table 14

Working Areas of CCBs in Hyderabad



GRAPH 8

Working Areas of CCBs in Hyderabad

4.9 Working Areas of CCBs in Both Districts

Respondents in both districts almost highlighted the same working areas of CCBs. In Hyderabad

people verbally show their interest but in of Mirpurkhas people are participating in various health

projects. The relevant questions, the mean and the graphical presentations of the same is as

under:

Q. CCBs are effectively working in the following areas of health sector in both districts.

(k) Opening and expanding dispensaries (5 4 3 2 1)

(l) Vaccination program (5 4 3 2 1)

(m) Labor room facilities to pregnant women (5 4 3 2 1)

(n) X-ray machines (5 4 3 2 1)

(o) Ultra Sound machines (5 4 3 2 1)

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Table 15

Working Areas of CCBs in Both Districts



GRAPH 9

Working Areas of CCBs in Both Districts

5. Conclusion and Recommendations

This paper was an attempt to access the role of CCBs in health sector in two districts of Province

Sindh: Mirpurkhas and Hyderabad. CCBs provide a platform to common people to enhance

participation in social development projects in their own constituencies. The present government

has transferred the powers at the grass root level by introducing the Local Government system in

2002 by LGO (2002). The main objective behind the new system was to increase the peoples’

participation in social development projects. The conclusion of this research paper is as under:

1. The system is ideal and people are interested to work in social development projects but

people are not well aware with this system

2. The Most important areas where CCBs can be more effective are Health, Education,

Infrastructure, and Entrepreneurship.

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3. The respondents are not satisfied with the present working procedure and it needs to be

more improved.

4. Peoples’ participation is increasing in health sector in district Mirpurkhas. People are

submitting the proposals for opening and expanding the new and existing dispensaries

respectively. Schools are working for vaccination program in their school through CCBs.

Women CCBs are very active to provide labor room facilities to pregnant women. Some

proposals have been submitted to create the awareness among the poor about the Hepatitis

B & C, and HIV AIDS. Doctors are also taking interest to open their clinics and hospitals

equipped with X-Ray and Ultra sound machines. Snake and dog biting are the prime

concern in many areas some proposals are in process to provide vaccination of the same.

5. The registration process is very high in district Mirpurkhas and till compiling this report

there are 730 CCBs have been registered while in Hyderabad 47 CCBs are registered, this

is very low in the district due to poor awareness among people and the district is not being

selected by the Devolution Trust Community Empowerment (DTCE).

6. The funds disbursement process is very slow. The funds have disbursed only to 38 CCBs

out of 730. Among them 04 are in health sector, 08 in Infrastructure, 18 in Education, 05

in entrepreneurship, 02 are in micro credit and only 01 in Entertainment. Total

Rs1,45,33500 have been disbursed21

. In Hyderabad 5 CCBs have funded and no one in

health sector.

7. The accelerated speed of CCBs registration in health sector reflects the better health

facilities in district Mirpurkhas. The Beneficiaries of 4 CCBs in health sector are very

satisfied. Other people are largely motivated and registering their CCBs in this sector. The

level of awareness about formation of CCBs in health sector and participation level is

better in district Mirpurkhas as compare than Hyderabad.

21

Source: Interviewed by govt. functionaries Mirpurkhas

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5.1 Recommendations

The recommendations are as under

1. The awareness campaign is the need of the hour. The Government must educate the

people about CCBs especially in Hyderabad district. Publication of literature in easy

regional languages, Television and Radio campaign at grass root level is required for

this purpose. It is recommended that the system should be introduced in the

curriculum at school, colleges and university level to attain the maximum

participation of common people. As the system is new so people have several queries,

2. Government further needs to improve the existing system. The complication in

registration process, documentations, and technical requirement are the areas where

people are facing difficulties and avoiding participating in development projects.

People must be well trained to make the budget of CCBs, motivate the other people,

operating the projects, teamwork and hunting the qualified and technically sound

people for their projects.

3. People must be properly educated motivated by government functionaries and elected

local members to work in various areas of health sectors. Government must facilitate

the doctors to work in rural areas.

4. Health, Education, Infrastructure, and Entrepreneurship are the more effective areas

of CCBs. Concerned authorities must motivate the people to form the CCBs in their

desired areas. Technical support must be provided to common people by concerned

authorities by developing the links with established educational and health units in

urban areas. The expertise must be invited to design the projects economically.

