The country has a long way to go before it becomes a welfare state, but Pakistan is said to have taken the first baby step under the PTI rule in the long journey towards providing universal healthcare.

The architects of Sehat Sahulat Scheme claim that it has transformational potential. “Soon, Pakistan will be the first developing nation to achieve universal health coverage,” a doctor in the prime minister’s health team boasted.

Amidst many negatives, independent watchers consider the recent developments in the public health domain reflective of suppressed positive energy and technological transformation underway in Pakistan. Hoping against hope, they pray for the success of the public health insurance scheme for the poor and the ailing.

While arguments continue in certain quarters, the Sehat Sahulat Scheme largely appears to be a win-win situation for all: the people, the government and the private sector

Fired by the PTI vision and encouraged by the handling of the Covid crisis and the subsequent inoculation drive that earned the country global recognition, the federal health establishment decided to initiate an ambitious health insurance scheme. Capitalising on the digitised database of the National Database Registration Authority (Nadra), drawing on local technological expertise to collate it with other data pools in entities, such as the provincial accounts offices, Federal Board of Revenue, etc, the health team developed market-based health insurance schemes to provide relief to the ailing poor.

The health story of Pakistan is sad with a high rate of wasting and stunting in children. According to the current Economic Survey, Pakistan is behind others in the region in terms of life expectancy and infant mortality. The country continues to struggle with the crippling poliovirus, a disease that has been long been eradicated globally; Pakistan and Afghanistan being the exceptions. The public health infrastructure is both insufficient and inefficient. Private healthcare is expensive and beyond the reach of many.

The PTI government has planned to initially offer health insurance to the most vulnerable and gradually extend the cover to anyone and everyone in need. The progress thus far is regionally uneven as health is a provincial subject and each province is free to decide the model, timing and scale of health insurance.

“We are constantly in touch with the health hierarchy in all the four provinces, nudging them to take the plunge, assuring them of full assistance administratively and technically in the launch and the management of health insurance. They are, however, expected to manage the financials on their own.

“We believe that each of the four provinces can actually deliver perfectly well within their current health budgets without any support from any external source. There are multiple innovative public health insurance models that weave with private health facilities in a way that serves social objectives and opens up a huge space for private sector growth,” a senior source involved in designing and execution of health scheme, informed Dawn privately.

Khyber Pakhtunkhwa, ruled by PTI, took a lead when it launched the micro-health insurance scheme in 2020 and started the distribution of Sehat Sahulat Plus cards to the eligible 600,000 families. The federal government also initiated a health card scheme for deserving residents of Islamabad, Thar, Azad Kashmir, tribal regions of KP and Gilgit-Baltistan. Punjab, the other province with a PTI-led government, has also launched the health insurance scheme last week and is expected to start the distribution of health cards early next year. Balochistan, where PTI is at the helm in a coalition, is said to be evaluating options, but Sindh, under a PPP government, appears reluctant.

Read more: Bilawal rejects Sindh’s participation in health insurance scheme

“Sindh’s public stance on Sehat Sahulat Card is political. It reflects their opposition to the ruling PTI and not to the idea of free access to health facilities for families that can’t afford to tend to their ailing members. The fact that people of KP residing in Sindh are availing the facility of free medical care at empanelled hospitals in the province is bound to mount pressure on the Sindh government to provide similar care for the locals.

“If you ask me, I don’t think a political party will allow its political capital to get eroded. The health hierarchy in Sindh must already be working on its own brand of a health insurance scheme. One shouldn’t be surprised if Sindh also launches one next year,” a health expert working with the federal government asserted over the phone. He is barred from publicly airing his opinion.

A CEO of a semi-charitable hospital in Karachi serving Sahulat Plus cardholders was impressed with the scheme and also with the quality of assistance provided by the State Life Insurance Company (SLIC), a partner in the scheme. “The SLIC staff provides card-holders verifications swiftly, monitor each and every case processed, and get the approval for the treatment we advise. For us, it is a win-win situation as we get to help more people without straining the budget as the government shares the cost,” Dr Danish of Creek General Hospital told Dawn over the phone.

Hafizuddin of SLIC promised to explain the whole model later but provided the list of empanelled hospitals and clinics in Sindh. There are seven second-tier and semi-charitable hospitals of Karachi, one in Hyderabad, and health centres and clinics in Mirpurkhas, Badin, Chachro, Mithi and Umerkot.

Mehar Khursheed, the media coordinator for the Sindh Health Department, questioned the efficacy of the scheme, which, she asserted, enriches the insurance company as the premium is paid even for those who are not using the facility. She pointed out several other shortcomings that, in her opinion, divert resources from government to private hospitals, hurting more than helping the healthcare system.

Published in Dawn, The Business and Finance Weekly, December 20th, 2021