Senior Citizens : A Case Study of Pakistan

Aging is a natural phenomenon. The impact of socio economic pressures has constrained to change life styles. Pakistan is no exception. More and more people demanding independent family units have been forced to rearrange family structures, therefore, joint family system is becoming unpopular. Work demands, transfers and posting and relocation have contributed to this phenomenon. On the other hand, under present socio economic conditions, in developing countries, family support is diminishing. The government welfare systems are almost non existent. The destitute elderly have no support to bank upon. Through this study we have examined the problems of elderly in Pakistan and also analyzed the government and other initiatives taken towards redressal of these problems.


INTRODUCTION
Pakistan's society has always stood for high value, respect and dignity of human life.Old age is regarded as a mark of esteem, wisdom and piety.This could be attributed to the strong ties that exist in the joint family system nurtured by religious values, dignifying the status of elderly segment of society.
The Constitution of Pakistan declares promotion of social and economic well being of the people as one of its cherished objectives and inter-alia cast an obligation on the state to provide basic necessities of life for those citizens who are permanently or temporarily unable to earn their livelihood on account of age, infirmity, sickness or unemployment [1].
Many people would probably agree with the following statements about the elderly: 1-Old people are usually senile 2-Older workers are less productive 3-Most old people live in poverty 4-Most old people are lonely 5-Most old people are set in their ways and unable to change It is also widely believed that keeping in view the above points it looks like that the senior citizens deserve special care and attention.

SENIOR CITIZENS: A GLOBAL PERSPECTIVE
In the last few months the United Nations Population Division and the U.N. Population Fund have released several updated reports on the world population and the impact of the increase in those aged 65 and older.Following are some of the highlights from these U.N. reports as they related to the older population [2].
"By July 2005, the world will have 6.5 billion inhabitants, 380 million more than in 2000 or a gain of 76 million annually.Despite the declining fertility levels projected over 2005-2050, the world population is expected to reach 9.1 and will still be adding 34 million persons annually by mid-century.
Today, 95 per cent of all population growth is absorbed by the developing world and 5 per cent by the developed world.By 2050, the population of the more developed countries as a whole would be declining slowly by about 1 million persons a year and that of the developing world would be adding 35 million annually, 22 million of whom would be absorbed by the least developed countries.The elderly population in developed countries has already surpassed the number of children (persons aged 0-14), and by 2050 there will be two elderly persons for every child.In the developing world, the proportion of the population aged 60 or over is expected to rise from 8 per cent in 2005 to close to 20 per cent by 2050" [2].
"During 2005-2050, nine countries are expected to account for half of the world's projected population increase: India, Pakistan, Nigeria, the Democratic Republic of Congo, Bangladesh, Uganda, the United States of America, Ethiopia and China, listed according to the size of their contribution to population growth during that period".As shown in Figure -1, population aging, which is becoming a pervasive reality in developed countries, is also inevitable in the developing world and will occur faster in developing countries.

INTERNATIONAL PLAN OF ACTION
"The developing countries, especially those heavily indebted, have plunged into great difficulties as a result of the world-wide economic recession and the process of globalization.The increase in debt servicing, withdrawal of subsidies on essential commodities and continuing denial of market access to exports have had a negative impact on the overall economic and social conditions in the developing countries.The vulnerable groups, especially the elderly, have been affected most severely.Thus, most of the countries have not attained the targets/commitments made under the International Plan of Action for aged population adopted in 1982 in Vienna" [3].This clearly indicates the gap in achieving the desired level of progress for the old age population.This is the opportune time that developing and developed nations should realize their role and attach importance to the best interest of senior citizens.On the basis of key lessons drawn out of the experiences of post First World Assembly era, the new millennium challenges ahead should be met without improved vision and strengths.Our prime consideration should be to advocate the cause of elderly population by promoting respect for the dignity, equality, non discrimination, violation free society, better health care and above all breaking the vicious circle of poverty.
With a view to asses the progress made in achieving the desired goals and also to identify gaps for redesigning/reformulating strategies and actions to support global initiatives/ commitment being made by this Assembly at Madrid, let us review the existing services & benefits for senior citizens in the developed and in developing countries.

