GVS Magazine Desk |

Dr Sania Nishtar is Special Assistant to the Prime Minister of Pakistan and BISP chairperson. She previously served in the interim federal cabinet in 2013 overseeing public health, education & science. She currently co-chairs WHO’s High-Level Commission on Non-communicable diseases along with the Presidents of Uruguay, Finland and Sri-Lanka. She also chairs the Advisory Committee of the UN’s Institute of Global Health. In 2017, Sania Nishtar was one of the three nominees shortlisted as candidates for the position of director-general of the World Health Organization. Najma Minhas, Managing Editor GVS, sat down with her to understand the government’s vision for the recently launched Ehsaas program.

GVS: Prime Minister Imran Khan keeps mentioning the Riyaast-e-Medina, what exactly is he referring to?

Dr Sania Nishtar: He is referring to the notion of a welfare state. That the state should have responsibility for those who are disadvantaged and those who are disabled, who can’t work because of a disease or infirmity or the elderly who have no one to fall back on, orphans, widows who are unable to earn a livelihood, the state should pay for them and take care of them.

GVS: This is social justice in general as a principle, what is it specifically that he has in mind?

Dr Sania Nishtar: Ehsaas the program which you are referring to has four pillars. The first pillar is centred around governance and state capture, the second pillar is the social protection, the third pillar is livelihoods, and the fourth pillar is the development of human capital, so it’s extensive in that sense.

Ehsaas is for those who require social protection; whether it is those who are disadvantaged, those who are disabled or ill or have no insurance, widows, and orphans, or the extremely poor. So, that’s the social protection category, and under this framework, there are two programs which are being launched that I can dilate upon subsequently.

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GVS: Are these pillars equally important or is there one more prominent?

Dr Sania Nishtar: They are all mutually reinforcing. For example, pillar one the governance and accountability is crucial in enabling other components. If you’re don’t focus on anti-corruption measures, transparency, reduce discretion from the system, and eliminate all kinds of measures that jump through rules; you will not be able to strengthen the social protection agencies to deliver the programs that you aspire to provide. So, governance and social protection are very much interlinked.

The same is the case with the livelihood pillar if you are not going to strengthen and improve oversight of governance institutions, and if you are not going to uphold rules based on decision making, then there will be corruption in giving out interest-free loans or giving out asset transfers that are part of the third pillar. You will not be able to roll out your solutions or innovations.

GVS: So, it’s more of a Venn diagram where governance is the central overlapping point?

Dr Sania Nishtar: I think that is a very elegant way of framing it because the governance and the state capture part is over-arching to the other three pillars and focus on implementation, delivery, and transparency.

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GVS: The three pillars: livelihood, social protection, and human capital development is there an order in which you are going to proceed with these?

Dr Sania Nishtar: Before I talk about the order you must appreciate that this is a huge program we are going to conduct, with 115 policy actions, executed by 26 federal agencies, four provincial governments, and AJK and GB. It is a truly intersectional program. If you look at the mandate of the program of a particular agency that individual agency may prioritize one pillar and action over another. So, BISP may prioritize what it wants to do earlier, vis-a-vis other ministries or agencies.

However, on the whole, things have commenced in tandem. So, for example, the aviation division which is responsible for bringing out a policy for air ticket subsidy for overseas Pakistanis have not come back to their country in seven years, is working concurrently with the railways’ ministry, which is supposed to work out a better ticketing formula for the disabled. Likewise, the provinces are working with their part in the ministry of education, or the ministry of overseas Pakistanis is proceeding with its own six agenda items.

GVS: Can you explain the mandate of the newly created division of social protection poverty alleviation for which you now have responsibility for?

Dr Sania Nishtar: The division is attached to the cabinet secretariat and BISP is attached to the division of poverty alleviation and social protection. There is a reason why it was created; because, previously the federal government agencies that were mandated to deliver social security which were; BISP, Pakistan Bait-ul-mal, Pakistan Poverty Alleviation Fund, and many other smaller entities were independently attached to different ministries.

BISP was attached to Ministry of Finance, Bait-ul-Mal was with the Cabinet Division, and Zakat was attached to the Ministry of Religious Affairs and so on. Each one of them had a different reporting line which created impediments for institutional policy coherence, fragmentation, and much duplication; by bringing them together under one division now, you are not only exploiting the synergy but also creating a door for one window operation.

