50% Pakistani households deprived of medical attention during COVID-19: report

• In Pakistan, a study of 2020 estimates that around 78% women living under poverty could have been excluded from Ehsaas payments.
• Oxfam reveals that across Asia, COVID-19 took away 147m jobs, pushing 148 million Asians into poverty.
• Reports says impact of COVID-19 combined with existing inequality has set back equitable development in the region.

ISLAMABAD: In wake of the devastation from COVID-19, 50% Pakistani households were unable to receive medical attention due to lack of money, The News reported, citing an Oxfam report.

According to the Oxfam report titled, ‘Rising to the challenge: The case for permanent progressive policies to tackle Asia's coronavirus and inequality crisis', in Pakistan, a study of 2020 estimates that around 78% women living in poverty could have been excluded from Ehsaas payments.

Oxfam — a British founded confederation of 21 independent charitable organisations — revealed that across Asia, the COVID-19 pandemic devastated lives and livelihoods, taking away 147 million jobs, pushing 148 million Asians into poverty.

However, it highlighted that the region’s billionaires grew their wealth by $1.46 trillion, leading to a staggering rise in inequality.

The report said that the impact of COVID-19 combined with the existing inequality has set back equitable development in the region for decades.

“Existing economic policies are rigged in the favour of the wealthy, allowing them to accumulate incredible amounts of wealth while narrowing the chances of the poorest to catch up,” the report said.

The report stated that household surveys in May 2020 found that 64 households in Indonesia and 50% in Pakistan were unable to receive medical attention due to a lack of money. In the Philippines, 46% of people reported the same issue in August 2020, and this jumped to 59% in May 2021.

Another study revealed that countries with higher levels of out of pocket (OOP) expenditure have higher rates of COVID-19 cases and deaths, 119 which illustrates the vicious cycle of economic and health inequalities that have been exposed and exacerbated by a coronavirus. In Pakistan, 22% had been fully vaccinated by the end of the year, it added.

In Pakistan, more than nine million families, across more than 90 districts, were enrolled in the Sehat Sahulat Programme, which allowed them access to free health services in both public and private hospitals. Another study conducted in 2020 also estimated that up to 78% of women living in poverty could have been excluded from Pakistan’s Ehsaas Emergency Cash payments.

However, the scale of action taken has shown that far more investment is needed and is possible when there is enough political will. For example, Indonesia, South Korea, Pakistan and the Philippines reallocated domestic spending to scale up social protection in response to the pandemic, and this was the only source of funding used in the Philippines.

The distribution of productive assets such as land has also long been highly skewed in Asia. For example, research before the current crisis found that the top 20% of farmers in Pakistan held 69% of the country’s agricultural land. In Thailand, the top 10% owned more than 60% of the land, compared to just 0.07% for the poorest 10%.

Longstanding underinvestment and poor government oversight of public health systems have led to an inadequate and unequal public health response to the pandemic in many countries.

Resultantly, this affects poor and marginalised people the most. High levels of out-of-pocket (OOP) expenditure for healthcare in the region has created great health inequalities between rich and poor that are being exploited by a coronavirus.

In 2017, OOP payments accounted for more than 60% of health spending in Pakistan, Cambodia, India, Bangladesh and Myanmar, 114 and 13% of households in Asia were experiencing catastrophic expenditure on healthcare before the pandemic.

For example, in Pakistan, 80.5% of economically inactive women were out of the workforce due to unpaid care responsibilities, compared to just 2.4% of economically inactive men. The figures were 66.6% and 6.8% respectively in Bangladesh and there were also large disparities in Cambodia, Myanmar, Nepal, the Philippines, Thailand and Vietnam.

Many interventions also used the same flawed targeting systems as ongoing social protection schemes, meaning some of the poorest and most vulnerable people will have been excluded from even temporary emergency assistance. For example, studies estimate that Pakistan’s Benazir Income Support Programme excludes up to 73% of intended recipients, while Indonesia’s Program Keluarga Harapan conditional cash transfer has an 82% exclusion error.

Similar issues have been identified in Sri Lanka's Samurdhi programme and the Philippines' 4P programme. The report states that the rate of internet use among girls is half that of boys in Nepal and a quarter in Pakistan.

Vulnerable groups such as women, girls and marginalised workers were worst affected as their incomes shrunk and their access to essential services was reduced. School closures have worsened the education divide with an estimated 10.45 million children dropping out of school and university forever, with far-reaching consequences for them.

"The ongoing pandemic has tested the vulnerabilities of healthcare systems. COVID-19 has acted as an inequality multiplier, widening the gap between the rich and poor, pushing families deeper into poverty. Pakistan government’s steps to improve social protection through its Sehat Sahulat programme, allowed more than nine million families, across more than 90 districts, to access free health services in both public and private hospitals. Better social protection schemes are needed to protect the vulnerable, especially women, girls, and marginalized communities from the pandemic’s economic pressure," said Syed Shahnawaz Ali, Country Director, Oxfam, in Pakistan.

The Pakistan government launched the Ehsaas emergency cash transfer programme, benefiting an estimated 67 million people, and included cash transfers to 6.2 million daily wage workers in the 2021 budget. However, these measures should not be temporary and needed to be made permanent.

Asia's richest were shielded from the impact of the pandemic and many even thrived. The number of billionaires in the region grew from 803 in March 2020 to 1,087 in November 2021. Billionaires were able to grow their wealth by 74%. Some wealthy Asians even profiteered directly from the pandemic and by March 2021 there were 20 new Asian billionaires whose fortunes came from equipment, pharmaceuticals, and services needed for the pandemic response.

Oxfam’s report makes recommendations to address Asia's growing inequality through progressive policy actions by governments that prevent millions of poor Asians from falling through the cracks.

According to the report, a wealth tax of 2-5% on Asia Pacific's multi-millionaires and billionaires, could raise an additional $776.5 billion every year. That would be enough to increase public spending on health in the region by 60%  and can prevent unnecessary and premature deaths in the future or enhance educational opportunities.