Pakistan’s first female cardiologist, Dr Sania Nishtar is a global health expert and a proponent of health reform. She is founder of many health institutions in Pakistan—the NGO think tank Heartfile, Pakistan’s Health Policy Forum and Heartfile Health Financing. Internationally, she is a member of many Expert Working Groups and Task Forces of the World Health Organisation, a member of the board of the International Union for Health Promotion, the Alliance for Health Policy and Systems Research, the World Economic Forum’s Global Agenda Council, the Ministerial Leadership Initiative for Global Health, the Clinton Global Initiative and is Chair of GAVI’s Evaluation Advisory Committee. She has previously led many global initiatives, including the award wining Global World Heart Day campaign. She is a regular plenary speaker, chair or moderator at global health meetings and a part of organizing major international conferences. Sania Nishtar is a key health policy voice in Pakistan, the author of Pakistan’s first health reform plan, Pakistan’s first compendium of health statistics, and the country’s first national public health plan for NCDs. One of her books, an analysis of Pakistan’s health systems became the blue print for the country’s health policy. She has authored 6 books, more than 100 peer review articles and around the same number of op-eds. She is the recipient of Pakistan’s Sitara e-Imtiaz, a presidential award, Global Innovation award, the European Societies Population Science Award, and many accolades of the International Biographical Centre, Cambridge and the American Biographical Centre. Sania Nishtar holds a Fellowship of the Royal College of Physicians and a Ph.D from Kings College, London.

  1. What is the most important ethical lesson you have learned (either personally or professionally)?

The overarching ethical lesson, both personally and professionally, I have learnt over the course of years is rather simple. Anything that needs to be veiled and concealed is often wrong and unethical. On the other hand, if one has no qualms about openness and transparency, the likelihood of ethical behavior is much higher both in personal as well as in professional conduct. Of course this has to be in context. In personal life the context is social and cultural whereas professionally, stated norms and policies become the milieu around which these behaviors have to be gauged.

  1. What is the most shocking corporate ethics matter you have seen in the news recently? Non-profit sector? Why?

Since I live and work in Pakistan and have an interest in governance from a public policy advocacy standpoint, I am painfully familiar with collusive practices at every level within the state and societal system, of which the corporate sector is a part. Relevant to your question, what immediately comes to my mind is the Isotab drug scandal in Pakistan, which highlighted the salience of blatant regulatory graft at one level and inattention to compliance with stated norms by the local corporate pharmaceutical sector in Pakistan on the other. In fact developing country medicines value chain and its regulatory oversight provides many examples of shocking corporate ethics when it comes to connivance with state entities.

  1. What do you see as the opportunities for the corporate sector and non-profit sector to collaborate in raising the bar in ethical matters?

The ethics-conscious and bonafide entities in the corporate and not-for-profit world should see the potential within collaboration to exploit synergy. Unethical behaviors and absence of a level playing field hurt the economy because of growth of the black market; additionally, they undermine bonafide businesses because of infringements on their legitimate prerogatives, and cause social pain as they divert resources away from those in need. Advocating in unison against these practices through a variety of complementary channels can help raise the bar, in terms of better norms and regulation and better incentives for ethical conduct. In particular, technology offers a unique opportunity to ingrain better transparency in organisational governance, which should be leveraged better.

  1. What are the most effective strategies for mitigating risk of unethical behaviour in your organization?

At Heartfile, we use a range of strategies to mitigate such risks, ranging from transparency in governance, merit in staff selection and promotions, a clear disclosure and conflict of interest policy, segregation of roles at the operational level, clearly designated norms and stated policies with a mirroring reward and accountability system, a process of internal and external audit, and strategic use of technology. At Heartfile, we have zero tolerance for collusion and regard transparency as one of our hallmark core values. An example of the latter is the donation management system at Heartfile Health Financing, where innovations in donation management enable real time viewing of micro-transaction details, a feature unprecedented even by international standards. In the same program we have strived to supplant human discretion with automated algorithms, and subjective decision-making with preconfigured rules, which additionally help to ingrain better ethical values.

  1. What are your strategies for ensuring ethical policies and standards flow down through all levels of the organizing and to all stakeholders?

What is most important is to have the right policies, guidelines and standard operating procedures in place as well as implementing arrangements in human resource and institutional terms, as without them good intentions alone cannot deliver. Setting an example right at the top and leaderships levels is important. In developing country settings, adequate remuneration is critical, as most forms of collusion are of a ‘subsistence nature’

  1. Are there areas you think regulation should be more extensive in regulating corporate ethics? Non-profit sector ethics?

Regulation should be more extensive in relation to the enabling environment it can create; the system of checks and balances it can mandate; and the incentives that can potentially be institutionalized for the promotion of ethical behaviors. The more coercive the regulation, the higher the likelihood that people will find ways around it—here I am referring more to developing country environments, where governance challenges are usually quite a concern and regulatory effectiveness, is always a constraint.

  1. Should culture be an important contextual element in ethics analysis? What is unique about the ethical culture and environment in your country that should be taken into consideration?

I feel the concept of ‘right’ and ‘wrong’ is quite universal, subtle cultural and religious differences, notwithstanding. My country Pakistan is perhaps unique from an ethical perspective, as there are stark differences in the ethical values of the ‘state’ and the ‘society’. The state is predatory and collusive, and has fallen prey to rent-seeking and capture. The society, barring exception’s, on the other hand is deeply conscious of community support with a strong culture of philanthropy. What is worrying is that the societal fabric is wearing out with burgeoning of extreme ideologies, which are blurring ethical margins for illiterate masses on the mistaken notion that some practices are permissible under the religion.

  1. Do you think globally applicable ethics principles and practices are possible? Desirable?

Entirely—and I quite fail to understand why the global development community hasn’t aimed for these. We have the UN system and other multilateral fora, which have the convening ability and the mandate to engage heads of state around a specific agenda which can culminate in the setting of such standards. These institutions have resolutions on just about every other subject, except for this.

  1. What is the biggest mistake people make in making decisions around ethical issues?

The biggest mistake is underestimating the importance of ethical issues! Ethics is not just about right and wrong from a moral standpoint. It is also about policies, norms and institutional devices, requiring the right input as a way to build the necessary safeguards.

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