Health is an essential component of the Sustainable Develop-ment Goals (SDGs). The SDG 3.8 specifically aims to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” Pakistan lags on all the sustainable development goals except against climate action and environment. The country’s performance has further deteriorated during the last two years amid the global pandemic where poverty has worsened, unemployment has increased, inequality has widened, and public health has further degenerated.
Against this gloomy picture, the idea of a micro health insurance for all citizens of the country offers some hope for some initiative by the government to address the challenges that human development face in Pakistan. With all its negatives, the federal government’s Sehat Sahulat Program and its Sehat Card is a step towards achieving universal health care – albeit small.
As a part of its vision to become a welfare state, the federal government has launched the Sehat Sahulat Program with a Sehat Card. Though the health card has had many names - Sehat Card, Sehat Insaf Card, Sehat Sahulat Card, Naya Pakistan Sehat Card, and Qaumi Sehat Card – it is an initiative of health coverage and micro health insurance scheme. The Sehat Sahulat Program was launched in 2015 in KP as a healthcare initiative for the poor and marginalized citizens of the province. The same idea was replicated in Punjab under the previous government and the program was announced to be extended and expanded when the current government came to power in 2018. The concept of Sehat Card was first implemented in KP in 2020, and after its success, it was announced by the PM to be implemented across Punjab.
The program includes both public and private hospitals with State Life Insurance Corporation selected as the principal health insurance provider. Under the program, the registered families will be able to get free treatment up to Rs1 million. After covering over 6-7 million families in KP, the health card will now be covering over 30 million families in Punjab by March 2022. Other provinces with the exception of Sindh amid the opposition from the province are also expected to be added soon to the program.
The Sehat Card has now been launched in Punjab and ICT as well after KP, whereas the Government of Sindh is resisting its adoption. A key challenge that lies ahead for the SSP and the Qaumi Sehat Card is its sustainability. The entirety of its financing is upon the federal government – or its insurance company State Life Insurance Corporation of Pakistan– which means it will have to continuously fund the scheme from the development budget and not a penny from the taxpayers. For the program to scale and succeed there is also a need to consider the sky-rocketing inflation.
Moreover, the rejection from one province also raises questions on its long-term sustainability. The main contention that Sindh government has is the privatization of healthcare with this initiative as the health coverage includes many private hospitals in the panel.
Recently, the PM announced that the government will shut down district headquarters hospitals across the country and incentivize the private sector to provide healthcare to the people. This has invited ire as this means shutting down DHQ hospitals in rural and far-flung areas, hoping the private sector would fully facilitate the masses in healthcare provision, which too many seems impossible, inapt and too farfetched.
While it’s true that district headquarter hospitals have not been offering quality treatment and service to the masses, completely getting rid of them would mean increased burden on the private sector hospitals that are not enough to cater to everyone and are not present in all far-flung areas. Moreover, the government will have to significantly increase the empanelled private hospitals on the Sehat Sahulat Program to revamp the healthcare system, which would still not guarantee the success of the program.