Healthcare investment ensures high returns like financial and social returns, empowerment and political participation. This investment is not for the individual benefit but its social benefits over weigh the private benefits and society as a whole gets benefited. It has been observed through economic analysis that during the period 1970-2000, rate of growth was 11% in low and middle-income countries. The reason for this was a reduction in adult mortality during this period.
Table on Health and Expenditure shows that over the years total health expenditure has increased. Health expenditure as percentage of GDP is also increasing. Government is trying to provide health facilities to the people of Pakistan.
Universal health care perspective shows that essential health services must be for the entire population without any discrimination, giving priority to the most vulnerable. In Pakistan, government is spending less than the lowest international threshold on the health services. Therefore, 60% of the health expenditure constitutes out of pocket expenditure which results in a disaster for poor. If any of the family member falls sick and is hospitalized, the family becomes bankrupt. Those who are above the poverty line due to this out-of-pocket expenditure slide into extreme poverty and for the people already living below the poverty line this illness of a family member is catastrophic. Globally as per WHO and the World Bank have jointly declared that 100 million people are pushed into extreme poverty every year because of health expense.
Households facing catastrophic health expenses by province and sector of care (% of total) 9% of all households in Pakistan face catastrophic health expenditures, mostly due to outpatient expenditures.
Households driven to poverty due to health expenses by province and sector of care (% of total) 0.5% of all households in Pakistan driven to poverty due to health expenses (20% of all households)
To provide universal health coverage to people living below the poverty line in Pakistan, at micro level government has launched social health protection program of Sehat Sahulat Program (SSP). Many people belonging to low-income families and getting swift and speedy free in-patient healthcare services without any financial obligations.
All over the globe millions of people health expenditures has pushed many of them below poverty line. This program is for federal, provincial and regional governments. The objective of this initiative is to provide health insurance initially to the poorest ones living below the poverty lines and later to the remaining families. Marginalized and vulnerable groups including people with disabilities, transgenders, previously ignored by the health policy makers have been included in new health policy.
Different names have been given to this facility like Qaumi Sehat Card, Sehat Insaf Card and Sehat Card. These cards have been provided to the families in Punjab, Azad Jammu Kashmir (AJK), Gilgit-Baltistan (GB), Tharparkar, Islamabad Capital Territory (ICT), and Khyber Pakhtunkhuwa. All the permanent residents of these areas have been issued this Sehat Sahulat Cards as per NADRA Record. So far 8 million permanent residents of Tharparkar district, Sindh and 6 million from Punjab, AZK, GB & ICT have been benefitted with this facility.
Up till now as per expansion plan of Sehat Sahulat Program 30 million permanent resident of the above-mentioned districts will get their cards and in Balochistan entire population of 1.8 million families will be issued this card. Only 9 million families of Sindh with the exception of district Tharparker will remain out of this health Insurance ambit. It is likely that soon Sindh government will join this facility.
Sehat Sahulat Program will cover priority/tertiary care package and secondary care package.
Priority/tertiary packages cover high risk and most critical treatments like cancer, cardiac issues, accidents, ventilator’s support, burn, renal dialysis etc.
Secondary packages cover all the remaining medical and surgical treatments, including abdominal surgeries, medical conditions, deliveries/C-section etc.
These all types of facilities can be availed from more than 450 empaneled hospitals, both public and private, across Pakistan. Inter district and inter provincial portability of benefits is available from any empaneled hospital. Standard transport charges are paid at the time of discharge to the patient till his home or burial charges are paid in case of death given treatment is availed from the empaneled hospital.
Sehat Sahulat Program has targeted a nuclear family of husband, wife and unmarried children as entered by the NADRA. The unique feature is that no family has to apply for this facility but families are identified through NSER (National Socio-Economic Registry) data of EHSAAS program. Any Pakistani can check their eligibility status by texting their CNIC number to 8500.
Central Management Information System (CMIS) is monitoring the activities like patient’s enrollment at the time of admission till discharge is recorded. In order to get independent feedback on service delivery a call centre has been set up through third party NADRA. NADRA calls patients to get their feedback on the quality of service and treatment during their admission and to check their satisfaction level. All complaints are recorded, investigated and redressed properly. The program ensures health care for eligible and deserving patients and at patient facilitation counters paper scrutiny is practiced. A helpline (0800-09009) has been provided for beneficiaries to call for an enquiry or to register a complaint. Hospitals to to get empaneled for Sehat Sahulat Program can share their information through the given criteria form on NADRA website.
A self-assessment outcome with an application can be submitted directly to the program or to the contracted health insurance company directly for possible empanelment of the facility.
Sehat Sahulat Program is going to give following benefits:
1. Indoor health facility in Pakistan needs private/public sector partnership.
2. Beneficiary families should have free access to any private/public hospital without any financial constraint.
3. At all levels federal, provincial or regional public hospital should be given financial independence. In this way after empanelment in the program they can get reimbursement from the insurance companies on provided services.