SENIOR CITIZENS: POSITION WITH REFERENCE TO PAKISTAN
According to the 1998 census, there are 7.3 million senior citizens in Pakistan --a significant increase from 2 million in 1951 [8].
The aging phenomenon starts early in Pakistan and other developing countries, because of poverty and malnutrition.Especially the Pakistani women enter the old age in 30s because of the social and cultural set-up.Of those aged 60 or above in the country, 3.9 million are men and 3.4 million are women.They need special care, attention and protection.
Pakistan predominantly is a Muslim state where family system is influenced by Islamic culture and Islamic values, where respect, care and sharing for each other are basic norm.However, due to the influx of western media and other external influences we see and find western family patterns being more attractive.It is widely believed that the youngsters want to be more independent and the new married couples like to live separately and do not want to live with their parents for want of privacy.
Our elderly parents, who have raised us from child to a man have invested years in our upbringing, are left in lurch in spite of their expectations that the children will support during old age.Majority of them are suffering daily problems of life, which due to old age they cannot attend to, keeping their hopes and eyes towards some sort of care they deserve; but it is a far fetched dream.Some of the problems faced by elderly are discussed here under:-The low status of the elderly is closely associated with 'ageing" of a particular social category.Two hundred years ago, the elderly had a high status in our society, but now the status of the elderly has declined for several reasons.In Pakistan the elderly no longer hold positions of economic power.Children no longer learn their future profession or trade from their parents-instead, such skills are learned through institutions, such as the school system.In addition, the children of the elderly are no longer dependants upon their parents for their livelihood, as they generally are capable of making a living through a trade or profession that is independent of their parent's.Finally, the elderly no longer perform tasks that are viewed as essential by the society-often the older workers' skills are viewed as outmoded even before they retire.
The physical process of aging is one reason why the elderly has a higher rate of health problems.The elderly face a wide range of stressful situations; loneliness, death of friends and family members, retirement, change in living arrangements, loss of social status is reduced income, and a decline in physical energy and physical capacities.Medical conditions also may result in substandard diets, inadequate exercise, smoking, and excessive drinking of alcoholic beverages etc.
It has been reported in Pakistan, that most of the elderly are inadequate with no enough meat and lack of fresh fruits and vegetables (Pakistan National Council of Social Welfare 2000).
The other major problems that the elderly people are facing is the lack of transportation facilities in Pakistan.The non-availability of transport or the inability of the senior citizens to bear the cost for travel makes their movements restricted to the place of their living.Even for medical and other emergencies, their financial or physical handicaps make it difficult for them to easily reach the place of destination or come back to the residence.
There are also some special problems for the elderly, which are aggravated due to the loss of strength and increased dependability.Apart from the feeling of loneliness, the problems of economic pressure and poverty are considered as the foremost.
Among the elderly, many are left as single due to the death of their spouse.In many regions, the incidence of remarriage of widowed/divorced is lower among women than men.This is due to the cultural taboos inhabiting widowed/divorced women's remarriage.This contributes to keep the proportion of widowed or divorced among the elderly women high [9].It has been observed and believed that in Pakistan, many of the elderly live in poverty.A fair number lack adequate food, essential clothes and drugs, and perhaps a telephone in the house to make emergency calls.The financial problem of the elderly is compounded by additional factors.One factor is the high cost of health care as previously discussed.Second factor is inflation.Inflation is especially devastating to those on fixed incomes.Most private pension benefits do not increase in size after a worker retires [10].The biological effects of aging are slow and the speed of aging varies greatly from person to person, but the sociological implications are damaging and painful.
The situation of the pensioners in Pakistan is not better because the pensioners are often not adjusted correspondingly to cover for the inflationary effects.The rising trend in the cost had been a general source of worry for the retirees because the amount of their pensions remained unchanged for a long time.Most of the pensioners, therefore, rely on the position of their children or other relatives.Thus, such elderly whether residing in urban or rural areas are threatened by unfavorable socio-economic circumstances.
It is difficult to estimate with any accuracy the number of older people who are physically abused, since most cases of abuse go unreported.Partly because of the increased public attention to abusive relationships of all sorts, however, there is an increased concern that "elderly abuse is a widespread and significant problem.This concern in part reflects the stereotype of the elderly as frail and dependent and, therefore, highly vulnerable to others" [11].
Although cases of abuse certainly exist, most research suggests that "it is not as widespread as is commonly perceived, and it is certainly well below the commonly cited figure of one out of every ten" [11].
Furthering our discussion, it has been seen that large proportion of elderly people are living with their husbands or wives.Those elderly who can not have sound relationship with their spouses can not divorce each other because of the social, cultural ad traditional constraints of the society.Therefore, the feelings of loneliness and isolation are still there although they have their respective spouses with them.
Urbanization and modernization has led to the change in the structure of family system in Pakistan.
More and more children are leaving home to set up their own families in separate homes.When the last child leaves, most parents find the "empty nest" lonely and meaningless.Some of the elderly people think themselves as inadequate as they are dependent on their children and even a small quibble results in family crisis and create situation of conflict and strain among the family members.

