GUIDING QUESTIONS FOR THE FOCUS AREAS OF THE X SESSION OF THE OPEN-ENDEDWORKING GROUP ON AGEING:  Social protection and social security (including social protection floors);
question 1 national legal frame work, answer;
Pakistan is a developing country of South East Asia, with all the incumbent difficulties currently being faced by the region. Insufficient public healthcare facilities, poorly regulated private health sector, low budgetary allocation for health, improper priority setting while allocating limited resources, have resulted essentially in an absence of palliative care from the healthcare scene. Almost 90% of healthcare expenditure is out of the patient's pocket with more than 45% of population living below the poverty line. All these factors have a collective potential to translate into an end-of-life care disaster as a large percentage of population is suffering from chronic debilitating/terminal diseases. So far, such a disaster has not materialised, the reason being a family based culture emphasising the care of the sick and old at home, supported by religious teachings. This culture is not limited to Pakistan but subsists in the entire sub-continent, where looking after the sick/elderly at home is considered to be the duty of the younger generation. With effects of globalisation, more and more older people are living alone and an increasing need for palliative care is being realised. However, there does not seem to be any plan on the part of the public or private sectors to initiate palliative care services. This paper seeks to trace the social and cultural perspectives in Pakistan with regards to accessing palliative care in the context of healthcare facilities available.
question 2 : availibility 
The Government of Pakistan had promulgated the Employees’ Old-age Pensions Ordinance in 1972.  However, this was never implemented. Later on, in 1976, this was substituted with an act of parliament, called Employees’ Old-Age Benefits Act, 1976. This social insurance system was started to achieve the objective of article 38 (c) of the Constitution, which is as under:

The State shall:

Provide for all persons employed in the service of Pakistan or otherwise, social security by compulsory social insurance or other means;

This Act is applicable to the private sector only while Government has 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 while under the Pakistan Baitul Mal Act, 1992 and Benazir Income Support Program Ordinance, 2010 (program was started in 2008); assistance is being provided to all the citizens of Pakistan irrespective of their religion.
Employees’ Old-Age Benefits Act is applicable on all firms (industrial or commercial, including banks) where 5 or more workers, whether contractual or regular, are employed or were employed during past 12 months. The laws remains applicable even if the number of persons employed is subsequently reduced to less than five. The business with less than five employees can get their employees registered with EOBI on voluntary basis.

As for the benefits, it provides following four types of benefits to insured persons or their survivors.

Old-Age Pension (or Reduced Pension)
Survivors’ Pension
Invalidity Pension
Old-Age Grant (if an employee is not eligible for pension)
question 3;
Health coverage, and particularly access to health care when it is needed, is crucial for human well-being. In addition, of all the elements of social protection, health care is most essential to the economy as a whole and to economic recovery in particular. Against this background, health protection schemes and systems that are well designed and implemented, and are embedded in appropriate economic and labour market policies, have the potential to recover large parts of their costs at the national level. Thus, both the population and the economy are beneficiaries of investments in social health protection.

Given the critical importance of the right to the highest achievable standard of health for individuals, as well as for the social and economic development of the societies in which they live in, it is important that countries and development partners across the world be aligned in support of the objective of establishing universal coverage.
question 4 adequacy;
The right to adequate housing derives from the right to an adequate standard of living and is of central importance for the enjoyment of all economic, social and cultural rights. ... It should be seen as the right to live somewhere in security, peace, and dignity.
question no 5 Accessibility ;
Social Security and Pension System in Pakistan. ... In accordance with the constitutional provision of article 38, Government of Pakistan started a social insurance scheme in Pakistan for the private sector employees. Under this scheme, four types of benefits are provided
question 6
The old age, survivors, and disability insurance program (OASDI) is the official name for Social Security in the United States. The OASDI is a comprehensive federal benefits program that provides benefits to retirees, disabled people and their survivors. ... To qualify for old age benefits, a worker must be fully insured.
question 7 Equality and non-discrimination ;
One-third of Pakistan’s population continues to live in poverty, corresponding to some 50 million poor individuals. Women and children (out-of-school/working), disabled, and potentially the elderly, are the most vulnerable groups of poor.

The poor live mainly in rural areas, are unskilled, and work in the informal sector. Employment opportunities are scarce and real earnings have declined in the last decade. The poor also lack in all of the basic human, physical and productive assets and have limited or no access to essential social services.

