Pakistan’s ‘miraculous’ new health card scheme provides affordable treatment for the poor

·5-min read
Pakistani workers spray disinfectant at PIMS hospital in Islamabad, Pakistan - SOHAIL SHAHZAD/EPA-EFE/Shutterstock
Pakistani workers spray disinfectant at PIMS hospital in Islamabad, Pakistan - SOHAIL SHAHZAD/EPA-EFE/Shutterstock

Ishtiaq Ahmad has had heart trouble for years, but on security guard wages of only £72 per month, the chances of finding the £2,000 he needed for surgery had long seemed impossibly remote.

In his home city of Peshawar, in north west Pakistan, the free public hospitals are too often notorious for their poor care, while the better-regarded private hospitals are beyond the reach of all but the rich.

“I would look towards God to help, otherwise there was nothing. It was natural that if a person did not have the money, he will die, or suffer a lot,” he explained to The Telegraph.

The reason Mr Ahmad is now finally convalescing after heart valve surgery is a new government-funded health insurance scheme which is being rolled out across Pakistan.

The scheme's architects claim it has the power to quickly transform healthcare in a country where it has long lagged behind other developing nations. The Sehat health card which began as a flagship policy for prime minister Imran Khan's ruling party will soon be rolled out to cover most of the world's fifth most populous nation.

International observers say the Sehat health card is the latest example of canny politicians pushing new health schemes as powerful electoral tools.

“We are seeing this in a number of big countries that for years have been behind the curve,” said Rob Yates, a health financing expert at the Chatham House think tank. “Smart leaders on a state or provincial level are saying if you can introduce universal healthcare then it's an electoral winner.

“We have seen it in India, in Thailand, in Indonesia and now in Pakistan. And it does appear to be a vote winner. It's changing people's expectations about what the government should provide.”

Patients using the scheme say it has delivered them from the worry of medical debt, where serious illness often means having to sell land or livestock, or take out loans, to pay doctors. Yet opposition critics have accused Mr Khan's Pakistan Tehreek-e-Insaf (PTI) party of planning to use the insurance scheme to try to privatise healthcare and cut funding to public hospitals.

The Sehat card provides critical care cover worth up to 1 million rupees (£4,200) per family per year and has had 100 per cent coverage in Khyber Pakhtunkhwa province since late 2020. It has quickly grown in popularity and is now being used by one-in-12 families. Punjab and other provinces are to follow.

Dr Syed Shahkar Ahmed Shah, chief executive of the public Peshawar Institute of Cardiology, said: “Previously it was very frustrating because you could see these kids and adults who did not have money to pay and the government did not have enough money to fund the public hospitals.

“The families out of desperation would end up selling their land or cattle or homes to be able to afford these surgeries and the whole family would go deeper into poverty. Literally if you had a major health issue in Pakistan, it was a death sentence for the whole family. Economically they were just ruined. The Sehat card has been amazing. It really is a miraculous scheme.”

Treatment is provided through approved public or private hospitals and the comparatively low cost of healthcare in Pakistan has meant the state-owned insurance provider has been able to provide cover at around £3 per head. The card is currently costing 22bn rupees (£93m) out of a total health budget in the province of 146bn rupees (£620m).

Taimur Jhagra, a former McKinsey consultant who now holds both the health and finance ministerial portfolios in Khyber Pakhtunkhwa, said: “It shows us we can do big things in this country in a short amount of time. Somehow in Pakistan, and perhaps it's true the world over, you almost always feel that if there's anything with a good story, it has to be too good to be true.

He went on: “It's giving quality access to those that tend to be viewed by many as second class citizens and deserving of only second class facilities.”

The scheme will plough money into both public and private healthcare, he said, which he predicted would raise the standard in both. He defended giving money to the private sector, saying the government already funded public care. “We are not funding the private sector, we are funding health care for our citizens, wherever they want.,” he said.

Dr Shah said he had been able to use payments from the scheme to increase his doctors' pay, which he predicted would stop them jumping ship to private providers.

But the opposition has accused the government of planning to use the reforms as a way to privatise health care.

Palwasha Khan, a senator with the Pakistan Peoples Party, said the initiative, coupled with an overhaul of management in public hospitals, “is a very clever move to make way for total privatisation of the health care”.

“It will result in further slashing the already low allocation to health care,” she said.

Mr Yates said that while universal critical care coverage was to be welcomed, it was more often bills for medicines and chronic care that tipped people into poverty.

Meanwhile at the hospital, patients said that without the scheme they would have been unable to get treatment. “My father was a cardiac patient and we used to take loans from relatives to take treatment. Selling land, property or livestock is common. It's impossible for the common man to get treatment without this card,” said Gul Zara, a 61-year-old from Mardan,.

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