4. Focus should be on improving standard treatment protocols.
5. In addition, the monitoring system has to be made robust and vigilant to review the implementing process of social health insurance schemes and for prompt redress of complaints and grievances.
Outpatient services have vital importance in achieving universal healthcare in Pakistan. There is a need for capacity building activities for public sector health care facility management. Since health insurance is a relatively new subject, people should be educated about claim processing, reimbursement, cost management and quality assurance.
World Health Organisation (WHO) and German Development Agency (GIZ) are collaborating with Sehat Sahulat Program on improving the program implementation and expansion. Operation research and pilot projects are being conducted by the program with WHO & GIZ.
The best Universal Health Care to any poor is the provision of free health care for any kind of disease in private/public hospital. It will not only alleviate poverty but will provide financial health protection against catastrophic health care expenditure and people will be more willing to contribute the best towards the economic development of the economy of Pakistan.
The card holder can get medical treatment of Rs.720, 000/- annually. If the card holder or his family member suffers from a major disease and this limit is exhausted then an extension of Rs. 360 ,000/- per family per annum case further be provided by the government. In case of patient’s death Rs.10, 000/- support is also paid for burial.
The details of available packages are as under:
By using Sehat Sahulat Card, patients can avail support in transportation of Rs.1000/- paid per family per visit for a maximum of three visits per year.
Sehat Sahulat programme is a flagship programme of government and people can check their eligibility of the programme via SMS, Online or Via Mobile App.
Sindh Government has criticized Sehat Sahulat programme and the health minister has said that this card might weaken the existing weak public hospital’s infrastructure because the planning is shifting budget to private sector at the expense of public health mechanism.
Sindh Minister for health and population Affairs Dr. Azra Pechuho defended Sindh’s health sector by saying that Sindh is already using Universal Healthcare even at the tertiary level. Treatments like Cyber Knife, Gamma Knife, Liver transplants, Bone Marrow transplants are offered for free and health insurance Rs. 1 million Cap would not be sufficient to pay for the chronic and terminal illness of Cancer & Dialysis. Sindh government is paying more than Rs. 1 million on a need basis. There are instances when patients have been sent abroad for treatment.
Since the transparency of the health system will be compromised due privatizing health. It will create more problems than solving the existing ones.
The State Life Insurance Corporation (SLIC), government partner in this health insurance scheme was convinced of the effectiveness of health card schemes. This health insurance scheme was launched in 2015 by Nawaz Sharif government at small scale and was relaunched by PTI government in 2020 & 2021 but idea was floated by Asif Ali Zardari in 2012. The Sehat Sahulat programme has not only sustained a political change but expanded over the last three years, PM National Health Program has been changed into Sehat Sahulat Programme and Seht Insaf Card has become the National Health card or Qaumi Seht card. KPK, Gilgit Baltistan, Tharparkar, Azad Kashmir erstwhile FATA are utilizing this Health Card facility. Uptill June 2021, around 18 million poor and non – poor families i-e around 81 million people 37% in Pakistan had been enrolled in the programme. People living below the poverty line have been identified through National Economic Registry of the Benazir Income Support Program’s poverty data base that is linked with Nadra. This program represents private public partnership of more than 500 private and public hospitals existed across the country and are getting insurance benefits.
The government has outsourced State Life Insurance Company for health insurance and federal and Punjab government pay premium of Rs. 1998 per family per year and KPK premium payment is of Rs. 2849. The company empanels the hospitals and then reimburses them for patient treatment package costs. The Insurance package limit for Federal & Punjab government is Rs.720, 000 per family per year whereas for KPK it is up to Rs. 1 million. The program is fully funded through Public Money. Uptil now more than a million hospitalized patients have benefitted from this programme and their satisfactory responses have been recorded.
The other marginalized and vulnerable groups of disabled, transgender and informal sector labour and those living in remote areas have been considered and this benefit is also for them given they are part of NADRA as registered citizens of Pakistan. This programme has opened up Pakistan’s politics and Activism. All successive leadership has targeted equitable healthcare for the whole population of the country. There have been issues of disparities in its distribution on a large scale and this healthcare facility has not been accessed majority of the people, inadequate budget and a soaring population growth have jointly compounded Pakistan’s pursuits for health intensive development.
However, government efforts to provide Universal Health care are becoming visible especially in KPK. Sehat Sahulat programme is a government run health protection initiative that provides below poverty line segments significant financial coverage. Government is providing secondary and tertiary treatment facilities to the poor. Most of the patients have opted tertiary treatment – the most specialized and costly bracket of Health procedures like Angioplasty, cardiovascular treatment and organ failures.
“I am suffering severe chest burns. If something was to go wrong with my kidneys, I could not afford the costs without Seht Sahulat Card”. A 55 years old Patient said at Lady Reading Hospital, KPK.