An interview with Dr Sania Nishtar 'We are embedding welfare policies into every ministry's work'

Dr. Sania Nishtar is Special Assistant to the Prime Minister on Social Protection. She is also the Chairperson of the Benazir Income Support Program and the Poverty Alleviation Coordination Council. Dr. Nishtar is responsible for administering Ehsaas, an umbrella initiative for welfare schemes launched by the Prime Minister. Previously, she served as Federal Minister in the 2013 caretaker government with responsibilities for Health, Science and Technology, Information Technology, and Higher Education.

Currently, Dr. Nishtar also co-chairs the WHO High Level Global Commission on NCDs and the World Economic Forum's Global Council on the Future of Health and Healthcare. Dr. Nishtar graduated from Khyber Medical College, with her Bachelor of Medicine and Bachelor of Surgery, in 1986. She holds a Fellowship of the Royal College of Physicians and a PhD from King's College London. This year, she received a D. Sc (Honoris Causa) from Kings College London.

BR Research recently sat down with the distinguished minister to get a better understanding of the Ehsaas programme. Selected excerpts are produced below.

BR Research: The history of poverty alleviation programmes in Pakistan goes back many decades, with BISP being the most recent flagship. How does Ehsaas build on the previous governance experience?

Dr. Sania Nishtar: Ehsaas is an umbrella initiative, with a whole-of-government, multi-sectoral and inter-sectoral framework that is aimed at welfare, human capital development, creating livelihoods for the poor and addressing state capture. This initiative will lift marginalized people and bring them into the mainstream.

Ehsaas currently has 134 policies and programs across 34 ministries. Thus, the sheer scale of the programme is unique. The fact that it pulls all government levers for welfare is unique. The fact that our starting point is governance and integrity is unique. And the fact that we are embedding welfare policies into the work and projects of every ministry is unique. In addition, the mechanism through which partnerships with the private sector are being envisaged is also unique.

BRR: Is Ehsaas, in a way, a consolidation of welfare measures scattered across various government divisions and departments?

SN: Ehsaas is much more than a consolidation of existing policies and actions in different ministries. There are several new programmes, and many existing programmes are being reformed. Welfare is being embedded in the work of every ministry. Overall, there are 134 actions/policies and programmes. The division of Poverty Alleviation and Social Safety is responsible for twenty-nine of them. The rest of the policies and programmes concern other ministries and entities.

The policies and programmes under Ehsaas mapped so far are products of consultation with government entities. This is not a top-down, to-do list. Between January and March 2019, we undertook several consultations at the PM Secretariat to arrive at these actions.

BRR: The myriad interventions across a cross-section of sectors may suggest that Ehsaas is very ambitious. Currently, what kind of organizational structure, human resource and technology base do you have to design, execute and monitor interventions?

SN: Execution of the programme at this scale requires setting up appropriate institutional arrangements and this has gone side by side with programmatic planning. I would refer to seven things in terms of foundation-building. Setting up of the ministry was the first thing to bring all the fragmented social protection initiatives under one umbrella and this was done immediately after the launch of the Ehsaas programme.

Second is the structuring of the programme itself, the Ehsaas strategy, around which we had an online consultation. It was the first time that the government consulted the public on a strategy of this scale.

Third is the budget which was allocated in the on-going fiscal. Fourth is the Governance and Integrity Policy to bridge leakages and pilferages from the system. In fifth place, the digital payment system had to be re-hauled and over a ten-month period, we have successfully concluded the most difficult procurement of the government of Pakistan which involved bringing two commercial banks on-board to process digital transfers of the government.

Sixth is the data backbone on which we are working now. The National Socio-Economic Registry is ten years old and it needs to be revamped, which we are currently working on. Then, there is a data portal, which consolidates all the data of the government from population-based surveys to assist with provinces in decision making. We will launch this before the end of the year with the World Bank's collaboration.