5. The powers and responsibilities must be well defined in every tier of government.

Due to overlapping in powers and responsibilities at district, provincial, and federal

level hurdles are creating. Some respondents were highly reluctant and de-motivated

to participate in social development projects.

6. Philanthropists and NGOs must be invited to play their active role in CCBs projects.

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7. This study focuses on the contribution of CCBs in health sector in Mirpurkhas and

Hyderabad. Further CCBs contribution can be evaluated in other sectors like

education, infrastructure, and Entrepreneurship. The study can be further extended to

the other districts of province Sindh. The criteria to select a district by Devolution

Trust for Community Empowerment (DTCE) must be studied. Other districts have

not been selected yet.

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VOL 4, NO 4

References

[1] Sandstorm Seven (1994) ‘Poverty Reduction: Learning the lessons of experience,

finance & development, September, 1994 Page no. 30-33

[2] UNDP (2002), ‘Human Development Report 2002’ New York Oxford press

[3] Article ‘Families:Victimes of Poverty and Homelessness’ 1996, Published by

United Nations on International Day of Families

http://www.un.org/esa/socdev/family/IntObs/IDF/Backgrounders/Backg96.htm

[4] World Bank 2003, ‘World Development Report 2003’ New York Oxford Press

[5] Khan Shadiullah, 2006, “Local Govt. & Participatory Rural Development” PhD

thesis, Gomal University, Dera Ismail Khan

[6] UNDP, 1999, Decentralization: A sampling of definition

[7] Manor, J. 1999, The Political Economy of Democratic Decentralization,

[8] World Bank Report 1999-2000

[9] Paracha “Open Society Institute, Central European University” Devolution Plan

in Pakistan: Context, Implementation and Issues

[10] Mehnaz Gul, M.Phil. Thesis, ‘Findings influential in Decision Making Process of

Local Government, University of Begen, Norway

https://bora.uib.no/bitstream/1956/1185/1/master-gul.pdf

[11] Khan Shadiullah, 2006, “Local Govt. & Participatory Rural Development” PhD

thesis, Gomal University, Dera Ismail Khan

[12] Facts & Figures, Governance. Page 1

http://www.presidentofpakistan.gov.pk/FFGovernance.aspx

[13] www.opencube.com

[14] Introduction: Page 1 http://www.dtce.org.pk/DTCE/index.htm

[15] Article, History, Location of Mirpurkhas page 2

http://en.wikipedia.org/wiki/Mirpurkhas

[16] http://www.dtce.org.pk/DTCE/sources/sindh/Mirpurkhas/Mirpurkhas.htm

[17] Action by Churches Together International (ACT) Appeal Pakistan: Sindh

Drought – ASPK-21 2002, Geneva

http://www.un.org/esa/socdev/family/IntObs/IDF/Backgrounders/Backg96.htm

https://bora.uib.no/bitstream/1956/1185/1/master-gul.pdf

http://www.dtce.org.pk/DTCE/index.htm

http://www.dtce.org.pk/DTCE/sources/sindh/Mirpurkhas/Mirpurkhas.htm

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[18] District Government Mirpurkhas, Local Government Department, Government of

Sindh, Page 1

http://www.sindh.gov.pk/dpt/PopulationDev/mirpurkhas.htm

[19] District Mirpurkhas, Local Government Departments, Government of Sindh, page

no 1 http://www.lgdsindh.com.pk/

[20] Khan Ishrat Ali, 2002, Idarak Publications “Hyderabad

[21] History and Geographical Climate of Hyderabad, page 1

http://en.wikipedia.org/wiki/Hyderabad,_Pakistan

[22] Hyderabad Profile & Statistics, Hyderabad City, website of Apna Hyderabad

www.apnahyderabad.com

[23] Vishnu Parmar 2004, “Investment Trends in Hyderabad”, Research Project, JISR,

(szabist) Vol. 3 No. 2 pg. 29

[24] Vishnu, MS thesis 2006, “A Comparative Analysis of Economic Performance of

Two Eras” pg no. 67

[25] Rober D. Atkinson, Article, 1999,”The new economy metropolis: Quality of life”

http://www.ppionline.org/ppi_ci.

[26] District Government Mirpurkhas, Local Government Department, Government of

Sindh, Page 1



http://www.lgdsindh.com.pk/

http://en.wikipedia.org/wiki/Hyderabad,_Pakistan

http://www.apnahyderabad.com/

http://www.ppionline.org/ppi_ci


CCBs Contribution in Health Sector to the People of Sindh: Mirpurkhas & Hyderabad

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