​Address by Chief Guest

Dr Sania Nishtar​, Special Assistant to Pakistan’s Prime Minister on Social Protection and Poverty Alleviation ​

Trustee of the University, Mr Zakir Mahmood;
Provost Carl Amrhein;
President Firoz Rasul;
Faculty, family, leaders, distin​guished guests;
The graduates of 2019​

Assalam-u-alaikum and good morning. 

I am truly honoured to be here today and I want to thank you for this opportunity. I have long admired Aga Khan University for its excellence and its commitment to pluralism.

Pakistan needs a lot more institutions like this. In fact, Aga Khan University has been a very remarkable catalyst for change in a variety of different ways. It has set the bar very high in terms of standards with regard to clinical care and quality of education. It has produced a number of different remarkable and outstanding individuals who have really stamped Pakistan’s name in gold in the committee of academics internationally. 

The University has also done remarkably well in terms of research and we just heard from President Rasul about the Centre of Excellence in a very cutting edge, normative area: access to surgery for which I wish to congratulate you. The University has also held the hand of the government of Pakistan in terms of building its capacity in a number of different, large, broad-based areas. The Lady Health Worker programme is an illustration of that.

More recently, as we firm up the design of the Ehsaas Programme – which as you know is Pakistan’s multi-sectoral and multi-component programme – we are drawing heavily on data and evidence from the National Nutrition Survey and I really want to thank the investigators for the input that they have provided there. So for a number of different reasons I wish to thank His Highness the Aga Khan for the investment that he has made in this institution but also his commitment more broadly to improving quality of life.

Graduands today is a very special day for you and I have this very pleasant duty of sharing with you the crux of my professional journey. Like many of you who are on either side of this stage my professional journey has been very long and winding. But there was this one particular incident that changed the course of my career in a very drastic way. If there was a 360 degree turn that was the day. 

Two decades ago I worked as a cardiologist; I do not work as a cardiologist any more. I used to work in a cath lab and my day job involved pushing catheters into people’s hearts, visualizing their coronary arteries and examining where they were stenosed and what we could do to alleviate their chest pains. And there was a hospital directive that was given to professionals working in the cath lab demanding that we should not open disposable catheters for patients who could not pay. That day was a turning point for me because I decided that I was not going to pursue with business as usual. 

That particular incident become emblematic of a variety of different inequities which I had continued to observe as a medical student working very close to the Pak-Afghan border and northern Pakistan as a clinician. I am sure this is not something that’s new for many of you because we’ve all been through such situations. It was very emblematic of the problem and I decided to do something about it. So I embarked on a journey to find out a solution and the journey has been a very long and winding one. 

It has taken me from patients to systems and governance. From hospital to boardrooms. From a civil society role to a ministerial position. From founding grassroots institutions to chairing multilateral initiatives and the crux of my experience leads me to believe that in order to make lasting and sustainable change you have to root your actions in integrity. 

So while I completely agree with President Rasul that courage, perseverance and agility are essential ingredients for success I would, with all humility, like to add integrity to that list because I think that it is so profoundly important. 

And when I was asked to structure the Ehsaas programme – which is a very ambitious, welfare-centered programme for the country – and is in the initial stages of getting deployed, my starting point was the Governance and Integrity Policy. So at the same time the programmes were started, I started conceptualizing the policy and ensuring that institutions were complying with it. I’m very humbled to let you know that three weeks ago the Cabinet gave approval for the broad-based application of the Ehsaas Governance and Integrity Policy. 

So my humble, unsolicited advice to you is that if you arm yourself with the attributes that the president talked about and you combine it with integrity, then when you walk into the real world there is very little that you will not be able to achieve. It has become a bit cliché but the time-old adage of doing the right thing for the right reasons is something that you must hold very dear to your heart as you walk into the real world and into the context that is out there for you. That context is also rapidly changing because your textbooks do not prepare you for the real world that you are walking into. 

The real world is beset by many of the challenges that the president talking about: widening inequities, demographic challenges, a number of epidemiological shifts, rapid urbanization and a context in which collusive behaviours are deeply entrenched. A number of different conflicts, humanitarian crises, the threats of pandemics and climate change are looming. A context in which trust in multilateral institutions is waxing and waning, an environment in which there is interconnectedness of risks. 

But you must also appreciate that this is a huge opportunity and that many solutions exist. In fact, the Sustainable Development Goals give us the framing for those systemic solutions. The emphasis on human capital development is another positive ray of hope around which the global community is rallying and technology is certainly another. Technology can be very disruptive in terms of giving you the solutions that the world desperately needs. But in order to tap these solutions you have to stretch your imagination and you have to get out of silos and sectors that we are used to working in. Many of you belong to the health sector so I’d like to give you a few examples from there.

Today, all the opportunities for reform, reengineering and for making quantum leaps and changes in the health sector are not coming from the ministries of health. They are coming from financial institutions and actors who are involved in online retailing. We know that artificial intelligence could be the solution to worker shortages which have plagued us for generations. We know that with the declining cost of genome sequencing, coupled with advances in pharmacogenetics and flexible small volume manufacturing, precision medicine could actually become a default option within our lifetimes. 

With advancements in immunotherapy, we could use cells as pills and of course we are all aware of the disruptive potential of digitization and smartphones in a variety of different ways. So I’m convinced that as soon as 2025, if we get our strategy right, it may be possible for a woman in the Thar desert to start managing her diabetes with her smartphone – in an environment where artificial intelligence will obviate the need for workers to a very large extent. 

It is technically possible, even today, for a wearable sticker to monitor blood glucose levels. Technically, it is possible, even today, for a microchip in her pill to ascertain her condition. And for both of these to interact with the internet of medical things and throw her information into her personalized electronic medical record into the cloud. Technically, it is even possible today for that information to be analyzed by an algorithm and a) alert the doctor, b) alert the woman, c) book her an Uber automatically, and d) make a payment automatically through her mobile wallet. 

Even today it is possible, technically – and in isolation – for someone to print pills at a local pharmacy, to have insulin delivered at the doorstep through Amazon. Very soon one of you is going to be involved in joining these dots. One of you is going to be involved in this massive transformation which is actually on the anvil. Imagine what it could do for the world if countries jump straight to 4G and 5G: a world that is on track to meet digitisation SDG-related targets.

We could reimagine universal health coverage and healthcare altogether and many other sectors. Technically all these things are possible and you have the opportunity to play a very strategic part in this transformation which could be catalytic for the world and for many other sectors and help overcome the issues that our generation has not been fully able to overcome.

In fact, somebody very rightly said that at the time of the First Industrial Revolution the cotton mills increased the demand for unskilled workers. And today’s Fourth Industrial Revolution does exactly the opposite. It generates demand for those with knowledge and skills. Of course it also creates a number of different imperatives because we need new institutions, new designs of institutions, we need new governance arrangements, we need new norms and regulatory frameworks. But it is only through the skills and expertise of young blood like yourself that it is going to happen which is why the world’s emphasis on human capital development is so salient and so important. So important is human capital development that it has now been documented that human resource contributes 60 per cent to the wealth of a nation.

I just want to let you know how fortunate you are. What an auspicious time you have been born in and what an opportune time it is that you are graduating. Because you have the opportunity to change the world dramatically and you have the opportunity to play a very salient part in that. So hold your head up high, do embrace the things that we’ve talked about and congratulations class of 2019.​