Dr. Sania Nishtar — Behind the scenes when government goes all-out to combat poverty

The Innovation Dividend Podcast, EP 7

The Innovation Dividend explores how innovation in society and government are paying off. Over the coming weeks, we’ll be exploring how ‘policy frontliners’ are innovating in real time in the COVID-19 pandemic and asking which of these changes and “raw learnings” might become part of our new normal. You can see the backstory by Kal Joffres here, Podcast EP 1, Podcast EP2, Podcast EP3, Podcast EP4, Podcast EP5, and Podcast EP6.

Pakistan’s Ehsaas programme is providing cash transfers to 9 million families. We get a behind-the-scenes look at putting together the Pakistan government’s largest operation from Dr. Sania Nishtar, founder of the programme and special assistant to the Prime Minister of Pakistan on poverty alleviation and social protection. Dr. Nishtar speaks about managing a whole-of-government response with multiple federal ministries, provincial governments, telcos, and banks; the challenges that come with the scale and reach of Ehsaas; and the prospects for universal basic income in Pakistan. This interview was recorded May 20, 2020.

Dr. Sania Nishtar: I think never before, outside of a wartime situation, have I seen such synergy and concordance coming together to respond- this response has been quite unprecedented.

Kal Joffres: Hi, and welcome to The Innovation Dividend, the podcast that explores how innovation in society and government are paying off. I’m your host Kal Joffres and over the next few weeks, we’ll be exploring how the COVID-19 pandemic is unleashing some interesting and unexpected sources of innovation in government.

Today we have Dr. Sania Nishtar, who is special assistant to the Prime Minister of Pakistan on poverty alleviation and social protection. She’s also the founder of the government signature program, Ehsaas, which is a multi-sectoral program aimed at lifting people out of poverty. The program is providing cash transfers to 12 million families during the COVID-19 pandemic.

Dr. Nishtar was previously a nominee for the Director-General of the World Health Organization and served as a Minister in Pakistan’s 2013 caretaker government.

Dr. Nishtar welcome to the podcast.

Dr. Sania Nishtar: Thank you very much. I’m very pleased to join you.

Kal Joffres: When did it first become clear to you that a significant response would be needed for the COVID-19 pandemic?

Dr. Sania Nishtar: I think as soon as the lockdowns started taking effect, because Pakistan has a very large segment of the population that subsists on either daily wages or on piece rate remuneration or is self-employed at the bottom of the pyramid.

So, according to a labor force survey, more than 24 million individuals, basically belong to these categories. And if the assumption is that they are the breadwinners and bring food to the table, then effectively, in the context of the household size, which is 6.45, according to our recent census, we are looking at, upwards of 160 million individuals.

So right from the very beginning, we were quite clear that we were stepping into a very troubled scenario for this segment of the population.

Kal Joffres: And what was the response from Ehsaas to COVID-19?

Dr. Sania Nishtar: So, before Ehsaas, let me outline that the government has a multipronged response to this crisis. And our Prime Minister announced an economic package amounting to 8 billion. Now out of this, in the first phase, we were given 900 million, to run an emergency cash program. Of course, fast forward a couple of weeks and we have now been given an additional envelope, other streams of resources have also been committed to Ehsaas emergency cash based on its successful footprint on the ground.

Our mandate was to run emergency cash for 12 million families all over the country, and we were meant to give them the equivalent of $75 each. the estimates were that this would be enough to give them subsistence nutrition for the next three, maximum four months. Our assumption was that by that time, the pandemic would, our curve would go down, so to speak, that the economy would revive and that these individuals at the bottom of the pyramid would then, go back into a productive livelihood.

Because there was an urgency involved and we were quite conscious that we needed to roll this out as soon as possible, we drew on the systems that we had developed over the last one year. As you may be aware, Ehsaas was formally launched in March 2019 and it took us almost a year to put institutional mechanisms in place.

The ones that came into play for this particular, initiative, the disbursement of cash were, number one, a digital payment system, that we had procured over the last one year. Secondly, there was a data analytics mechanism that we had established, to profile individuals based on wealth related proxy indicators. And we had also used it in December last year to exit non-deserving individuals from social protection lists.