In seventh place are the private sector engagement policy and the procedures, protocols, SOPs and online portals associated with it. And finally, Monitoring and Evaluation is an important part of foundation building. Extensive work has been done over a ten-month period. The Ministry, money, data, payment systems, Governance and Integrity Policy, private sector portals, and M&E are crucial foundations, work on which has been critical to allow the programmes to be deployed with integrity.

BRR: At its launch, the programme involved 115 policy actions that relied on cooperation of 36 federal and provincial entities. What is your strategy to create a whole-of-the-government approach, which has not been successfully executed in Pakistan before at this scale?

SN: This is the Prime Minister's programme, so I don't envisage an issue in terms of whole-of-the-government collaboration. However, since it is being done for the first time, what is critical is to develop metrics for whole-of-government's performance assessment, incentives for collaborative division of labour and tools to track progress of labour, and this is currently being done.

BRR: Since most of the policies and programmes are under other ministries, what kind of a mandate do you have to enforce compliance by ministries and autonomous bodies?

SN: As this programme has the ownership of the Prime Minister, he assigns the tasks to all the ministries and they have to show compliance. We at the Poverty Division have the largest role in that we are responsible for the execution of a very major chunk of Ehsaas - 29 policies/programmes/actions. And of course, we have our own reporting mechanisms. The tasks assigned to other federal ministries and entities are monitored by the Prime Minister. Every six months there is a Steering Committee meeting that is chaired by the PM.

We are also working with the provinces, albeit in an advisory role. We advocate the provinces on how to embed welfare into the governance agenda. Three provincial governments are currently working with us to incorporate welfare measures into their social programs.

BRR: Since there are so many policies and programmes, can you tell us about the priority actions or interventions that have been identified thus far?

SN: First, we need to understand that while 134 policies and programmes seem like a lot, but when you break it down among 34 ministries, the list of measures is not long for each one. At most, there are six to seven actions for any ministry or division to embed public welfare in their agenda. The Poverty Division has a long list, yes, but it will be implemented by six organizations in this division. For us, the most critical aspect is to implement the Governance and Integrity Policy, and to implement the new survey, which has just been approved, because both these things impact the integrity and impartiality of all initiatives.

In addition, we are leveraging stakeholders and partners to help us roll out initiatives. One-Window Ehsaas is a priority since it brings together all the fragmented initiatives in one stream, making them accessible. The Ehsaas mobile app, stipends under Kifalat, interest-free loans, education scholarships for the needy, on-demand support in the event of a catastrophic situation under Tahafuz, specially for medical conditions to protect against catastrophic expenditures, specialized nutritional food for mothers and children to address stunting, initiatives for laborers under Mazdoor-Ka-Ehsaas, the Rural value-chain building policy, the orphanages initiative for better standards, Langars, food-card scheme for merged districts of FATA, policies for the disabled, Solution Innovation Challenge to catalyse private investment in welfare, and Pledge to Ehsaas for the private sector - there is a lot on the anvil and some programmes have been launched.

As for the timelines, we have started a high-level mapping exercise where every initiative has identified a policy steward, as well as a detailed mechanism for design, execution, monitoring and evaluation. Currently, every organization is in the process of devising their timelines. For instance, for the air ticket subsidy, the Aviation Division is meant to examine whether they will be able to operationalize it in two months or two years. We cannot force a timeline on other government bodies. They are in the process of giving us their timeline.

For monitoring purposes, the National IT Board has made a policy dashboard for us, based on our requirements in which we are plugging in the timelines. This dashboard will have a traffic-light system where the Prime Minister will be able to track the progress of different initiatives.

BRR: Some initiatives may not be cost neutral. What are the estimates and sources of funding to create the fiscal space for the measures that actually cost the treasury?

SN: There are projects which are cost-heavy, for which we have the budget. Then there are many initiatives which simply involve joining the dots, bringing constituencies together, and these are not very costly.

For instance, we can do so much for parents by launching a lost-and-found mobile app for the missing children. Therefore, Ehsaas, in collaboration with the Prime Minister's Delivery Unit, has created the "Mera Bacha App"; the App was made in-house, with no cost at all. Through this platform, Ehsaas will mobilize its partners working in the area to create awareness alongside police officers.

