Health and the NSP

THE best definition of policy is that it helps one avoid becoming a hostage to events. A compass that continues to provide a direction transcending individuals and circumstances. This doesn’t mean it is a static concept. Good policies have inbuilt mechanisms and time frames for review and renewal which keep them relevant and fit for the purpose with the changing times. Another significant aspect of a policy is the process of its formulation which is as important as the final product. That ensures its legitimacy and ownership and hence implementation and sustainability.

Pakistan’s first-ever National Security Policy (NSP) is a welcome development on many counts. First and foremost, it is backed by a good consultative process. Hundreds of experts have been consulted and the policy has passed through federal-provincial and civil-military scrutiny. The process eventually involved tabling the document in an in camera briefing at a Parliamentary Committee on National Security; the opposition members unfortunately boycotted the proceedings. The policy then passed through the National Security Committee and federal cabinet which finally approved the NSP on Dec 28, 2021. It had been in the making since 2014.

It is interesting to note that most countries do not make their NSPs public at all. In our case, we have kept a part of the document on sensitive security issues confidential but a major part is now in the public domain. It is indeed a brave and strategic step. It opens up and expands the security domain for public debate which has always been considered a no-go area, fenced and fastened by a barbed wire.

In our context, it is also an important development that it has been championed by a civil technocrat under the patronage of an elected prime minister. National Security Adviser Dr Moeed Yusuf has a high international standing on security issues and has written extensively as an academic on the subject and has served on well-known, related American institutes. As NSA, Dr Yusuf has increasingly impressed Pakistanis with the way he has presented and defended the case of Pakistan at international forums and in bilateral parleys and the media, including BBC’s HARDtalk and an interview by Indian journalist Karan Thapar. For steering the process of the NSP’s development successfully, he deserves high appreciation.

A comprehensive national security policy has to have a proper place in it for human health.

We have grown to think of security only in traditional terms of borders, defence and military — the guns versus butter debate. One great contribution the NSP makes is to broaden the concept of security to human security. “The policy links the security of Pakistan with the economic and social well-being of its people.” The policy places economic security at the core of national security. Organised in eight parts, it covers almost all important aspects of a comprehensive national security framework: national cohesion; economic future; defence and territorial integrity; internal security; foreign policy in a changing world; and human security. The last section on human security covers population growth and migration; health security; climate and water stress; food security and gender security. The NSP places education in the “securing our economic future” section as a means to achieve an employable and skilled labour force in a highly competitive, technology-driven global job market.

The health security part sounds good but is patchy in concept. It is mainly driven by the Covid pandemic and how to prepare and respond to health emergencies in future and does not pay serious attention to the need for strengthening essential healthcare for all without discrimination which is not possible without investing in primary healthcare and advancing universal health coverage.

Health is a precondition to, as well as a consequence of, every other aspect of socioeconomic development. Human security, and for that matter national security, is inconceivable without a healthy population.

Pakistan has one of the world’s highest population growth rates; 40 per cent of its children live with irreversible physical and mental stunted growth; it has anaemic mothers, a high incidence of communicable diseases like hepatitis (second highest global prevalence), tuberculosis (fifth largest burden globally), HIV (the highest rate of increase in new cases in Asia-Pacific), and has seen a sharp increase in diabetes, blood pressure, cardiovascular diseases, depression and anxiety disorders, cancers — the list goes on.

Most of these problems are preventable but not prevented. Most of these problems are treatable if diagnosed early but remain undiagnosed until they become fatal conditions. Healthcare in the public sector is grossly inadequate and the private health sector is highly unregulated, unethical and exploitative. We are the lowest spenders on health, even among low-middle-income countries. Inequities mar our health record. There is huge discrimination when it comes to access to healthcare between the rich and the poor. Lack of reliable, quality healthcare and deteriorating health conditions superimposed with public health emergencies constitute an existential threat.

A comprehensive NSP has to have a proper place for human health. If economic security is at the core of national security, then health is at the core of economic development. There is now ample evidence of high economic and social returns on investing in health.

A huge question about the NSP is its implementation. We can have the best of policies and laws but the devil lies in the implementation. For something so overarching and cross-cutting, a seamless whole-of-government approach is needed which in view of the current state of governance is a tall order.

The good thing about the NSP however is that it has an annual review process as an ongoing monitoring system to see how the policy is implemented, the bottlenecks it faces and the advances it makes. Public discussion and oversight would be key to taking the NSP forward. For example, if healthcare thinkers take it seriously and drill deep to entrench the health dimension in the national security framework, this will hugely enrich the national security paradigm. It will also bring whole-of- government policy coherence to healthcare and eventually raise the level of investment and attention it deserves.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.

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