Rehabilitating Pakistan’s Elderly Population: Ever increasing issues

of Old age

Zinnia Arshad

MGMT 261: Introduction to Policy Analysis

Dr. Azfar Nisar

26/10/2018

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Introduction and Problem statement

Pakistan has failed to fulfill its duty towards many segments of its population. Many

groups have been marginalized due to their ethnicity, religious affiliations, age and caste. This

policy analysis focuses on the alienation of old people from the society at large. It will review why

this issue is significant, the policy actors included in this matter and the alternatives available to

Pakistan for the betterment of this segregated group. This investigation will also look at some

policies made by welfare states in Scandinavian countries like Sweden that Pakistan can utilize as

an ideal to modify and contextualize in its own culture.

The Government of Pakistan as an institution has made multiple efforts to protect the

elderly from the economic, social and political injustice that they face. To ensure their basic

human right to work and learn newly developed skills, the constitution of Pakistan in article 38

promises all citizens the right to employment, well-being and basic necessities.1In article 25, the

state also promises all citizens to be treated equally in all spheres of life. 2 Provincial governments

have also introduced acts to protect the well-being of senior citizens e.g. the KP Senior Citizens

Act 2014 which would allow the ability to apply for Senior Citizens Cards to citizens over 60. These

cards aim to improve accessibility to cheap health facilities, financial assistance and free access

to libraries.3

1 "The Constitution of the Islamic Republic of Pakistan," February 28, 2012, accessed October 26, 2018,

http://www.na.gov.pk/uploads/documents/1333523681_951.pdf. 2 Ibid. 3 Bureau Report, "KP Senior Citizens Act 2014: Elderly People Urge Govt to Implement Law,"

Peshawar | Thenews.com.pk | Karachi, September 30, 2018, , accessed October 26, 2018, https://www.thenews.com.pk/print/374936-kp-senior-citizens-act-2014-elderly-people-urge-govt-to-implement-law.

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Numerous acts have been introduced in the Parliament e.g. Employees Old Age Benefit

Act 1976, Social Security Act 1965 and Pension for Government Employees and Government

Employees Benevolent Fund that aim to give financial stability to old people (mostly older than

60) once they retire. The Public Sector Development Programme (PSDP) and Ten Years

Perspective Plan were also introduced in the hopes that they would make senior citizen

homes/community centres and establish geriatric wards in hospitals. 4 However, all these efforts

have not improved the status of the elderly in our community as they have yet to be

implemented. No social protection programme has been launched yet which holistically solves

old age issues.

4 Khalid Sallahudin and Amanat Ali Jalabani, Dr, Senior Citizens: A Case Study of Pakistan, working

paper, SZABIST, , accessed October 26, 2018, https://pdfs.semanticscholar.org/3ca9/8848a74968741173b074f1bd0ea07b0368fe.pdf.

Figure 1:footnote 6

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The significance of this problem can be gauged by the fact that in 2011 4.2% of Pakistan’s

population came in the elderly bracket. 72% of this bracket had five or more health problems

(diabetes, arthritis, hypertension etc.) and 22.9% were clinically depressed. 5 Pakistan has been

ranked the fifth worst country for seniors to live in by age rights-based international NGO:

HelpAge International in a UN backed study.6 The poverty, helplessness and loneliness could be

seen in Old Age Happy Homes member - Mr. Saleem’s eyes when he said, “Beti meray paas aapko

denay ke liye duaaon ke illawa kuch nae hai, aap ne humaray saath ye time guzara tou yehi kuch

ghantay ab humari baaqi zindagi ke yaadain ban ke reh jae gae.” (I have nothing to give you

except my blessings daughter, the moments I’ve spent with you will be memories that I cherish

for the rest of my life)