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GVS: The government has promised to make a constitutional amendment in which it will be the state’s responsibility to provide housing, education, medical relief, and clothing. This will be moved from the principles of the policy section and placed as a fundamental right. What is the importance of this, and what is the likelihood of you being able to make the constitutional amendment to do that?

Dr Sania Nishtar: In terms of the difference, the ‘principles of policy’ are non-enforceable as opposed to the ‘fundamental rights.’ So, yes, principles are meant to be followed, but they are non-enforceable by the judiciary. If it is in the ‘principles of policy’ section, nobody can go to a court and demand it as a right. However, by moving a specific subject into the fundamental right’s section, to the first section of the constitution, it becomes a right and by virtue of that becomes enforceable by the courts.

So, the idea is to move part of the section, part of the language that is currently under article 38(d) into the rights section. It would essentially mean that if somebody is sick with no one to fall back on if somebody is disabled or is unable to find a job for a particular set of reasons, then it is the state’s responsibility to provide social protection. Moreover, this would be quite a fundamental statement in terms of social protection to make within the country.

Now, in terms of the second part of your question, will we be able to do that? Of course, it is the Ministry of Law’s mandate to bring it to the table; first to get cabinet approval and then for parliamentary approval. The government realizes that it does not have a majority, but a constitutional amendment of this nature will be extremely difficult for anyone to oppose except on grounds, that it will create expectations and demands which might not be fiscally feasible.

GVS: Education is already a part of the fundamental rights (article 25a), but 25 million children are out of schools. In addition to that, you are now saying that you are going to provide the right to housing, medical, and clothing.

Dr Sania Nishtar: You are right in saying that despite article 25(a) there are a significant number of children out of school and that’s a correct statement to make. But as a result of the article, it could be argued that there has been a pressure on the provinces and the federal government to invest in this area, to come up with innovations such as vouchers, contracting arrangements with private schools, where there aren’t any schools.

Now we can debate about the effectiveness of that; the transparency with which those were done and the overall effectiveness and that is a separate matter. However, after article 25(a), notwithstanding that there was a lack of awareness generally amongst the masses, there has been a significant impetus to increase investments in primary education and hopefully when the government’s economic environment improves this, will start accruing benefits in the way that it should.

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GVS: The government has announced that going to be conducting a survey for a national socio-economic registry, what exactly is this survey about and who are you covering and what’s your timeline in mind?

Dr Sania Nishtar: In 2010, the then government conducted the first National Socio-Economic Survey, it was a door-to-door survey, it was almost a census, and the socio-economic registry was developed as a result of that. BISP was the custodian of that registry. We use that for our cash transfer system, which as you know is based on three monthly stipends to currently 5.7 million women, but with 7 million-plus eligible.

So that registry has become outdated now because such socio-economic registries need to be updated on a five-yearly basis because the socio-economic conditions of families change, they migrate and so on, especially when the 2010 registry was made, due to the floods there was much movement.

GVS: You think that some of those people might now be taken out of the national socio-economic registry?

Dr Sania Nishtar: Yes, and others included. The other day I was speaking to a woman; who said she was eligible to be a BISP beneficiary back in 2010, when she had recently been widowed, and the community members had put her name forward. However, now she said my kids are overseas, they send me money, and so I feel embarrassed using my BISP card so can you please take it back?

Thus, the socio-economic conditions change, and by virtue of that you have to exclude some, include others, but there are other ways of making a registry live, which is something we are going to institutionalize as well. So hopefully once the 2020 registry is created, we will obviate the need for extensive national census-type surveys to be conducted because we are going to use big data analytics to do triangulations that would be necessary to update the registry.

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GVS: Do you have any calculations or estimates whether you are going to have fewer people or more people?

Dr Sania Nishtar: It’s a nationwide survey, and the way it works is that everybody falls on a certain score, so even you and I fall on a specific score which starts from zero and goes up to 100. Each household will be assigned a number. We don’t have any numbers to share currently. The survey has been started with the country divided into eight clusters, and we are quite far along. It should be concluded by early 2020.

GVS: It is almost like the national census which we did last year – why didn’t that cover the socio-economic dimension at that point?

