The present government has an avowed mission of turning Pakistan into a welfare state. To this end, in its three years in power, it has launched a number of schemes to promote the socio-economic well-being of the public and especially the less-privileged. Among others, these include the Ehsaas Progamme (the renamed and expanded BISP), the Kamyab Jawan Programme, Panahgahs (shelter homes), low-cost housing financing and the Sehat Sahulat programme.
Even a little thought will make it obvious that for a welfare state to be established, a government will require considerable financial outlay. As such developed countries with strong economies are much better placed to establish welfare states, with other aspects also giving vital support, like comparatively smaller populations, higher literacy and an advanced industrial base. Nevertheless, developing countries like Pakistan too must aim for establishing welfare states, even if takes longer and the task is substantially more arduous. To this end the mission of the present government to pursue this goal is to be lauded.
Many if not all such ambitious public welfare centric programmes look brilliant on paper, peppered as these are with lots of statistics about the very large number of people who will benefit, the impact on the economy and so forth. While the government’s mission may be altruistic and with all good intention, it is imperative for any such large-scale programme to succeed that certain critical factors that will assure the desired results are given full attention right from the programme’s conceptualization stage. These targets may be realistic or not, but even to achieve the targets to an appreciably high extent if not fully, the success-controlling factors. As mentioned earlier, sufficient funding of course must be available for the programme’s implementation in a phase-wise manner. What are some other factors? Let’s consider these in relation to the Sehat Sahulat programme by way of an example.
As described on its website, the Sehat Sahulat Programme ‘is a milestone towards social welfare reforms; ensuring that the identified under-privileged citizens across the country get access to their entitled medical health care in a swift and dignified manner without any financial obligations. The SSP program’s objective is to improve access of the poor population to good quality medical services, through a micro health insurance scheme.’ Leaving the availability of funding for the programme aside, the obvious first question that comes to mind is how is the programme going to be implemented?
The simply stated answer to this question is that the targeted, pre-defined beneficiaries will be issued health insurance cards of a certain value, which they will use for in-patient (hospitalization) medical treatment. A red flag can be seen here. Does the insurance company entrusted with the task of issuing the health cards and managing these, has both the capability (experience and expertise) and the capacity to first issue millions of cards in a short timeframe and then process all transactions timely, efficiently and fully accountably on an ongoing basis?
It is to be noted that the Sehat Sahulat programme has already been initiated in KP province with the State Life Insurance Corporation (SLIC) being the implementation agency exclusively. It is too early to evaluate the results empirically, but there are certainly many questions which can be raised. What is more worrying, however, is the possibility of the government giving the execution of the much larger programme in Punjab, estimated at Rs100 billion, to SLIC exclusively, totally excluding the participation of the private sector insurance companies on a questionable technicality? The government needs to seriously re-evaluate the wisdom of this.
To start with, the private sector insurance companies have a much longer experience of health insurance than SLIC, especially in key areas like customer management system and claim management system. Second, it is highly doubtful that SLIC on its own can effectively handle the sheer magnitude of the programme for Punjab. Here it is to be noted that SLIC’s health insurance exposure is around Rs25-27 billion and similar is the value for the private sector companies all together. So it is evident that neither SLIC on its own, nor the private sector companies on their own without SLIC can take on the Punjab programme and assure desired success. And not to forget, giving SLIC a monopolistic position is not only unfair, but also highly detrimental for the whole private sector insurance industry, which has really put in a lot of effort and investment over decades to build up the industry to what it is today.
As said earlier, the government’s vision in providing free healthcare to the needy first and eventually to all citizens deserves the highest praise. But the government needs to be extremely wary that bureaucratic procedures and a blinkered approach to project implementation does not result in programme failure. As the Nobel laureate economist Milton Friedman once said, “One of the great mistakes is to judge policies and programs by their intentions rather than their results.”
The writer is a media practitioner