Whither the Old?
A lot more needs to be done in Pakistan to provide care for the aging, including better government programs.
Around the world, the elderly population is on the increase and the situation is no different in Pakistan. A developing country facing various challenges such as political instability, lack of economic growth, low savings of the elderly and a weak pension system makes life difficult for the elderly here.
Geriatrics as a specialized area of medical training is neither recognized nor practiced in Pakistan. There is no widespread practice of health insurance coverage, hence, the population relies on out of pocket expenditure for the treatment of all ailments. Pakistan’s demographic trends show that between 1990 and 2010, population aged 60+ years increased by 75.1 %. It is projected that the life expectancy will increase to 72 years by 2023. A WHO report published some years ago projected that 5.6 % of Pakistan’s population was over 60 years of age,
with a probability of doubling to 11 % by 2025. As such, the country needs to develop a national health policy for the aging, which would assist in integrating the population of senior citizens and offer them better social security and health care.
An aging population is the result of various interrelated development achievements. This generally happens when people begin to live longer not because of improved healthcare but also due to supplemental factors, such as better nutrition, sanitation facilities, education and incomes. However, aging also presents a range of socio-economic challenges for individuals, families, and societies at large. It is for this reason that the United Nations Population Fund has highlighted aging as the most significant population related issue for the current century. While one in nine people in the world today are aged 60 years or over, this ratio is expected to increase to one in five by 2050. This major shift in population structures will have far-reaching implications, especially for the developing world.
While aging is happening all over the world, it is the fastest in the developing world. Amongst 15 countries with more than 10 million older persons, seven are developing countries, including Pakistan. In order to prepare for this inevitable outcome, measures must be taken to provide effective health and other social services for the elderly within the country. Otherwise, families in the future will be faced with a tremendous burden – taking care of their elderly while struggling to meet their children’s needs as well.
A Senior Citizens Bill is pending in parliament since 2007. The creation of a senior citizen welfare council is envisaged by the draft bill to help formulate policy proposals, conduct research and compile data in order to introduce interventions for the welfare of senior citizens.
Once the senior citizens council is established, its goal should be to introduce proactive measures for the aging population. Efforts must be made to invest in the elderly by providing them with increased business opportunities and supporting their roles as caregivers to their grandchildren so that they do not feel that their ability to make a positive contribution to society has ended by the time they reach their sixties.
Moreover, greater efforts must simultaneously be made to address the pending health and economic empowerment of the aging population. Making public healthcare facilities more proactive and elderly-friendly is one possibility; trying to devise health insurance schemes to cater to the elderly in particular, is another issue that needs closer attention.
Investment in pension systems is seen as one of the most important ways to ensure economic independence and reduce poverty in old age. Besides government retirees and well-to-do private firms, employees can hardly expect much support once they physically stop working. An Employees’ Old-Age Benefits Institution (EOBI) scheme was established in Pakistan decades ago. The EOBI Act 1976 was passed to provide compulsory social insurance benefits for all employees. The EOBI, however, does not receive any financial assistance from the government. Rather, employers are required to provide five per cent of minimum wages for each employee and employees themselves must contribute one per cent of minimum wages from their salaries to secure EOBI benefits upon retirement.
About a decade ago, EOBI was estimated to be providing coverage to only five percent of the active labour force in the country. The situation has probably not improved much since most employers try their best to avoid the EOBI and other obligations towards a significant proportion of their workforce by not declaring them as permanent employees on their official records. The informal sector, including agriculture and cottage industries, also does not provide EOBI benefits to their workers.
In 1999, the government designed a national policy for the promotion of better health of the elderly. This policy incorporated training of primary care doctors in geriatrics, availability of dental care, domiciliary care, and a multi-tiered system of health care providers for the elderly, including physical therapists and social workers. Green slips for prescriptions were also made. Unfortunately, implementation of the policy is still being awaited. Only a few nursing homes exist in some of the bigger cities.
Unless the government reprioritizes its policies to ensure that more employers comply with pension coverage for their workers and begins to allocate more money to health and social safety needs of the elderly, Pakistan as a nation will not be able to offer much comfort to its aging population.