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.
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Iqbal, Nasir, Musleh Ud Din, and Ejaz Ghani. "The Fiscal Deficit and Economic Growth in
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http://www.lahoreschoolofeconomics.edu.pk/EconomicsJournal/Journals/Volume
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