The urgency and significance of this issue has to be recognised by all countries to ensure

the physical, emotional and financial independence of seniors as the number of citizens over 60

is set to skyrocket from 809 million to more than 2 billion by 2050. The problem lies in the

additional costs which accompany old age due to health issues and the dependence of these

individuals on their family members for emotional, physical and financial help since practically

none of them have employment or monthly pension. Additionally, the loneliness that can

accompany this age is something has lasting effects on mental health which can aggravate the

5 Yasir Habib, "No Place for the Elderly in Today's Society?" Pakistan Today, October 1, 2011, , accessed

October 26, 2018, https://www.pakistantoday.com.pk/2011/10/01/no-place-for-the-elderly-in-today’s-society/. 6 Infographic: Index at a Glance | Data | Global AgeWatch Index 2015, , accessed October 26, 2018,

http://www.helpage.org/global-agewatch/population-ageing-data/infographic-index-at-a-glance/.

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problem. To sum it up, the elderly need access to pensions, employment opportunities,

transportation, emotional support, physical/mental health facilities, housing and legal power.

Cause Analysis

Pakistan’s fiscal deficit soared to a record high of $17.994 billion (5.7% of GDP) at the

end of the fiscal year on June 30 2018. This is 44.7% higher than last year. The rupee fell by

22% at Rs128 to US Dollars since last year

which made buying more expensive for the

public and hence the real income

Figure 2: footnote 8

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decreased majorly.7 This has led the country to borrow domestically in an effort to reduce

external borrowing which in turn has had an adverse effect on the country’s financial sector

as banks are unable to invest in private ventures due to lack of liquid cash available. This set

up has affected all sectors fundamentally due to their dependence on banks to invest in

positive NPV projects. High debt servicing costs were due to the mismanagement of various

departments including the State Bank of Pakistan, the Debt Policy Coordination Office and the

Central Directorate of National Savings. Consequently, due to low GDP growth the government

had less money to spend on social protection programs for the poverty stricken elderly.8

Along with the government of Pakistan focusing on other sectors, lack of federal

level legislation dealing with the

presence of geriatrics is another reason

why there has been no progressive

trajectory to achieve this goal. A senior

citizen bill (2007) was circulated in the

parliament which included “the creation

of a council which would formulate and

recommend plans to be implemented for

ensuring the protection and prosperity of

7 Salman Siddiqui, "Pakistan's Current Account Deficit Peaks at $17.99b," The Express Tribune, July 20, 2018, , accessed October 27, 2018, https://tribune.com.pk/story/1762078/2-pakistans-

current-account-deficit-peaks-17-99b/. 8 Nasir Iqbal, Musleh Ud Din, and Ejaz Ghani, "The Fiscal Deficit and Economic Growth in Pakistan: New Evidence," September 22, 2017, , accessed October

27, 2018, http://www.lahoreschoolofeconomics.edu.pk/EconomicsJournal/Journals/Volume 22/Issue SP/03 Iqbal.pdf.

Figure3: footnote 10

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senior citizens in the country.”9 Unfortunately, the bill has not been passed to this day because

the government constantly puts the elderly on the backburner since they aren’t the strongest

group in terms of power and visibility. This phenomenon is quite apparent in the 2018 national

budget as Social protection is scarcely 0.05% of the total expenditure. Even this allocation is spent

on regressive programs like BISP that have a tokenistic approach since they give barely Rs1600

per household. Health and housing in the budget are also 0.3% and 0.05% respectively and these

sectors are focused on the entire nation without any particular significance or distinction for the

elderly. The defence and general public service (majorly including Servicing of Domestic Debt,

Foreign Loans Repayment) takes away a major proportion of our budget i.e. 24% and 69%

correspondingly and the priorities of our government are very clear from this comparison. 10

