Sehat Sahulat Programme is one of the key milestones of the government of Khyber Pakhtunkhwa towards social welfare reforms with an objective to improve access to quality medical services in a swift and dignified manner without any financial obligations. It is the first-ever initiative aimed at providing free of cost indoor healthcare services to the entire population of the province in private and public sector hospitals.
The federal government, in collaboration with the Punjab government, is also implementing the Sehat Sahulat Programme covering the entire population of AJK, FATA, Tharparkar, Sahiwal and D G Khan Division. At the same time, the below poverty population of Islamabad, GB and the rest of Punjab is covered under the Federal Scheme.
At present, the State Life Insurance Corporation of Pakistan manages both programmes making it the largest micro-health insurance provider in the country, covering more than 100 million members in the designated areas. State Life offers healthcare services in more than 90 districts of Pakistan, with its extensive network of more than 500 hospitals across Pakistan.
The organisation is responsible for enrolment of families, empanelment of hospitals, treatment rate negotiations, in-patient care provision, complaint redressal, hospital claims processing, fraud control, risk and financial management of the programmes.
As part of the implementation process, SLIC has stationed its own staff Health Facilitators at each panel hospital while District Medical Officers conduct regular rounds to observe the quality medical practices. Different IT enhancements, including real-time information and mobile application, were introduced to improve customer experience, cost efficiency and ease of delivery of services. State Life has, therefore, a significant role in the successful implementation of health insurance programmes.
Over the course of five years, State Life has developed strong technical capacity, ground network, IT and human resource development to ensure effective implementation of programmes. More than 1.1 million patients are treated under the health programmes with more than 97% satisfaction rate as per 3rd party, i.e., NADRA’s assessment. The maximum amount of ground-work completed by State Life makes those programmes successful.
It is pertinent to mention that the government of Khyber Pakhtunkhwa carried out an open tendering process in 2020 among leading private and public sector insurance companies to implement the Sehat Sahulat Programme. The shortlisted organisations include i) State Life Insurance Corporation; ii) A joint consortium of Askari Insurance, Jubilee Life, Jubilee General, AXA, Takaful Pakistan and System International; and iii) A joint consortium of United Insurance, SPI Insurance & Association of Development of Public Health.
State Life was awarded the contract for the implementation of SSP as a result of its highest technical score depicting the solid technical knowledge, historical experience, strong liquidity and financial strength of the corporation. Besides technical weightage, State Life has also quoted the lowest premium in comparison with other insurance companies. All the other insurance programmes procured by State Life have resulted from a similar open bidding process. As such, the perception of direct awarding of the Sehat Sahulat Programme to State Life is incorrect.
The organisation is in competition with other private sector insurers for UHI in Punjab, GB and ICT. The programme is expected to implement in phases, whereas State Life has already covered the entire DG Khan and Sahiwal divisions.
The health insurance industry of Pakistan remains under-utilized mainly due to the unavailability of health products at competitive premium rates and continued focus towards selected elite/urban classes. To this is extent, it would also be incorrect to term State Life as a monopoly over the social health insurance sector, given the sector remains under utilised.
State Life perceives Sehat Sahulat Programme as a social welfare service to the people of Pakistan rather than a purely commercial venture. It returns 90% of profits on health programmes back to the government treasury while absorbing potential losses through its own resources.
State Life remains committed to contributing its utmost to ensure the successful implementation of the Universal Health Insurance as per the vision of the Honourable Prime Minister of Pakistan to the service of the people of Pakistan.
With the rapid expansion of micro health insurance programmes and investment of billions of rupees in health insurance, the implementation of programmes would become more delicate in terms of risk and operational management. A prudent approach will be required to ensure the selection of the organizations with adequate financial liquidity, solvency and technical capacity and proven ability.
Copyright Business Recorder, 2021