Reading Time: 4 minutes The World Health Organization’s recommendation for the percentage of GDP of a country to be spent on health care is 5% but Pakistan’s stats are deplorable. The Pakistan Economic Survey 2020-2021 stated that the country’s healthcare expenditure out of its GDP is 1.2%. On a per capita level, $14 is spent yearly by the public sector while the people are forced to pay $28 out of their pockets. Due to the government’s incapability of matching private hospitals’ costs, the public ends up spending 60% of healthcare costs out of their pockets.
The World Health Organization’s recommendation for the percentage of GDP of a country to be spent on health care is 5% but Pakistan’s stats are deplorable. The Pakistan Economic Survey 2020-2021 stated that the country’s healthcare expenditure out of its GDP is 1.2%. On a per capita level, $14 is spent yearly by the public sector while the people are forced to pay $28 out of their pockets. Due to the government’s incapability of matching private hospitals’ costs, the public ends up spending 60% of healthcare costs out of their pockets.
Under Pakistan Muslim League (N)’s government in 2016, National Health Vision Pakistan 2016-2025 was outlined by the Ministry of National Health Service’s Regulations and Coordination. The document highlighted eight areas of work: multi-sectoral approach, financing, Research and technology, governance, implementation, and service delivery. UHC Partnership played its part to improve universal health coverage in the country.
Advancement in the healthcare sector was achieved by the PTI government in 2020 when it announced the Sehat Sahulat program. Sehat Card was already successful in Khyber Pakhtunkhwa and was soon expanded to the rest of Punjab. As of now, the cards have been distributed to people in Punjab, Azad Jammu Kashmir (AJK), Gilgit-Baltistan (GB), Tharparkar, Islamabad Capital Territory (ICT), and Khyber Pakhtunkhwa.
Sindh has not yet joined the Sehat Sahulat program. Murtaza Wahab of the Sindh government said, “Sindh government doesn’t believe in issuing ‘Sehat Cards’, but every citizen should have access to health facilities.” Despite the Sindh government’s refusal of being included in the program, the Federal government distributed Sehat cards in Tharparkar and Umerkot districts.
In the first phase of the Sehat Sahulat program, the government was successful in dispensing Sehat cards to 5.1 million people. With the card, low-income groups can avail free of cost medical services. It is mostly believed that the allotted sum per anum is Rs. 1 million but it is originally only Rs. 460,000. A family is granted Rs. 1 million only under special circumstances. The care packages are divided into priority disease treatment package and secondary disease treatment package which covers cancer, cardiac problems, different kinds of accidents, ventilator support, burn incidents, renal dialysis, abdominal surgeries, medical conditions, deliveries/C-section, etc.
Around the time that PTI was being expelled from the government, Sehat cardholders went into despair over the possibility of discontinuation of the Sehat Sahulat program due to the change in the governing party. A worker of a government hospital claimed that from 1st April, many hospitals were not entertaining new patients or scheduling new surgeries on Sehat cards and said, “The management of the hospitals are concerned as to how the money will be collected from the new government if the PTI government is thrown out of power.”
It was reported that Shamshad Hussain, a patient of the Rawalpindi Institute of Cardiology from Muzaffarabad was, at first, given the green light on his bypass surgery and related expenses on Sehat card. “Now, doctors are refusing to conduct the operation despite their assurance. They have asked me to go to a private hospital. When I visited a private hospital with the Sehat Card, the hospital refused to accept the card and demanded cash,” lamented Shamshad explaining the effect of the government change. The officials of Rawalpindi District Health Authority did not clarify the situation and stated that hospitals have not received any orders to turn away the patients on such a basis.
In a statement in the early days of April, the Ministry of National Health Services (NHS) discredited claims of the Sehat card not being accepted by hospitals in light of government change and said, “Any social media messages to the contrary are patently false, malicious and baseless. In case of any problem, please call toll free helpline 080009009 or approach the relevant hospital’s Sehat card counter for prompt assistance.”It further added, “Under the Sehat Sahulat Programme, families are able to get free treatment from empanelled public and private hospitals all across Pakistan. All hospitals empanelled with Sehat Sahulat Programme continue to provide free of cost hospitalization services to all citizens as per an agreement. There were around 9,000 hospital admissions on Friday and 8,000 on Saturday (April 9) across Pakistan under the programme.”
Unseen by many officials of the government, sehat card did come with its own set of problems. One minor example would be when some companies stopped the employees’ health insurance and expected them to rely on the sehat cards. Zeeshan Sohail, a worker affected by such a problem, said, “We have been deprived of our insurance facility of a complete health cover. What we are getting now is limited services only for certain ailments under Sehat Cards.”
In the first phase of the program, there were a few problems including fear of privatization of public hospitals, customer satisfaction and its monitoring, the difference between the allotted sum and charges of private hospitals, etc.
Prof Dr. Ashraf Nizami, the president of the Lahore chapter of the Pakistan Medical Association (PMA) commented on this issue, “The incompatibility of official rates and the market price of treatment, especially involving surgeries, points to the haste in rolling out Sehat Cards. It shows us that this was done prematurely and the required consensus among stakeholders was lacking. This has also exposed their inability to plug the loopholes in the system surfacing every now and then.”
Dr. Yasmin Rashid expressed hope for the program’s maturation and said, “The nascent initiative will have teething problems. These will be resolved with the time. The people of Pakistan and the media must back this massive public health initiative in the interest of poor people.”
One ongoing worrying factor shared by many is the threat of privatization of the public sector hospitals. Dr. Salman Haseeb, a part of the Young Doctors’ Association, Punjab, said, “Treatment through Sehat Cards may eventually lead to the privatization of public sector hospitals,… Shaukat Khanum Memorial Cancer Hospital (SKMCH) was not empanelled for treatment under Sehat Cards, but experimentation in the public sector hospitals is considered kosher.”
Healthcare services in Pakistan still have a long way to go. The hope is that the government would prioritize healthcare, and consider it an investment and not an expenditure.
Renewable energy has emerged as a game-changer in the global energy landscape, offering sustainable and… Read More