The collectivistic nature of families in the country’s culture and their immense pride

stigmatises taking money from the government directly through non contributory schemes. They

feel like they have been stripped of their honour, classified as poor and needy and are looked

down upon in our society. This can be detrimental to a family since social image is very important

in Pakistani culture. Their social standing decides their interaction with other groups and dictates

who will talk to them, do business with them, form ties with them etc. Harris Gazdar says that

class and caste decide one’s treatment in society which makes these factors extremely important

for all Pakistanis. Guzdar states, “The kinship group, known variously as ‘zaat’, ‘biraderi’ and

9 Foiza Azam, "Senior Citizens Bill Awaits Cabinet's Approval," The Nation, July 06, 2009, , accessed October 27,

2018, https://nation.com.pk/07-Jul-2009/senior-citizens-bill-awaits-cabinets-approval. 10 Pakistan, Finance Divison, Secretary to Government of Pakistan, Budget in Brief, by Arif Ahmed Khan, , April 27,

2018, accessed October 27, 2018, http://www.finance.gov.pk/budget/Budget_in_Brief_2018_19.pdf.

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‘quom’ in different parts of the country, remains a key – perhaps the key – dimension of

economic, social and political interaction.”11

As the state fails to function and provide properly the private sector (NGOs) have started

crawling in this sphere. There are multiple NGO’s currently working for elderly welfare e.g. Edhi

Foundation, Old Homes, Old Age Happy Homes, The Senior Citizen Foundation of Pakistan etc.

Although they’re doing tremendous work they have their limitations. Their major problems are

funding, arduous bureaucratic process, no clear mandate and enhanced corruption. Firstly, their

funding is majorly done by the public or international agencies so they don’t have a fixed stream

of revenue coming in. Thus, most of them have to work within their own means. According to

the owner of Old Age Happy Homes (OAHH), “We only have the means to give 50 seniors a

comfortable life. We believe in quality, not quantity.” Secondly, they don’t have any

accountability standards in place which paves way for employees to cause corruption and misuse

undue power. Miss Kulsoom (member of OAHH) told me, “I don’t like the cook over here, she’s

always acts like our boss and doesn’t even cater to our needs properly.” Lastly, since all NGOs

work on their specific owner’s principles they don’t have congruence in their aims which in turn

leads to them having an impact on the lives of a very small proportion of the seniors when it

could be bigger. Consequently, they can’t cater to the expensive and specific health

care/nutritional needs of all their members hence deteriorating the quality of life of these

individuals.

11 Harris Gazdar, "Class, Caste or Race: Veils over Social Oppression in Pakistan," January 13, 2007, , accessed

October 27, 2018, http://www.researchcollective.org/Documents/Class_Caste_or_Race.pdf.

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Policy Actors

The main policy actors are:

1. Elderly: They fall in the dependents category due to their weak power and

positive construction in public opinion. Their basic physiological, safety, love/affection

and self esteem needs are at stake. They are the ones who are directly being affected by

all the policies of the state/private sector.

2. NGOs: They lie in the dependents category and are the ones who are

indirectly responsible for the well-being of the elderly. The private sector isn’t directly

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involved in policy making for this issue but they can act as a pressure group and force the

politicians into focusing on their issues. They can also work for the welfare in their own

means but by having compatible aims.

3. Media: It has a strong power but negative construction in the public eye:

contender. It is responsible for showing the public the truth of the state of all old age

homes, hospitals, work places etc. Hence, it has a very major liability in the formation of

policies. It is through this channel that a lot of issues have been raised and altered in the

parliament e.g. Tehreek e Labaik's protest got so much attention in the media that the

public stood with them and the government was coerced into changing the blasphemy

clause within weeks.

4. Military: One of the strongest organisations in this country in terms of

power and public image therefore they fall in the advantaged category. They will be

directly affected by government’s actions to increase funding to social protection

programs as this would mean that their proportion of the budget would be cut. This could

have impact on their salaries, fringe benefits, pension, ammunition etc.

5. Bureaucrats: Lying in the contender’s category, they would be effected by

this policy implementation as well. Their responsibilities and accountability will increase

and their salaries wont increase proportionally which can be a source of aggravation for

all officeholders.