And the third system wide capability that we drew upon was a demand-based assistance seeking mechanism, for which we used a four-digit SMS code. as you may be aware, every citizen in Pakistan has a unique identification number and there are a number of different things tied to that unique identification number, your history of travel, your ownership of assets, the taxes you pay, the utility bills, your employment status, particularly government employment status.

9th of April, we kick started this process. As of now, 8.8 million individuals have been helped it, which means 8.8 million families, we’ve disbursed over 107 billion PAK rupees.

Kal Joffres: It sounds like in the lead up to the pandemic you had invested in making the infrastructure behind Ehsaas fully digital infrastructure. If you could just give me a sense of as a citizen, how does that change my experience with the program? Especially as someone from a rural area.

Dr. Sania Nishtar: The use of mobile phone is very pervasive in our country, especially feature phones. smart phone penetration is not as pervasive. But some estimates tell us that 90% of the households have access to a cell phone. In terms of your question, and in terms of, a layperson’s user experience, when we started messaging that people can seek assistance through this route, all people had to do was to text us their national identity card numbers.

And then the process would start from there. If they were government servants, they would get an immediate message. You are not eligible. If the spouse of a government servant texted, they would get a message. Your spouse is a government servant, you are not eligible. If they failed on the wealth profiling, they would get an immediate message.

And if they were put in the queue, they were told they were being put in an assessment queue. For an ordinary user to know that they would not have to line up outside offices for hours, and they would be able to alert the government regarding their needs just by texting, sitting back at home was hugely empowering. Now, of course, there have been operational challenges. Some people got messages within two days, but others had to wait because we were sending a dated message; there was a rationale behind sending them a dated message. We didn’t want the entire throng of 5 million people to land up on cash collection sites because of the COVID situation.

So we had to send the messages incrementally. in lots of 300 thousand, 500 thousand, on a daily basis. So some people had to wait for weeks. and of course, that wasn’t the ideal situation, but given COVID, there really was no other way.

And of course there were other challenges. We have continued to, evaluate in real time, develop solutions in real time, but in terms of your question, this was hugely empowering for a lay person.

Kal Joffres: Could you tell me a little bit about what are some of those solutions that you developed in real time? How did you adjust the program after it launched?

Dr. Sania Nishtar: Let me categorize the challenges in two categories. There were issues that we could foresee, and then there were other issues that arose on the go.

Now, in terms of the issues that we could foresee, we knew that we were rolling out operations during the lockdown; that section 144 of the criminal procedure code was in effect, which prohibited public gatherings. We knew that provincial governments were very reticent to open sites, and they really had to be convinced that this is needed and that they must join us in taking responsibility.

Then of course there were connectivity issues because our payment is predicated on real-time biometric verification from our registration authority. So internet availability is a prerequisite, and in some of the remote areas, the connectivity is not very good. So we constantly had to go back and forth with the service providers.

Then because when we launched, we were also rolling out delivery of cash on holidays. And if some of the banks were closed, we ran into problems with, with low liquidity in some areas because there was a huge amount of cash that had to be delivered to these very remote corners of the country.

All along we were conscious that this should not be seen as something politically biased or politically tilted. So we continued to share the information about the digital and fully automated origins of the decision making system. As you know, Pakistan has seven federating factions. Four out of those seven federating factions are ruled by political parties, which are other than the one that rules at the central level, which has formed the government of which I am apart. So signaling to them the confidence that this is totally apolitical, that all federating units are being given a level playing field. There has to be constant communication.

Now I come to the nuts and bolts of the operational challenges that we faced. For example, during the first couple of days, I realized that a lot of people did not have balance on their cell phones, so they could not SMS. So the 8,171 four-digit SMS scheme that we had launched, that number had to be made free. We had to intervene at different levels to make sure that that was free.

Then secondly, I figured out that a lot of people had cell phones, could receive a call, but they could not message. So I had to appeal within the first week, I had to appeal to volunteers that they should go and help people and help them send the SMS and then help them interpret the response that was being sent.

Thirdly, in the first week, we realized that as we were sending payment notifications that some people whose national identity cards had expired could not collect the money because the system wanted a valid CNIC. So we had to request the national database registration authority to do away with this conditionality.

