Evidence for Health Policy Design


Evidence for Health Policy Design

Asad Ejaz Butt and Izza Qayyum

The Prime Minister of Pakistan, while speaking at the Ehsaas Telethon which was launched for Corona Relief Fund, raved about the diligence of his health advisers Dr Zafar Mirza and Dr Faisal Sultan. Each morning, he said, his advisers analyze health data to staunchly prepare for the National Command and Operation Centre (NCOC) meetings. Their analysis is instrumental in determining the direction the government takes to allay economic risks associated with a total lockdown.

Health numbers that originate from different data streams across the country enable public health practitioners to apprise the NCOC of the repercussions of easing the lockdown all too quickly. Since data has not been a thing of the Pakistani policymakers, it is quite satisfying to learn that policies that decide the fate of more than 200 million people are not made anymore on whims, predilections and opinions of those at the helm. They are perhaps informed by a systematic process of research and inquiry which is aided by data and technology. But since the complexity of the situation demands greater precision of analysis, the success of the government policies and the results they achieve depends ever so greatly on the veracity and completeness of the data. As they say ‘half-truth is a great lie’, the incompleteness and unsophistication of data that informs policy in a situation of such uncertainty is only going to make things worse. Experts say that the pandemic will soon hit its peak and the worst times are yet to come. If, however, the government’s data and its proprietary models fail, what we know of the worst will turn out to be only an underestimation.

An emergency hospital is set up with nine hundreds beds for coronavirus infected patients, in the Expo Center, Lahore, Pakistan, Thursday, March 26, 2020. The virus causes mild or moderate symptoms for most people, but for some, especially older adults and people with existing health problems, it can cause more severe illness or death. (AP Photo/K.M. Chaudhry)

A piece recently published in the Dawn newspaper described the scenes in the NCOC meetings, which led one to imagine how perfectly the data and technology software, powered by the ISI, to track terrorists is now assisting the government track the virus-carriers. If such is the sophistication of data used by the government, some reporting on a few hidden aspects of the virus would have made the situation slightly less precarious than what it is right now. By April 25th, when I write this piece, we should have been certain about whether the economy should be locked down completely or smartly—as the government calls it—and closing which sector would entail what quantum of losses to the economy. Clearly, we don’t know where we stand today, what we’re going to do in the weeks to come and where would our economy be by the end of May, when the number of cases has been predicted to rise up to 50,000 by some health models. These questions are derivatives of some larger questions that shall draw the attention of decision-makers toward data points that they should have looked at before deciding in favor of a certain variant of a lockdown (total, partial or smart). I would use this space to pose some of the larger questions one by one.cartoon-for-06-05-2020-1-1250x739

What is the total number of daily wagers in Pakistan? Labour Force Survey (LFS), the flagship data product of the government that reports employment and labour market data, does not tell us the number of daily wagers that were working before the crisis hit in February. No such estimates emerged during the crisis and the fact that no functionary of the government or any reporting agency has reported the number leads me to believe that the government does not have the number even today. The wedge between locking down completely, as is the case pleaded by the Sindh government, against a partial lockdown proposed by the Prime Minister has been drawn at the question of whether a stunted economy would be able to provide for the millions of daily wagers in the country. Yes, we know the number is in the count of millions which probably led the government to profile 12 million families for the first phase of the Ehsaas Kifalat programme. But, clearly, no one knows if the actual number of daily wagers is greater than 12 million or not, and if the NCOC does, there is no estimate of how many of those work in what sector and what industry; how many of the daily wagers rendered jobless have an alternate source of income (receiving dual benefits) and how many working in full-time permanent positions before the outbreak have become unemployed. We do hear stories of daily wagers and non-permanent employees who are protected by some sort of financing support by their employers despite the fact that they did not work under a regular or permanent employment arrangement.

