The writer is a public health specialist, anthropologist and human rights activist based in Islamabad
The sociologist T H Marshall described the modern welfare state as a distinctive combination of democracy, welfare and capitalism. The Westernised concept of welfare state is based either on the Marxian philosophy or on the principles of welfare economics of Professor Pigou. But the Islamic concept of welfare state differs fundamentally from the prevailing notions. This concept is so comprehensive in nature that the welfare state in Islam aims at achieving the total welfare of mankind of which economic welfare is merely a part. This concept is derived from ‘Madina Ki Riyasat’ that has manifested itself as a model welfare state to be followed by nations in all eras to come.
The notion of ‘Madina Ki Riyasat’ revolves around the idea of ‘Rehm (mercy)’. To broadly outline the concept behind the welfare state driven by the Quran and the teachings of the Holy Prophet (peace be upon him), firstly, it started with belief inculcated among fighting Bedouins of ‘Ikhwa’ as stated in the Quran: Surely all believers are brothers. So make peace between brothers and fear Allah that mercy may be shown to you. (Ch.49:V.11)
Secondly, the welfare state takes measures for the one (wealthy) to spend not store as the Quran says: And whatever you spend, He will replace it; and He is the Best of the providers. (Ch.34: V.40)
The Quran does not restrict the concept of charity to merely a donation in cash or kind. It encourages Muslims to voluntarily participate in welfare projects (Ch.61:Vs.11-12). The philosophy is to share and transfer knowledge and expertise to the needy and poor, thereby improving their economic plight (caused by the unequal distribution of wealth in society).
As per the sayings of the Holy Prophet (peace be upon him): Allah has made zakat obligatory upon Muslims. It is to be collected from the wealthy among you and distributed among the needy ones. Further, the Holy Prophet (peace be upon him) said: The state is the guardian of anyone who has no other guardian. The verses of the Quran and sayings of Prophet Muhammad (peace be upon him) establish beyond any doubt that the responsibility of providing basic needs to its citizens lies on the state.
Article 25 of United Nations’ Universal Declaration of Human Rights 1948 states, “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.” Currently sustainable development goals (SDGs) also revolve around social policies augmenting health and economic systems where financial hardship of the poor and needy is taken into account.
In the existing system’s scenario, the principal problems in the establishment of a welfare state is not only rarity of political will but its administration is also dependent on factors like defining the desirable level of provision of services by the state; ensuring that the system meets the needs of target population while guaranteeing adeptness in the operation of state monopolies and bureaucracies; and the equitable provision of resources to finance the services.
Poor human development and poverty worldwide are inextricably linked. The causes of poverty for millions globally are rooted in political, social and economic injustices. The economic and political structures that sustain poverty and discrimination need to be transformed but it can’t be fixed without contextualising the gruesome situation of previous style of governance.
Previous rulers used the excuse of lack of resources for failures in healthcare. But evidence points more to the lack of political will, coherent policy and implementation capacity. A clear understanding of the path to progress has not matched the rise of Social Health Protection under Universal Health Coverage as a development goal. In the hands of the provincial governments with their vastly divergent means and capacities, it is a clear case of moral hazard.
Since the foundation of Naya Pakistan is based on the principles of Islamic welfare state, it should address human development and poverty nexus as a unit. Imran Khan, in his speeches, has reiterated his resolve and will to transform Pakistan into a true Islamic welfare state with its foundations in the ‘Madina Ki Riyasat’. Various initiatives introduced by the present government are positive steps towards this transformation.
A lack of Social Health Protection under Universal Health Coverage and poverty are closely linked. The shift in our public health spending is inevitable as out of pocket health expenditure had touched 70% of our net expenditure on health, despite the fact that 29% of the population lives below the national poverty line. Poor families face a huge financial risk due to a catastrophic health spending if they face a serious health event, pushing them further below the poverty line. The answer to this problem lies in Social Health Protection through Universal Health Coverage which not only has the benefit of improving access to needed health services, but also has a significant potential to transform our entire healthcare system for the better.
Sehat Sahulat Programme, piloted by the previous government of Khyber-Pakhtunkhwa, is being expanded to cover all deserving families across Pakistan. Beneficiaries of the Health Insurance Card are those living below the national poverty line. The government will pay premium for the poor households to an insurance firm, which in turn procures healthcare services for the covered population through a network of public and private hospitals. Health card will apply a cash-free mechanism at point of service. Financial protection worth several hundred thousand of rupees is conferred upon these households and costs billions of rupees to the government in premium, annually. The scheme is a need of the day and a positive step towards a welfare state. The programme is envisioned to expand coverage to all deserving families for free medical treatment by the end of next year. Health card holders would be able to get medical treatment free of cost at public and private hospitals worth up to Rs720,000 per family, an amount significantly higher than offered in the past.
Perhaps a more tangible step towards ‘Madina Ki Riyasat’, as per the vision of PM Imran Khan, is recently undertaken by establishing shelter homes in cities like Rawalpindi, Islamabad, Lahore and Peshawar. These shelter homes depict the resolve of the present regime to act on the concept of ‘Rehm’ in moving towards a true Islamic welfare state, where the impoverished have the opportunity to be fed and sleep under a shelter.
It is heartening to know that the newly-elected government with its austerity drive focusing the privileged upper class is aware of the needs of the vulnerable and marginalised segments of our society and is taking steps to ease the plight of the common man of Pakistan.
Published in The Express Tribune, January 2nd, 2019.
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