Dr Sania Nishtar: So, when the national census was done, it was done in a different setup and parameters, and of course there were two opinions on how the socio-economic survey could be conducted at that time. I was on the BISP board then, and I was strongly of the view that the questionnaire of the socio-economic survey could have been integrated with the national census, because that could have obviated cost, but then, of course, the board decides through majority, and I was a minority voice at that time. That certainly would have been a cost-effective and quicker way of doing it.

GVS: How have you defined poverty within the registry?

Dr Sania Nishtar: As I was explaining that every family falls on a score from zero to a hundred. Anybody who is below the score of 23 is poor. We use the cut-off point 16.7 for BISP targeting, but for other initiatives, for instance, the eligibility for the interest-free loans, they take a cut off point for 23, and it may well be that if the same data is used that microcredit on the market mechanism may be used for a score of 40.

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GVS: Okay, so you have different scores, depending on which particular segment/project you are looking at.

Dr Sania Nishtar: This is very different to measuring poverty in a cross-sectional survey because when you come up with a national number, you do cross-sectional income and expenditure surveys from which you compute the poverty metric on the income parameter. On the income parameter, currently, the official figure also endorsed by the World Bank is that Pakistan has 24 percent of people living below the poverty line.

However, then the United Nations system has another metric which does not only factor income but also a number of different parameters into constructing you know, your socio-economic status; the level of education, your accessibility to health, your living standards, etc. – that’s the multi-dimensional poverty index and based on that 38 percent Pakistanis are below the poverty line.

GVS: Your national registry does it fall between these two?

Dr Sania Nishtar: No. Those two numbers are derived from population-based surveys which the Federal Bureau of Statistics does, and those are used for measuring performance and impact in poverty levels. The data is extremely highly charged because for different political governments, those numbers are very sensitive.

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GVS: Will the projects start after you have completed the registry in 2020?

Dr Sania Nishtar: It depends on which projects. There is segmentation in terms of the intervention targets. The registry will be updated in 2020, but we are already working based on the existing database, and BISP is continuing its targeting on that. We will switch after the new 2020 registry is completed. Some people will fall out, and others will be added. We are trying to do it in an as apolitical manner as possible to keep it very professional.

In October this year, a new program “kafaalat” will kick in which women will set up bank accounts through a handset policy, we are going to push which of them are going to have handsets. Once women are digitally included and financially included, the world opens for them, in terms of opportunities for economic empowerment, in terms of them being able to take benefit from many other reforms where digitization has been mainstreamed.

GVS: When you speak of lofty aims to give everybody a job, to provide everybody medical relief, housing, clothing the majority of developed countries in the world have not been able to do this. They have set limits and set cut-off points.

Dr Sania Nishtar: Of course. If this constitutional amendment goes through and it becomes binding for the government to frame such policies, there will be limits around what the government can do, and the conditions under which individuals can go to court demanding those benefits. Then there is this whole literacy piece that has to be backed up, because part of the reason why the number of out of school children has not gone down to zero, despite Article 25A, is that there is very little awareness.

I recall, back in 2013, in the interim government when I had the education portfolio, I would often ask poor women with children in private school uniforms, ‘Do you know about Article 25A’, and consistently they would tell me that they do not know what that is. So, I think that the Constitutional Amendment piece, which is just one piece out of the 115 areas that Ehsaas is intended to pursue, is partly aspirational, and it would be a very bold move for a sitting government, and for a sitting parliament to espouse this.

Also, Insh’Allah, Pakistan will not stay in such economic dire straits forever; we will at some point have this fiscal space to be responsible for such policies. So, it’s aspirational, it is forward-looking, and at some level, it is also very pragmatic, because you define the limits of what you will be able to provide to a specific category of individuals.

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GVS: A lot of the money that goes into BISP comes from the World Bank and other donor agencies, and it comes in the form of USD loans. What sense is there in taking out dollar loans and giving them out as handouts, which we eventually have to return at a much higher PKR amount?

Dr Sania Nishtar: Well, first of all, the idea that a significant chunk of the money in BISP comes from donors and loans, is a widespread misconception. I, myself, had that very same impression before I joined as a member of the BISP board. However, 85% of the money going to these poor women through BISP, is Pakistani taxpayer’s money. Yes, we do have a small envelope of technical assistance from the World Bank, but the main portion of money that goes to these women, I reiterate once again, is Pakistani taxpayer’s money.

