Whither the Old?

A lot more needs to be done in Pak­istan to pro­vide care for the aging, in­clud­ing bet­ter gov­ern­ment pro­grams.

Southasia - - CONTENTS - By Sam­ina Wahid

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.

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