User:Wiki id2/Sehat Sahulat Programme

Sehat Sahulat Programme (lit. Health Benefit Programme) is the flagship healthcare policy of Prime Minister Imran Khan to reform Pakistan's healthcare system along the lines of a welfare state. The rollout of health insurance coverage aims to expand health insurance to millions of Pakistanis who previously had no healthcare coverage or limited healthcare coverage, the aim of the series of reforms is to eventually introduce universal healthcare across Pakistan. As of 2021, Pakistan's largest province by population is rolling out healthcare coverage in various districts of the province. While, one of Pakistan's poorest provinces has since 2020 rolled out coverage across all districts of the province.

This series of healthcare reforms can be traced back to 2013, five years before Khan became Prime Minister when his party won regional elections in Khyber-Pakhtunkhwa, the government of then Chief Minister Pervez Khattak instituted a pilot project called "Sehat Ka Insaf" meaning "Justice in Health", alluding to Khan's ideological commitment to social justice. After Khan became Prime Minister in 2018, the health reforms were scaled up significantly with the provinces of Punjab and Khyber-Pakhtunkhwa implementing mass healthcare coverage. As of July 2021, over 250,000 people have undergone free (at the point of consumption) healthcare treatment in the province of Khyber-Pakthunkhwa alone in the first 6 months of 2021.

The programme was expanded in phases, with both an increase in the number of households covered and increases in budgetary allocations per household. See this article for phase-by-phase increase.

First launched in August 2020 in Pakistan's North-West region of Khyber-Pakthunkhwa, it became the first region within Pakistan to provide universal healthcare coverage to its population. The programme was extended into Punjab. Also, in 2021, the healthcare facility was expanded beyond the provinces and into areas administered by the federal government such as Islamabad, Gilgit-Baltistan as well as Azad Jammu and Kashmir.

Background
In 2013, a study of Pakistan's healthcare system revealed that the country lagged behind peer countries. For example 78% of the public had to pay out-of-pocket at the point of receiving healthcare, 75% of healthcare services were provided by the private sector and doctors outnumbered nurses/midwives by a ratio of 2:1.

Structure of Sehat Sahulat
Sehat Sahulat is structured as subsidised healthcare insurance. Essentially, each household is allocated a maximum amount of money by the government, this money is used to subsidise access to healthcare per household per year i.e. the government pays for the healthcare treatment of a patient up to a maximum amount per year. The health insurance can be availed at hospitals run by the government as well as private-sector hospitals and clinics that have agreed to participate. The programme is funded by State Life Insurance Corporation (SLIC) a Pakistani state-owned insurance company, in which the federal government and provincial governments contribute funds on a per person basis to pay for insurance claims as they come due.

Challenges
The reforms have faced significant headwinds - firstly since the 18th Amendment to Pakistan's constitution, the power of the federal government is limited so the federal government is unable to directly initiate health reforms under the constitution, since healthcare is devolved to the provinces. Nevertheless, as Imran Khan's party controls Pakistan's largest province in addition to Khyber-Pakthunkhwa, he has tasked his loyalist Chief Ministers (Mahmood Khan and Usman Buzdar) who have in turn appointed the Minister of Health in the province to implement these reforms. However, Khan's coalition partners in Balochistan have yet to instigate these reforms, while Sindh province is ruled by the opposition Pakistan Peoples Party and have refused to co-operate with Imran Khan's federal government over healthcare reforms.

Prime Minister Khan's former advisor on health Zafar Mirza argued that such a social healthcare insurance programme may require further reforms in the future, namely that upper-income and middle-income households would have to begin contributing to health insurance premiums, rather than having insurance premiums being fully funded by the federal government of Pakistan and the devolved provincial governments in Pakistan. He argued that it would be difficult to justify the government providing the same free at the point of consumption healthcare to those who can afford to pay for treatment fully (upper-income households) or who can pay partly (middle-income households). Nevertheless, Faisal Sultan praised the government's decision to include people with disabilities and transgenders in the health insurance scheme for free healthcare treatment at the point of consumption. Sultan also praised the government of Imran Khan for trying to de-politicise healthcare, by removing politically partisan branding, the Sehat Insaf Card named after the ruling Pakistan Tehreek-e-Insaf of Imran Khan was renamed by Khan's government to Qaumi Sehat Card (i.e. National Health Card).

Initially the programme was for government hospitals, and although some private sector hospitals have agreed to participate, not all are on board, which means citizens still may have to pay out-of-pocket if treatments are undergone at those private sector clinics. Other challenges include the burden of Covid-19 on Pakistan's already weak healthcare system - with already limited health resources allocated to the fighting the pandemic, the ability of hospitals to cope with additional non-Covid patients was a matter of concern. Another headwind facing the government was that most transgenders did not officially state on their NIC (National Identity Card) that they were transgender, they identified either as male or female. Thus, those transgenders who were in fact transgender, but identified as male or female on their ID card could not avail the free healthcare service.