Just by facilitating a reputed Trust - in terms of providing the space for setting up the Langars - we are developing 112 Langars all over the country, with zero cost to the government. We are working with the housing authority to ensure that every house underwritten by government funds will have a septic tank with public health outcomes; and that every contract given out by the government will ensure that laborers are paid the minimum wage through bank accounts. There are hundreds of other examples of how we envisage embedding welfare in the scope of every ministry and department.

In terms of the budget, the Poverty Alleviation and Social Safety division and its allied organizations have their own budget, so their projects are budgeted for. Other items in the Ehsaas list have their own budgets and stewardship mechanisms with respective ministries. For example, there are several welfare measures embedded for overseas workers in the scope of work of the Ministry of Overseas Pakistanis and Human Resource Development (OPHRD), from greater number of protectorate of emigration offices, biometric payments for pensioners to increasing number of welfare attaches. OPHRD leads on these and has the budget.

The Prime Minister monitors the embedding of welfare in the work of each ministry at every cabinet meeting. So, it is not just Ehsaas but the overall agenda of the Government to lift people that were previously been left behind.

BRR: What sorts of monitoring and evaluation mechanisms exist under Ehsaas?

SN: There are layers of monitoring and evaluation. One is the policy dashboard, which tracks process indicators and will tell us the level of progress on different policy actions. Then there is slightly more granular monitoring. The Poverty Alleviation Division's implementing agencies have monitoring departments that conduct activity-specific evaluations, both quantitatively and qualitatively. Then there is external, third-party monitoring that is conducted by independent agencies that are hired to do spot checks, exit interviews with clients, etc.

On the evaluation side, we are doing process evaluations, quasi-experimental analyses, randomized control trials, etc. There are Harvard academics conducting randomized controlled trials and evaluation is embedded in project designs. The Tahafuz program we are at the anvil of launching is going to embed extensive process evaluation because it is a new structure. In December, we are convening a "metrics committee" where we will discuss different dimensions of poverty measurements and how to assess income cut-off points.

Then we are designing evaluation mechanism for programmes like Langars. We are also going to see what impact the undergraduate scholarships have on poverty reduction. So, evaluation will be embedded in every programme and will not be an afterthought.

BRR: How has Ehsaas been received by Pakistan's development partners? Based on previous collaborations with those partners, are there any specific kinds of assistance that they can provide?

SN: I think that our development partners look at Ehsaas very positively, as they should. The government is committed to transparency, more than anything else. The partners will notice that the government is driving the agenda. The government is committed to use all its levers to bring welfare to the marginalized segments. We have convened an Ehsaas Partners Forum, where we are seeking technical advice from all development partners and are doing that in ways to maximize synergy and avoid duplication. The technical assistance is very important. We want to engage partners individually based on their comparative advantage.

BRR: Generally, what are your thoughts on poverty alleviation in the country?

SN: If you look at international experience, it is economic growth that has led to quantum leaps in poverty eradication, coupled with the capacity and ability of governments to accrue the benefits of growth to populations, equitably. Although, we cannot eradicate poverty through social safety nets alone; they do play a very important part.

Poverty alleviation and social-safety nets are two different but deeply interlinked approaches, in my view. Due to the economic hardships as a result of fiscal austerity measures, we need to strengthen the social-safety nets as an immediate priority. However, in the long run, we need to aspire for massive economic growth and jobs-creation to reduce poverty, and the government is working on that front also.

BRR: That sounds like an argument for trickle-down economics. Is there scope for redistribution under Ehsaas?

SN: I think the two - economic growth and redistribution - are not mutually exclusive; in fact, they reinforce each other. Redistribution has a very important role to play in relation to bridging inequality. Our core work right now is to administer social-safety nets and to have some redistributive elements to bridge inequities. That is why we are undertaking programmes such as scholarships, loans, assets, food stamps, Tahafuz, etc. However, massive strides in poverty eradication anywhere in the world have happened because of factors in addition to social-safety nets.