Source: “10 things to know about Sehat Sahulat Programme” https://dunyanews.tv/en/Pakistan/477223-things-know-about-Sehat-Sahulat-Programme
In this episode of The Quotient podcast, I talk to Fahad Khan, a program manager and healthcare delivery specialist with the Indus Health Network’s Global Health Directorate, about Pakistan’s healthcare delivery system and whether recent efforts by the government to achieve Universal Health Coverage are realistic.
Universal Health Coverage (UHC) by the year 2030 is a Sustainable Development Goal.
Despite this commitment, however, extending healthcare remains a challenge for national governments and public health officials. According to the World Health Organization, for instance, at least half of the world’s population lacks access to essential health services. Out of pocket health expenditures, meanwhile, are pushing as many as 100 million people into extreme poverty. In low-income countries particularly, there is a lack of quality and coverage when it comes to basic healthcare.
What kinds of policies, infrastructures, and actors will help achieve UHC? And can developing countries – with their resource constraints, complicated healthcare delivery systems, and disproportionate disease burdens – help lead the way in achieving UHC?
Pakistan on the forefront?
This is the question posed by the Government of Pakistan’s recent effort to extend healthcare throughout the South Asian nation.
In 2015, the government of Khyber-Pakhtunkhwa – one of Pakistan’s four provinces – launched the Sehat Sahulat Program (SSP), a publically-funded insurance plan that sought to provide free healthcare to poor families within the province. Fast forward to 2020, the federal government sees the SSP as a blue print to extent UHC across the country. Officials claim that over 7.1 million families have access to health coverage worth Rs.720,000 (roughly $4,500) per year under the program. Earlier this month, Prime Minister Imran extended coverage to the administrative territories of Azad Jammu and Kashmir and there are plans to expand the SSP in Punjab, Pakistan’s most populous province, in 2021.
Such an extension is ambitious, even if one ignores the already complex and multilayered healthcare delivery system in Pakistan where various private actors are de-facto providers.
A public health delivery perspective.
Here are three takeaways from my conversation with Fahad:
1) Private sector innovation remains not only widespread in delivering healthcare across income groups according to Fahad, but also necessary and currently irreplaceable when it comes to securing funding from international donors, public health messaging, door-to-door immunizations for diseases like tuberculosis,* and identifying emerging areas of care such as mental health.**
2) Government programs like the SSP might do very little to take the burden off the private sector, at least in the short term. This is because such a program is unlikely to address the wide breath of healthcare services required in Pakistan.***
3) Fahad is hopeful, however, that the SSP might help in ways that don’t involve direct healthcare delivery. Specifically, the program may improve the quality and quantity of healthcare data, as well as underscore the need to collect taxes and devote public funds to providing healthcare.
Time will tell how effective Pakistan’s government healthcare programs will be. For now, healthcare delivery experts like Fahad remain skeptical about such large-scale initiatives.
* Reporting cited in this episode on the incidence of first time and drug resistant cases of tuberculosis per year is from the WHO’s Regional Office for the Eastern Mediterranean website.
** The WHO report cited in this episode regarding per capita mental health spending in Pakistan is the WHO Mental health Atlas country profile 2014.
*** This podcast incorrectly states 175 doctors are registered with the public sector. The correct figure, according to the Journal of the Pakistan Medical Association, is 175,000.
Episode 2: In the Developing World, a Roadmap for Universal Health Coverage?