6. Politicians: Falling in the contender’s category, they are directly

responsible for passing all bills in the parliament and senate. It is only after their approval

that any bill can become implementable.

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7. Educational Researchers: These dependents have the responsibility of

highlighting the problem’s significance, policy alternatives and recommending ways for

the government to ensure maximum utility of the policy.

8. Youth: This advantaged segment of Pakistan comprises 64% of the total

population hence their needs precede the elderly’s.12 The youth in Pakistan is relatively

more organised as well and fight for their basic rights.

Alternative Construction

No action analysis

The state, civic society and the private sector need to take immediate action for

the prosperity of the elderly. If they are unable to do so, 4% of our population will continue to be

ostracized and remain a very easy target

for physical, emotional, financial and

sexual abuse. This is a direct violation of

their constitutional rights of equality,

protection and non discrimination in

services/public spaces. This violence is

often conducted behind closed doors, within the privacy of homes and care institutions and goes

unreported causing unreliable statistics of elder abuse. There is no proper way for these elderly

12 "Pakistan Currently Has Largest Youth Population of Its History: UNDP Report," Pakistan |

Thenews.com.pk | Karachi, May 03, 2018, , accessed October 28, 2018, https://www.thenews.com.pk/print/311910-pakistan-currently-has-largest-youth-population-of-its-history-undp-report.

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to report this abuse and it makes matter even worse for them. Their helplessness and weakness

in the face of so many adversities should compel the government to take instantaneous action.13

The above image shows a very old man being forced to work as a cobbler at his age due to lack

of state provided assistance.

Ideal Situation analysis

The welfare of elderly has been upheld in the Scandinavian countries and the UK. We will

be discussing Sweden in our paper as it ranks number one on the GlobalAge Watch Index with

the life expectancy of 81 and 84 for men and women respectively. Sweden has 10 million citizens

of which 20 percent are over 65 years of age. In 2014, the total cost of elderly care in Sweden

was SEK 109.2 billion (USD 12.7 billion), but only 4 per cent of the cost was financed by patient

charges which makes it evident that municipal taxes and government grants cover majority of

these expenses.

The major aim of elderly care is to increase financial, emotional and physical

independence. Hence, the government provides them with their own homes, help staff,

communal meals at centres, financial assistance, health care, daytime activities for those in need

of stimulation and rehabilitation, transportation services and pension. On the preventive side,

the government ensures elders get physical activity on prescription, information available for

13 Muhammad Akbar Baig, "With No Welfare in Sight, the Elderly Prone to Abuse," The Express Tribune, May 08,

2015, accessed October 27, 2018, https://tribune.com.pk/story/883418/with-no-welfare-in-sight-the-elderly-prone-to-abuse/.

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fixing houses so they can reduce injuries from falls and encouragement of artistic hobbies to

stimulate their brain. 14

Swedish government allocated SEK 2 billion annually in 2016–2018 to increase quality in

elderly care. Another noteworthy feature is their formation of a national inquiry chair whose task

is to construct a long term national quality plan for the seniors. The plan will focus on

development of equitable and gender-equal elderly care.

Alternatives for Pakistan

The government needs to work with the private sector to tackle this situation due to lack

of resources in both the areas. First and foremost, the Senior Citizens Bill needs to be passed and

implemented. For its implementation a significant proportion of budget should be allocated to

social protection and a taskforce should be formed which has representation of all the policy

actors listed above, especially the elderly. This dynamic taskforce should recommend ways to

improve welfare for this part of the population. It should also be continuously researching for

ways of provision of social security programs at minimum cost. Secondly, a national social

security program needs to be devised which ensures the elderly can get independent. The

poverty scorecard used in BISP should be used in the targeting this program to the very needy. It

shouldn’t be a general program for all: the rich and affluent should be excluded from this service.

