It is primarily because of the disparity between the quality of private and public sector healthcare in Pakistan that even the poor go to the private institutions for their treatment. Furthermore, government hospitals are not free since they charge for multiple items, including medicines.
Sehat Sahulat Program
First of its kind and fully subsidized by the government for its recipients, it was started in 2015 (named Sehat Sahulat Program (SSP) in KP and PM’s National Health Program across the country – both were named SSP after 2018), and is administered by the State Life Insurance Corporation (SLIC). Under this program, the Sehat Insaf Card, now known as Qaumi Sehat card, was issued to families to use as part of this program (although physical card not needed – CNIC is enough to show eligibility).
The government currently pays a fixed premium, around Rs. 2,000, per eligible family (average family assumed to be 5.7 people) to SLIC, which in turn manages members’ healthcare expenditure. Ninety percent of any unspent net premium is refunded to the government at the end of the three-year contract period with SLIC.
Through this program, each family will receive health coverage of Rs.720,000 per year (In KP this is around Rs. 1 million under their universal health coverage program – their premium is around Rs. 2,800). This accounts for all medical and surgical procedures, excluding liver transplants. The average cost of treatment so far has been calculated at around Rs.30,000 with the most common procedures being cardiology and cancer management related.
The program was extended in phases. As of now, nine million families across Pakistan have enrolled in the program with over one million hospital visits conducted. It has a presence in 96 districts all over Pakistan (the majority in Punjab and Khyber Pakhtunkhwa).
The Program has inter-district and inter-provincial compatibility – patients can go to any of the 380 hospitals on the panel across the country. The utilization percentage is between 3 – 8 percent, which is the average uptake of such services across the world. The government aims to extend SSP further into Balochistan and Sindh as well.
Who is Covered
Currently, all people living below poverty, i.e. earning less than $2/day in Punjab, KPK, AJK, GB and 100% population coverage for newly merged districts of KP and District Tharparkar (Sindh) are covered. Persons with disabilities (in AJK, GB, ICT, Punjab) and transgender community (across Pakistan), who are registered in NADRA and have special CNIC are also covered.
What is Covered
All indoor hospital services including, dialysis, eye surgeries, appendix, caesarean, etc. are covered except liver transplants.
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Universal Health Coverage
In August 2020, the KP government announced that its Sehat Sahulat Program would move towards providing universal health coverage in the province. Under this, every citizen, above or below the poverty line, will have access to free health care. Implementation is yet to start. In October 2020, the Prime Minister briefed the Punjab Health Minister to review UHC in two of its major cities on the KP model for its expansion purposes.
In September 2020, Punjab Health Minister, Dr Yasmin Rashid announced that she would also look into launching universal health coverage in the province, starting in two of Punjab’s major cities. So far, Sehat Sahulat Program has been expanded in all 36 districts of Punjab to 5.2 million families. The SSP is an ambitious program.
Officials believe that it is sustainable and will produce a competitive environment for public and private hospitals and motivate the public sector to keep up with their quality and improve their health services as the eligibility for registration has high criteria that follows quality standards and protocols.
Furthermore, apart from the public sector, the private sector will see this as an opportunity to open their services in small cities and remote areas. This way quality health care will be accessible to all citizens on even shorter distances. The Sehat Sahulat model was established in accordance with Pakistan’s commitment towards achieving Universal Health Coverage by 2030, as part of the Sustainable Development Goals (SDGs).
The Program is viewed by many stakeholders as a key building block as Pakistan moves towards UHC. If successful in all provinces, Pakistan will be closer to fulfilling its commitment of contributing towards the SDG goals.