Fourthly, we discovered that there were limitations of data-driven messaging. So if head of a household had died and the family had not logged the death certificate in our database registration authority, there was no way we could authorize the next of kin to get the assistance.

And, therefore, the message had gone in the name of a person who was deceased. So they had to be a lot of communication around that, explaining to the people why some people were getting messages in the name of the dead father.

We had to really maneuver to make sure that the offices of the database registration authority were opened. There was a lot of reticence. and it wasn’t until the third week that we were able to get them open to provide the service.

Then of course, one of the biggest challenges that we had was that the retailers of banks who were giving the cash at small cash points, because remember we were given cash not only in big sites, but also at small retail shops who are the branchless banking operators of big commercial banks. the retailer said, this is a very difficult environment. The commission that you’re giving us on this transaction is not enough. You have to give us an additional incentive. So I had to basically take a proposal to the cabinet saying that the advance income tax that we are withholding on their commission should be waived off.

And then I had to go to each province, pleading to them that the 16%, general sales tax that they levy on the same commission should also be waived off. So that a total of 40% is freed up for them. This is only for the emergency cash operations.

Then we had to deal with unscrupulous retailers who were, you know, deducting cash because a lot of these people are illiterate and if the retailers tell them, I’m withholding 500 rupees because the government has asked me to do that, you know, the poor illiterate person believes them.

There were constant attacks on, this fully digital system. So fake SMS schemes, fake websites, I had suddenly many fake Twitter accounts, overnight, fake currency, and all this we had to deal with these issues on the go. Cyber entities that exercise cyber vigilance in different pockets of the government had to be brought; we constituted a group which meets almost on a twice weekly basis now to, to keep vigilance.

Then one of our biggest challenge with which we are still grappling — and in fact, we have a closure meeting today — is the prevalence of biometric failure. and our partner banks are devising a new FastTrack mechanism to cater to this. A lot of Individuals fail on the biometric machines of banks in the field. So they are now going to be called into the bank branches and they going to be paid there, rather than, out in the field.

The last thing that I’d like to talk about in terms of the challenges, you know, there’s always a risk when such large amounts of cash move out and people invariably go and buy rations from grocery stores, price gouging and food, food price inflation is always a risk. But the good thing is that at our prime ministerial level, there is currently, a strong movement ongoing against price gouging and profiteering and hoarding. So we benefited from that and the kind of price gouging and food price inflation that we had envisaged as a corollary to this emergency cash disbursement was something that we did not see.

However, there is one thing which has been kind of unfortunate because of the COVID situation, public transport was not allowed during the time that we’re giving them emergency cash and I realised a lot of poor people had to, hire private taxis to come and collect the cash. I wish it, it hadn’t been the case, but our hands are really tied because of COVID and the precautionary measures that command and control authority, was stipulating and for very good reasons.

We are still in the midst of operations very much committed that all emerging challenges will be dealt with to the best of our abilities.

Kal Joffres: It’s very clear that it’s a gargantuan effort working with multiple federal ministries, provincial governments, you mentioned the private sector banks, telcos have the way of working with different parts of government kind of coming together changed in any way? Are there any learnings around this kind of collaboration that you’re taking away from this.

Dr. Sania Nishtar: One of the founding premises of the Ehsaas strategy is that this has to be a whole of government response. And the experience of his last emergency cash has reinforced it even further. I think in terms of your question, and lessons learned, the importance of routines has been reinforced for me personally as someone leading this team.

So I think that chain of command is very important when peer agencies have to collaborate and if you are engaging a peer agency in a contractual role then what are the terms of those contractual agreements?

At a nuts and bolts level, how do you convene those daily meetings to take stock and who convenes those meetings? Who takes charge? And what is the tone of those meetings and what kind of evidence do you need to bring to the table? In our case, initially when we started holding these daily meetings everybody was saying the same thing.