14 "Elderly Care in Sweden," Sweden.se, January 04, 2018, , accessed October 27, 2018,

https://sweden.se/society/elderly-care-in-sweden/.

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The limited financial capacity of this country doesn’t allow them to give such large scale benefits

to all of the 10 million elderly.

The next step is the development of this program. This should be an all inclusive holistic

program that caters to the financial, physical and emotional needs of this segment. A monthly

pension system should be started for all private and public sector employs and the amount of

pension should be decided by their pay, rank, years in service and taxes paid by them. This will

give them a sound financial setting to begin this part of their life. Then, the local government

should be entrusted with the responsibility of disbursement of these pensions and any extra

financial assistance that they may need. Moreover, this program should focus on the immediate

need for housing of these individuals. Since providing separate homes would be difficult for the

state, institution should work to establish state of the art, well equipped and properly managed

old age homes. This will cater to their emotional need of relationships and loneliness as well.

Lastly and most importantly, health facilities need to be made easily accessible and

affordable for all. So, a health card should be issued to all poor individuals above 60 which allows

them to go to any public hospital and get free treatment. The weak status of the elderly in the

society needs to change and challenged by making the police forces more aware of the situation

and using uplifting campaigns to encourage old people to report cases of abuse. Their problem

of transportation also needs to be dealt with by giving them elderly passes which gives them free

access to public transport and reserving seats for them on all buses, trains etc. This policy

alternative comprehensively deals with all their existing problems and ensures that they will be

heard in the future too.

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Another policy option is that the government improves their current schemes like BISP,

EOABI and Bait ul Mal. This alternative doesn’t include the solution to all their problems but Bait

ul Mal will ensure shelter and BISP/EOABI will cater to their financial needs. However, health,

transport and emotional needs will still need to be addressed. Additionally, BISP barely gives

them 1600 rupees a month which will not be sufficient for their specific nutritional/health

requirements and considering inflation rates over the years. The government and complimenting

institutions therefore, need to recognise the gaps in existing policies and build future policies to

fill these gaps. As long as the inefficiency in the structure and implementation of current and old

polices is recognised, there is no reason why these policies cannot be used as a backbone to

mould the future ones.

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Bibliography

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Accessed October 27, 2018. https://nation.com.pk/07-Jul-2009/senior-citizens-bill-

awaits-cabinets-approval.

Baig, Muhammad Akbar. "With No Welfare in Sight, the Elderly Prone to Abuse." The Express

Tribune. May 08, 2015. Accessed October 27, 2018.

https://tribune.com.pk/story/883418/with-no-welfare-in-sight-the-elderly-prone-to-

abuse/.

"Elderly Care in Sweden." Sweden.se. January 04, 2018. Accessed October 27, 2018.

https://sweden.se/society/elderly-care-in-sweden/.

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http://www.researchcollective.org/Documents/Class_Caste_or_Race.pdf.

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Infographic: Index at a Glance | Data | Global AgeWatch Index 2015. Accessed October 26,

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index-at-a-glance/.

Iqbal, Nasir, Musleh Ud Din, and Ejaz Ghani. "The Fiscal Deficit and Economic Growth in

Pakistan: New Evidence." September 22, 2017. Accessed October 27, 2018.

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http://www.lahoreschoolofeconomics.edu.pk/EconomicsJournal/Journals/Volume

22/Issue SP/03 Iqbal.pdf.

"Pakistan Currently Has Largest Youth Population of Its History: UNDP Report." Pakistan |

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population-of-its-history-undp-report.

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people-urge-govt-to-implement-law.

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https://pdfs.semanticscholar.org/3ca9/8848a74968741173b074f1bd0ea07b0368fe.pdf.

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pakistans-current-account-deficit-peaks-17-99b/.

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"The Constitution of the Islamic Republic of Pakistan." February 28, 2012. Accessed October

26, 2018. http://www.na.gov.pk/uploads/documents/1333523681_951.pdf.