GOVERNMENT OF PAKISTAN INITIATIVES
The Government of Pakistan from time to time has made efforts to address the issues of senior citizens.However, such programs did not receive any implementation as no law has been passed to put force into such directive.Individual level attention has been paid to the issue and some organizations/ private companies/ clubs etc gave some relaxation to the senior citizens but such initiates are not enough.On August 26, 2004, the then Prime Minister, Chaudhry Shujaat Hussain approved a comprehensive relief package for senior citizens to provide basic needs of life on concessional basis and ensure their due respect and honour in the society [12].He said the package has been prepared in order to save the senior citizens from the awful situation in the hospitals and banks and to provide them special attention.With the implementation of the package, the senior citizens would be given priority at the railway stations, airports, hospitals and banks.The package also includes legal facilitation for the senior citizens and all the courts and concerned departments would be directed to give priority in handling the cases of the senior citizens.But all is still on papers.
Regarding traditional virtue of respecting and assisting aged persons, the package also include changes in the syllabi of primary and middle schools to incorporate the concept virtue of respect for elders as a part of moral education.It would elevate the social image of the senior citizens as the children in schools should be taught religious principles of respect and care of senior citizens.
Other steps/measures taken include; Employees Old Age Benefit Act 1976, Social Security Act 1965, Pension for Government Employees and Government Employees Benevolent Fund.
The issue of care, protection and well being of the elderly has been addressed under the Public Sector Development Programme (PSDP) and Ten Years Perspective Plan.These programmes provide for establishment of Senior Citizens homes to accommodate destitute, indigent and homeless persons without support.Also included in these Plans/Programmes are creation of Senior Citizen's clubs/centers at local levels to make use of their life long experiences, knowledge and, expertise.Apart from providing institutional care to the needy/elderly persons, major emphasis is being laid on strengthening our traditional joint family system.Establishment of geriatric wards in hospitals is another priority area in the direction.The scope of providing hostel facilities to the retired persons at their own expenses is being explored.Also special beds in the major Government Hospitals are being reserved for elderly patents.Besides the public sector, the private sector is progressively providing necessary health care facilities for elderly people.