And then gradually as time passed by, we started gathering data from the field, and displaying those data in a format that made instant sense. So rather than throwing numbers in tables, I encouraged my teams to select, so I sat with them, I selected a number of different variables, and I said, look for the nuts and bolts of what happens in the camps and the retail sites, we need simple trend lines. and just a quick look at the trend lines showed you, where, where we were running out of sanitizers, where we were running out of masks, where SOPs were not being followed, where they were queues, where there were liquidity problems, where there were coordination problems, et cetera, et cetera.

So we decided on a list of indicators, started mapping trendlines and that was one step forward. then of course, we started digging our teeth into more strategic problems. And one of the strategic problems was the cyber-attacks. So we made another group of individuals who were looking at that in detail. We had to convene other agencies of the government who had especial expertise.

And that is where the whole of the government approach became so very important because I realized that within the government system, there were capabilities where synergy could be exploited, the capabilities which complemented each other, and there was a way to join the dots, but because each agency was siloed and didn’t have a mechanism on drawing on the capability of the other agency, all it took was to give them a convening platform and a clear problem and a clear outcome of interest.

One of my key takeaways was that we think the government is one entity, but the government is not one entity. It is an archipelago of institutions and departments that have a disincentive to collaborate. So creating that, incentive has to, have several levers. Unless you do not have those institutional levers, those explicit mandates, incentives for whole of government collaboration metrics for a whole of government performance assessment, the whole of government, engine does not work. And it is so fundamental to the solutions that we need. Unless you find a way of, joining the dots you cannot make systems function.

Kal Joffres: What stands in the way of us taking a whole of government approach outside of emergencies? It sounds like this can happen in any kind of situation with the right platforms for convening with the right incentive mechanisms and the right formal relationships, but it’s clear that actually a whole of government approach has been very challenging in the past. So what, what, what do you think is standing in our way?

Dr. Sania Nishtar: Because we have not structured the system for all of government functioning and this is not a Pakistan-specific problem. I’m not talking about a Pakistan-specific problem.

I’m talking about a generic problem and the wider generic issue is not even specific to the developing countries. It’s very much a developed country problem as well, because the system is structured in such a way, a ministry has a budget line. You are protective of that budget line. You have no incentive to collaborate with ministry or department A, B, and C. There are a few whole-of-government convening platforms other than the cabinet. There are limited sectoral convening platforms.

And there is no joint accountability for performance. If you have to hardwire the whole of government functioning into the performance of ministries, there have to be systems instructors specific to that.

Kal Joffres: What are some of the unprecedented things that you saw happening in government over the last few months, as a result of COVID-19? The mountains that you saw move that maybe surprised you or things that you thought might never have been possible or very difficult to achieve, in government?

Dr. Sania Nishtar: I think that government exercised leadership. We put in place institutional arrangements, so the command and control structures and the, operational structures that reported, I think never before, outside of a wartime situation, have I seen such synergy and concordance between different fractions of the government, different factions of the state coming together to respond.

So I think at a leadership level, at the convening level, at the level of developing the right institutional arrangements at the level of setting aside the budget, at the level of mobilization of that budget. The response has been quite unprecedented.

Also in terms of using data for policy. we know that, especially during the initial weeks, the data points that we were using as inputs for modeling had many limitations, because there was so much about the disease that we didn’t know. but that notwithstanding, the willingness, the keenness the desire to use data for decision making. I mean, this is something that I’ve never seen before. and I think this, this is going to change the way we work forever because there was this huge appetite for information.

There was this huge appetite to learn from international experience. What’s happening in Europe, what’s happening in other, in Africa, what’s happening in the US? Why are curves behaving the way they are, what’s contributing to mortality. I mean, there was this appetite for evidence that I have never seen before at our decision-making tables that I think partly it’s because there was so much that was not known. and I very much hope that this quest for data and information and evidence is going to continue.

And then of course, we’ve talked a lot about multisectoral collaboration and we saw that actually in action specifically, in Ehsaas emergency cash, which is the biggest operation of the government.

In hindsight, I think, it was the scale of the problem, it was the needed urgency of the response and it was because there were so many multi-stakeholder institutional mechanisms in place to allow for that collaboration to forge. I think it was all these things, that was so unique about these last two months that we’ve had to endure.