In terms of your earlier comment in which you just re-echoed about handouts vs. economic opportunities, previously, the women were getting handouts. It may well be like that going forward, even after the one-woman-one-bank account policy, which shall come into effect in October, some may not be able to benefit from the economic tools that we are placing in their hands, because some of them are genuinely extremely poor and need immediate cash based help.

However, there is a particular category of women in our BISP beneficiary pool; who will be able to understand what a bank account is, they will be able to take benefit from the messaging that they receive from the mobile phone and, as I mentioned earlier, we are trying to find a way of putting more handsets into the hands of women through a handset policy.

And once we are able to achieve this target of digital and financial inclusion, layer it up with financial literacy, and partner it with the right private sector financial institutions, the objective will be to open up the opportunities for them as the banking sector will be able to layer up services for them, such as loans, savings, insurance, etc. So, we are making a transition from simple cash-out handouts.

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GVS: In terms of emphasis of government policy what percentage is it cash handouts versus economic empowerment?

Dr Sania Nishtar: So, the one-woman-onebank-account policy, as I said earlier, is going to come into effect in October, it is going to help us move totally in that direction. The extent to which women will be able to benefit from this opportunity will be dependent on; their capacity and awareness; the effectiveness of our digital literacy and financial literacy campaigns; and the ability of the private sector institutions to tap that opportunity. However, I have to tell you that even now, not all the stipends that we give go towards ration and utility bills.

There are these fantastic stories, you know, around how women were able to educate themselves and pay their matriculation fees with these stipends. BISP also has a conditional cash transfer program centered on education, specifically that if you send your kids to school, there is an additional stipend you get. Which is now being expanded to include nutrition and other points, including family welfare, this should also help in population planning.

GVS: Is population planning is going to play a part in the Ehsaas program?

Dr Sania Nishtar: Yes, when you come towards the end of the policy statement, before you enter policy 113 there is a chapter which says that the success of all these initiatives because it is a very ambitious agenda, focuses on: population control, integrity, and public-private partnership. So, the population is very much on the agenda, and the UNFPA is supporting our technical support unit for the government of Pakistan, and under Ehsaas, the technical support unit is meant to come under the stewardship of the Prime Minister.

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GVS: Is a gender bias going on here, in favor of women against men, I mean, why is it that you are only tapping into women? What about the men?

Dr Sania Nishtar: We have many programs, many features within Ehsaas that are specific to women and gender empowerment. For example, we have talked about the seven million women, but in addition to that, there are many other gender empowering features within programs. So, wherever there are educational schemes, 50% of these will go to women, whether it is schools or the new undergrad scholarship scheme that is being introduced.

If they are interest-free loans, women will have a 50% share. In the new housing policy of the government, women are going to have co-ownership of the houses, whenever the government underwrites any aspect of instruction. However, not all the programs are women focused. There is another social protection program called the Tahafuz, which is a shock-oriented safety net, and in that, we will not discriminate between men and women. So, if men have undergone a shock, whether it is a health shock or whether it is related to some other condition, they will have access to that window as well. Also, all the livelihood and development of human capital initiatives are open to both genders.

GVS: What is the on-demand window that has been mentioned in the Ehsaas program?

Dr Sania Nishtar: So, the on-demand window is the shock oriented decision safety net, which means, for example, if a woman has been thrown out of her house and cannot engage a legal counsel. She sends us an SMS, and we are all set up to provide her that assistance within 48 hours. For example, a laborer falls, breaks his leg, and is lying in a hospital. His family doesn’t have to go to the village and sell their cattle or their house or their piece of land, but will send us an SMS, and we will ensure that the nail and plate required to patch up his leg is provided in 48 hours. I think that capability will indeed be transformative in a social protection context.

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GVS: Which is the one part of this whole program that you really think is key in your mind?

Dr Sania Nishtar: I would want to push half of those initiatives into a one window operation. Of course, each one of these is hugely important, though financial inclusion beats the plethora of policies around the formal, informal, and mainstream sector. There is a long list, and I am passionate about all of them.

However, I believe that the one thing that is going to be profoundly transformative will be the ability of the country to consolidate all of its databases, to institutionalize big data analytical ability strategically, to update the registry an ongoing basis and then to have the on-demand window that we envisage creating through the Tahafuz.

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