THE ROLE OF NGOs
In order to access the ground facts for the purpose of this study efforts were made to contact with NGOs like 'Edhi Welfare Trust', 'Agha Khan Foundation (Karimabad)'.It was obvious that only two to three NGOs have been silently operating in this filed in Karachi.The Edhi Welfare Trust (EWT) houses elderly who either have been left by their children at the mercy of the EWT or family and relatives who left their elderly and sick to get rid of them due to socio economic reason.The number of such people is limited due to shortage of resources etc.The Agha Khan Foundation, Karimabad chapter, has established a senior citizen home in North Nazimabad Karachi.This centre only accommodates Agha Khanis and not outsiders, so basically, it is meant for the Agha Khan community welfare (interview with Senior Citizens Home Committee members).
Keeping in view the above facts in the context of Pakistan it seems that very little work has been done with regard to Senior Citizens.

SURVEY ANALYSIS
This research is an empirical study based on a consultative exercise through primary and secondary sources.As there is dearth of literature so the researcher has tried to collect data from different libraries, NGOs and Social Welfare Organizations in Karachi.As far as the primary data is concerned, senior citizen centers available in Karachi were visited.The management of senior citizen centers, policy makers and senior citizens were interviewed through a semi structured questionnaires, separately.Internet resources were used to get the required material on the subject as well.
In order to assess validation of the data, a general survey was considered in the urban areas of Karachi.This survey helped in diagnosis of the level of satisfaction among the policy makers, general public, senior citizens and NGOs.All the stake holders voluntarily participated in the survey.The target population size was 40 people include: Senior Citizens, NGOs, Policy Makers and General Public.
Selected ten people representation from each sector of stakeholders.Survey was conducted with he help of semi structured questionnaires and general discussions.

Results
General Public NGO Rep.

Policy makers Sr.Citizens
The results (figure-2) indicate that most of the stake holders are not satisfied with the Government initiative and were of the opinion that work is required to be done in this area.They were also of the opinion that Government has to play a policy formation role leading the way for the social welfare organizations and NGOs to carry out parallel working for better service and welfare of senior citizens of Pakistani Society.It is evident from the above statistics that almost 100% of Senior Citizens being the major & foremost receiver of the benefits were utterly disappointed of the reforms.

CONCLUSION & RECOMMENDATIONS
It seems that in Pakistan only political slogan and political speeches/ sermons and suggestion exists but no policy frame work is concluded or put forward for implementation.Though some social workers and NGOS have been working in this filed but their number was negligible and their working was limited, as such no significant contribution is seen towards community participation in this area.
However in contrast to the majority of nations , policy work appears to have been done at Government level by USA & European Countries; are working towards protection, facilities and rights of their aging population.
In this conclusion, recommendations for Senior Citizens in Pakistan are suggested as under which shall serve as a guideline for our policy makers and is a research topic within itself for further study.
⇒ To develop reforms through discussions, seminars, conferences etc. ⇒ To build public awareness and consensus required to support the reform through government, social parties, NGOs and the public.⇒ A new Government Department in the federal ministry for social welfare be created to form policies and implementation of plans regarding senior citizens.⇒ To establish a Senior Citizen National Database.⇒ To make facilities for senior citizens in all the existing civil structures and buildings like shopping malls , roads etc where old age people can easily walk, shop etc. ⇒ To develop the products that meet the material needs of the old people.⇒ Mature age employment quota to the extent of 1% can be reserved for senior citizens.⇒ A free of cost vocational training and technical training be provided to senior citizens.⇒ Public-private partnership schemes be encouraged for construction of supportive housing such as hostels, old people homes and special nursing homes, training centers etc ⇒ To provide free medical service to the elderly in the Services hospitals or other designated centers.⇒ Banks to support credit facility for senior citizen such as car loans, credit cards, microfinance facilities etc. ⇒ Payment of Monthly Stipend to non affording elderly be given by the government out of zakat or baitulmal funds.⇒ 50% reduction on all domestic and city routines by rail, bus, aeroplane etc be allowed to the older people ⇒ Utility services like electricity, gas, phone etc be provided at minimal charge.⇒ Free legal council services be introduced for senior citizens ⇒ NGOs and Social Welfare organizations should be encouraged to enhance their role towards elderly care services.