Kal Joffres: How do you see this as an opportunity to rethink some things that aren’t working as well as they might in government in the end, in the context of COVID-19, you know, are you seeing opportunities to create maybe structural change that brings more wealth, the resilience to the poor, such as programs like universal basic income?

Dr. Sania Nishtar: This disaster is going to lead to many rethinks, in the international system, and at a domestic level, it’s going to lead to many rethinks, specifically with regard to the resilience framework.

I think in a country like ours, a certain version of universal basic income will have to be on the table in terms of a policy question. And clearly when we say universal basic income, we don’t mean sending everybody a check because there are lots of people who are in gainful employment.

For us, a universal basic income essentially would mean that we have a data driven process through which we identify the eligible and the vulnerable, and we guarantee them a subsistence stipend and then we have a dynamic mechanism of ensuring on an ongoing basis, that people have the opportunity to enroll and exit from this process, as their socioeconomic status changes.

Also, under the Ehsaas, we have a number of different instruments. We have subsidized loans, and recently we’ve started conversations with our Ministry of Climate Change who have the mandate to deliver on the billion tree plantation project. And we would very much like to have a conversation with them to see how we can exploit to synergy between our cash transfer capability, and their tree plantation program to evolve a large cash for work program, which involves tree plantation, because that would hit several bottom lines. It would make our cash transfer program more meaningful. It will generate gainful employment for, for a very large segment of the population. and it would help to impact the environmental end points positively as well.

Kal Joffres: I’m curious if you think that government will be looking at uncertainty in a different light going forward. Many governments had the possibility of a major pandemic, you know, somewhere in their foresight analysis and in their, in their risk planning. But oftentimes there wasn’t an infrastructure that wasn’t necessarily, a basis for response in government for such a catastrophic risk. Do you think that the way that governments account in particular you’ll government accounts for these potential sort of black swan or very catastrophic risks has changed or will change?

Dr. Sania Nishtar: Our people and our government have seen many catastrophes I mean, there was the earthquake of 2005, which claimed, 75,000 lives within a matter of 48 hours. The flood in 2010 submerged an area equal in size to Italy with tens of millions displaced.

But what was very, very different in this catastrophe was the manner in which it brought livelihood for millions to a halt. Effectively upwards of 150 million lives have been affected and the need is evidenced by the numbers of requests that we have in this Ehsaas emergency cash. It’s truly astounding. I think governments all over the world will look at disaster situations very differently now and they will have to invest in preparedness.

They will have to invest in health systems and infectious disease surveillance. In my past professional life, I was a candidate for Director General of the World Health Organization. So back in 2017, Tedros, David Nabarro and I were the three shortlisted candidates for WHO director general. And I went through, a very massive two-year campaign, prior to that election when I met governments from 200 countries. I met them at head of state level, at foreign minister level. And I think I met almost all the ministers of health. My favorite statement during my speeches as the DG candidate used to be, that there are three things that can destroy the planet: a celestial event, a third world war, or a pandemic.

And honestly, I used to see these very amused looks. Governments never really believed that this could ever happen. And I truly believe in that, because if they did, they would have put certain institutional mechanisms in place. After SARS back in the early two-thousands when the international health regulations were finally agreed by all governments, they are legally binding instrument. After that happened, it was pretty clear what needed to be done. And SARS gave us a taste of how, an emerging already emerging infection could effectively bring, economies to a halt, throw countries into recession. So we had a taste of that.

We had a legally binding treaty, and they were very specific asks of governments. And there are many governments who never even moved to make the investments on these much-needed things. So when I used to speak to cabinet members in these 200 countries, they would have expectations from an incoming WHO director general. but I never got this impression from many countries that they actually had any intentions of putting systems in place or making the investments that were required. And I think this pandemic will change that for forever.

Kal Joffres: Dr. Nishtar, thank you so much for the time that you’ve spent with us on this podcast.

Dr. Sania Nishtar: I’ve enjoyed talking to you. Thank you so much and look forward to staying in touch.

Kal Joffres: That was Dr. Sania Nishtar special assistant to the Prime Minister of Pakistan on poverty alleviation and social protection and the founder of the government’s signature program, Ehsaas, a multi-sectoral program aimed at lifting people out of poverty.



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