APP39-04 ISLAMABAD: May 04 - Chairman Joint Chiefs of Staff Committee General Nadeem Raza called on Prime Minister Imran Khan. APP

The US-based news reporting agencies are providing live updates on the number of people rendered unemployed by the lockdown. The New York Times reported on April 24th that 26 million people have filed for unemployment claims – a social safety net provided by the government to those who lose their jobs due to the various types of unemployment – structural, functional, etc. How many people have become unemployed since the outbreak in Pakistan? Does the government have this data with precision? This is extremely critical because rehabilitation programmes for the unemployed cannot be designed without knowing the exact number of people who have lost their jobs purely to the crisis and in the aftermath of the lockdown. How can benefits be fairly distributed without having this kind of information? If this data is available, why has no source reported it? Why is no government organization talking about the number of unemployed persons? Unemployment is the most striking impact of the lockdown. The Prime Minister keeps telling the public that there is a tradeoff between saving people from the virus and letting them die of hunger or opening the economy systematically so as to contain the virus while also letting some sectors of the economy operate. How can the decision to facilitate the trade be taken without knowing the number of people who have lost their jobs while also having the numeric luxury of separating the unemployed between those who were daily wagers and who were not?

APP34-05 ISLAMABAD: May 05 - Prime Minister Imran Khan chairs meeting of the Federal Cabinet on Tuesday. APP

The government has decided to allocate some resources to the construction industry. It assumes that opening that industry would not impact the spread of the virus since its dynamics make it naturally poised for social distancing while it would have a larger impact on pushing economic growth than some other sectors like the services industry. It has also announced that the status of an ‘industry’ would be accorded to the construction sector which will make it eligible for some rebates and relaxations while a stimulus package may also be announced for the sector. Should the decision to open a sector be taken without knowing the number of SME and small businesses that operate and in which sector/industry? Daily wagers and low-income households must be protected. The economy also needs to keep functioning in a way that its progress does not ignite the spread of the virus. But there has to be a rationale behind the decisions that the government makes and the best way to justify what it does is to obtain the support of numbers which it, clearly, isn’t doing too well.pakistan-affected-country-map-of-coronavirus-vector

The best way to keep the economy moving is to ensure that people who can afford to buy get food to eat, daily wagers and unemployed persons who cannot afford to buy (if their numbers are known) are monetarily reimbursed by the state for incomes lost to the lockdown and lastly, that the small businesses in industries where social distancing is a norm otherwise too, continue to operate. Their balance sheets do not paint the sorry figure that they currently do. Akin to people having lost their jobs, which is information that the government does not possess with a lot of certainty. Do we know the number of businesses that have closed down ever since the outbreak? I didn’t know what data is flashing on the fancy screens at the NCOC but if policies have to be made devoid of evidence, they would be as whimsical as they currently are in Pakistan. The lack of consensus on the lockdown is not because of political differences, it is either because of the governments at the centre or in the provinces not knowing what is the right approach. The consensus which Sakib Sherani calls the ‘whole of Government’ approach is not developing because there is no data to support whether a total lockdown should prevail over a partial one and what are the economic impacts of each. If the Prime Minister could, with the aid of sophisticated data, explain to Murad Ali Shah how many people have already lost jobs in Sindh and in what sector, and how many businesses have closed down ever since the pandemic, his job of spearheading policy and convincing his colleagues in the provinces would have been much easier.APP55-06PM-Islamabad

Those economic impacts that are hidden because the government hasn’t invested in data, and this is where the disadvantages of being a Third World country extremely ‘data-poor’ kick-in, would have made the decision to implement a certain variant of the lockdown with full force and with utmost certainty possible without having any divergences from anywhere across the country. As I see it, the tradeoff that the Government keeps repeating is not between people losing lives and economic meltdown but between an indeterminable number of lives lost to the pandemic and an indeterminable loss to the economy. So much has been said and written on these pages about Corona. Some of that has included data on the number of cases and the lives lost but unless sophisticated economic data that can inform policy is available, the Government alongside its institutions like the NCOC would remain lost between searching for a safe haven between the divergent options available to tackle the virus. Corona is complex and so have to be ways, methods and tools that deal with it. Mediocracy and simplicity cannot easily deal with it. Apocalypse may not be caused by man’s increasing quest for technology but by man’s ignorance of the best ways technology could be deployed.

Asad Ejaz Butt is an economist and former director of the Burki Institute of Public Policy (BIPP). He can be emailed @ asad.ejazb@gmail.com

Izza Qayyum has a degree in Economics from LUMS and currently works as a marketing professional.


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