CARE FOR SENIOR CITIZENS IN PAKISTAN: A REAL CHALLENGE

Munawar Hussain Soomro

Abstract


Sorbonne Universités, UPMC Univ Paris 06, INSERM, Pierre Louis Institute of Epidemiology & Public Health, Epidemiology of Allergic & Respiratory Diseases Department, Saint-Antoine Medical School, Paris, France
Pakistan is a developing country with over 200 million people in an area of 7, 96,096 square kilometers (sq.km) and the population density is 260.8 per sq.km.1 The population demography is on the increase in Pakistan, life expectancy has risen from 59.9 years in 1990 to 67.7 years in 2016 with declining mortality and fertility rates. However, according to the United Nations report by Population Division of the Department of Economic and Social Affairs this is beneath the average life expectancy at birth of the global population which is about 71 years.2 The literacy rate is approximately 57.8%. About 60% of the population is between 15 and 60 years old, and about 4 to 5% population is above 60 years of age; which will be more than 15% by the year 2050.
Health care system of our country engaged much of its time, energy and resources to overcome the communicable diseases, to provide nutrition and improve sanitation. During the last decade, there has been a gradual shift from communicable to non-communicable diseases.3 Currently, the public and private hospitals are dealing more with non-communicable diseases than in the past.
The Government of Pakistan had promulgated the Employees’ Old-age Pensions Ordinance in 1972. However, this was never implemented. Later, in 1976, this was replaced with an act of parliament, called Employees’ Old-Age Benefits Act, 1976.4 This system was started to achieve the objectives of article 38 (c) of the Constitution. While Government has also created special systems for public-sector employees (where Civil Pension Rules are applicable); members of the armed forces; police officers; and employees of statutory bodies, local authorities, and railways. Other than these, Government is also managing other social assistance programs for the welfare of destitute and needy citizens. Under the Zakat and Ushr Ordinance 1980, benefits are provided to the poor muslim citizens of Pakistan.5
However, the provision of regular pensions is limited to formal sector employees. Few social protection schemes in public and private sectors are in place and only cover a tiny proportion of the elderly. The challenges of elderly population whether pensioners or otherwise, therefore, go beyond social security, health and morbidity issues.
Geriatrics education is a part of undergraduate and postgraduate medical education. However so far, there is no postgraduate course being offered in Pakistan. Hence, there is lack of expertise and experience in this specialty. There is of course lack of supporting staffs too.
As there is no separate geriatric wing in most of the public and private hospitals in Pakistan. acute and ambulatory care for the elderly is offered through internists in secondary and tertiary care hospitals. This is also unfortunate that the long term care for the senior citizens including assisted living and hospice care is still to develop like in other low income countries. However, a few old people’s homes are run by the non-government organizations.
Pakistan predominantly is a muslim state where family system is influenced by Islamic culture and Islamic values, where respect, caring and sharing for each other are the basic norms. Traditionally, particularly in rural Pakistan, growing old always brought more respect and importance in the society since the old age people were considered as reservoirs of knowledge and wisdom and there was an in-built trust between the young and the old. However, these traditional values are at risk with the globalization of lifestyle and cultures. It is believed that the youngsters inspired by western values and life styles, want to be more independent and the newly married couples like to live independently. They do not want to live with their parents for want of privacy. Government Organizations and Non-Government Organizations are working admirably well, yet this is not enough to meet the challenge and to take care of every elder of the nation.
Senior citizens are the asset of a nation. They have experience, wisdom and knowledge which can be used for the national development and progress. It is the responsibility of every one to take care of them. Old age is an inevitable stage of our life cycle and we must do everything for the care and comfort of our senior citizens.

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References


https://www.cia.gov/library/publications/the-world-factbook/geos/pk.html.

United Nations, Department of Economic and Social Affairs, Population Division (2013). World Mortality Report 2013 (United Nations publication). ST/ESA/SER.A/347.

Wasay M, Zaidi S, Khan M, Jooma R. Non communicable diseases in Pakistan: Burden, challenges and way forward for health care authorities. J Pak Med Assoc 2014;64:1218-9.

http://www.ilo.org/dyn/natlex/docs/ELECTRONIC/35086/118510/F540240820/PAK35086.pdf

The zakat and ushr (amendment) act 1997, The gazette of Pakistan, National Assembly Secretariat. http://www.na.gov.pk/uploads/documents/1324605100_355.pdf.


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© 2011 Gomal Journal of Medical Sciences