In addition approximately 56% of households can be classified as vulnerable. According to a special survey on safety nets commissioned for the social protection report, “Managing Household Risks and Vulnerabilty (2007), nearly two thirds of all respondents suffered from one or more major shocks in three years before the survey. More than half of all shocks (about 60 percent) were caused by individual specific factors (mainly health, sickness and disability) highest incidence of shocks. The remaining shocks were covariate (including droughts, economic shocks, etc.). These shocks imposed huge costs on the ultra-poor (54 percent of annual consumption) than the non-poor (18 percent of annual consumption). While the non-poor households used mainly asset based strategies (sale of physical assets, dissaving) to cope with risks, the poor relied more on behavioral strategies—reducing consumption, increasing labor supply). The devastating impact of shocks was painfully illustrated by the recent earthquake and droughts, which showed that households in Pakistan are vulnerable to natural disasters, with the poor often the hardest hit as they own limited assets. The recent commodity and financial crisis have also adversely affected many households.

Traditionally, Pakistan’s social protection system included several social assistance programs (Bait-ul Maal and Zakat) of limited coverage. As in all other South Asian countries, Pakistan implements a pension program for civil servants and private sector workers.

Challenges

A recent review showed that:

Safety net programs are fragmented and often duplicative.
Programs have limited coverage, covering approximately 2-3 percent of the total population as compared to a poverty rate of about 25 percent.
Programs are poorly targeted. For example, 25 and 32% of resources distributed by the Food Support Program and Zakat, the country’s largest cash transfer programs, accrue to non-poor households)
Implementation and M&E capacity is very low.
There are inadequate institutional arrangements for multi-sectoral orientation of social protection agenda.
Finally, existing capacity for the provision for rapid assistance to those affected by natural disasters, such as earthquakes and droughts is insufficient.
Considerable investment in effective administrative systems will be needed to ensure that safety net programs are able to overcome these constraints and efficiently target the poor. The Government has already made an impressive step in this regard by adopting a national targeting formula and is in the process of identifying and strengthening its implementation.
Accountability  8
National Socio-Economic Registry for harmonizing social protection initiatives both at the federal and provincial government levels. More than 30 federal and provincial organizations are already using this registry to improve the pro-poor orientation of various social sector programs. As per international best practices, BISP plans to launch update of the Registry within the current financial year, which will likely be completed by December 2017.

Empowerment of women by providing them access to the National ID cards and making BISP payments to female head of the beneficiary families, enhancing their ability to take decisions on the use of cash transfers. Since the introduction of BISP, the female registration of Computerized National Identity Cards (CNICs) has almost doubled, which can potentially open avenues for their socio-economic and political empowerment.

Improved transparency and efficiency of the program with more than 93% of the current 5.2 million beneficiaries of BISP being paid through technology based mechanisms, offering even the poorest women access to branchless banking accounts for the first time ever in their lives.

Advancement of human capital development through implementation of a Co-responsibility Cash Transfers (CCT) program in 32 districts, linking cash transfers to primary school education while incentivizing admission of children of the poorest households. Todate more than 1.3 million children have been enrolled in the program out of which nearly 50% are girls.  

Control and social accountability standards have helped in improving credibility and refining program implementation through third party monitoring systems such as spot checks, process evaluations, impact evaluations and a comprehensive case management system (CMS). The CMS is further enhanced through the inclusion of a Social Mobilization, Accountability, Reporting and Tracking (SMART) structure at the community level by establishing BISP Beneficiary Committees (BBCs) headed by "mother leaders" to initially support the CCT program for primary education and later cover the entire spectrum of BISP's programs for poor families. Over 45,000 BBCs have been created and are linked directly to government offices to ensure sustainability beyond project life.

Proactive partnership with the provinces to collectively promote National Enrolment Drive to achieve the education outcomes amongst the poor and pave the way for design and delivery of complementary services by using the national targeting and delivery systems
Question no 9 ;
Millions of older people suffer human rights violations every year, ranging from discrimination and social and political exclusion, to abuses in nursing facilities, neglect in humanitarian settings, and denial and rationing of health care. Most of these abuses go undocumented and the perpetrators unpunished. With 2 billion people—a quarter of the world’s population—expected to be over 60 years of age by 2050, the rights of older people cannot be ignored. Human Rights Watch is setting out to make an impact for change for older people today and in the future