User:Wiki id2/Sehat Sahulat Programme

Sehat Sahulat Programme (lit. Health Benefit Programme) is a flagship healthcare reform inaugurated by Prime Minister Imran Khan. The rollout of health insurance coverage aims to expand health insurance to millions of Pakistanis who previously had no healthcare coverage or limited healthcare coverage, the aim of the series of reforms is to eventually introduce universal healthcare across Pakistan. As of 2021, Pakistan's largest province by population (Punjab) is rolling out healthcare coverage in various districts of the province. While, one of Pakistan's poorest provinces Khyber-Pakhtunkhwa has rolled out coverage across all districts of the province.

This series of healthcare reforms can be traced back to 2013, five years before Khan became Prime Minister when his party won regional elections in Khyber-Pakhtunkhwa, the government of then Chief Minister Pervez Khattak instituted a pilot project called "Sehat Ka Insaf" meaning "Justice in Health", alluding to Khan's ideological commitment to social justice. After Khan became Prime Minister in 2018, the health reforms were scaled up significantly with the provinces of Punjab, Pakistan and Khyber-Pakhtunkhwa implementing mass healthcare coverage. As of July 2021, over 250,000 people have undergone free healthcare treatment in the province of Khyber-Pakthunkhwa alone.

The programme was expanded in phases, with both an increase in the number of households covered and increases in budgetary allocations per household. See this article for phase-by-phase increase.

First launched in August 2020 in Pakistan's North-West region of Khyber-Pakthunkhwa, becoming the first region within Pakistan to provide universal healthcare coverage to its population. The programme was extended into Punjab. Also, in 2021, the healthcare facility was expanded beyond the provinces and into areas controlled by the Federal government such as Islamabad, Gilgit-Baltistan as well as Azad Jammu and Kashmir.

Background

In 2013, a study of Pakistan's healthcare system revealed that the country lagged behind peer countries. For example 78% of the public had to pay out-of-pocket at the point of receiving healthcare, 75% of healthcare services were provided by the private sector and doctors outnumbered nurses/midwives by a ratio of 2:1.

Structure of Sehat Sahulat

Sehat Sahulat is structured as subsidised healthcare insurance. Essentially, each household is allocated a maximum amount of money by the government, this money is used to subsidise access to healthcare per household per year i.e. the government pays for the healthcare treatment of a patient up to a maximum amount per year. The health insurance can be availed at hospitals run by the government as well as private-sector hospitals and clinics that have agreed to participate.

Challenges

The reforms have faced significant headwinds - firstly since the 18th Amendment to Pakistan's constitution, the power of the federal government is limited so the federal government is unable to directly initiate health reforms under the constitution, since healthcare is devolved to the provinces. Nevertheless, as Imran Khan's party controls Pakistan's largest province in addition to Khyber-Pakthunkhwa, he has tasked his loyalist Chief Ministers (Mahmood Khan and Usman Buzdar) who have in turn appointed the Minister of Health in the province to implement these reforms. However, Khan's coalition partners in Balochistan have yet to instigate these reforms, while Sindh province is ruled by the opposition Pakistan Peoples Party and have refused to co-operate with Imran Khan's federal government over healthcare reforms.

Initially the programme was for government hospitals, and although some private sector hospitals have agreed to participate, not all are on board, which means citizens still may have to pay out-of-pocket if treatments are undergone at those private sector clinics.

Other challenges include the burden of Covid-19 on Pakistan's already weak healthcare system - with already limited health resources allocated to the fighting the pandemic, the ability of hospitals to cope with additional non-Covid patients was a matter of concern.