Saturday September 18, 2021

Sehat Sahulat programme: a bonanza for private hospitals

PESHAWAR: Though the Sehat Sahulat programme, the flagship project of Pakistan Tehreek-e-Insaf (PTI) government in Khyber Pakhtunkhwa, is a blessing for millions of patients, it desperately needs a review as it is being misused by the private hospitals.

The initiative was first launched in Khyber Pakhtunkhwa as Sehat Insaf Card in September 2016 to provide free-of- charge health care to families living below the poverty line.

The government must thoroughly investigate which criteria was used in selection of private sector hospitals for the Sehat Sahulat programme as according to official sources, some of the hospitals on the panel are ill-equipped and below the standard of even a basic health unit (BHU).

However, these hospitals are selected for this lucrative programme and making huge money.

Though Health Minister Taimur Jhagra had earlier told The News that he was not aware of the selection process, there were widespread reports that selective private sector hospitals were brought under the umbrella of the healthcare programme.

“Apart from RMI and Northwest, which qualify on merit, some private hospitals such as Pak Medical Centre, Irfan General Hospital, Charsadda Road, were registered on the basis of political connections. Many good hospitals have not been empaneled,” said an official source. A PTI MNA from Peshawar owns the Pak Medical Centre known for undertaking maximum surgical procedures under Sehat Sahulat card to make money.

Ironically, most of the well-equipped public sector hospitals, including Lady Reading Hospital (LRH), Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC) in Peshawar and Mardan Medical Complex and the remaining tertiary care hospitals could not properly utilise the Sehat Sahulat card programme due to a host of reasons.

“Most of the people in public sector hospitals believe that those handling the Sehat card programme prefer the private sector as their rates are higher than public sector. If a laparoscopic surgery is done in the public sector hospital, the surgeon will get Rs3000 as his share and the anesthetist is paid Rs1500, but if the same procedure is done in private sector, the surgeon will get Rs10,000 and anesthetists Rs5000,” a senior surgeon told The News in Peshawar.

According to him, almost all the doctors and support staff including anesthetists of the MTIs serve in private sector hospitals in the evening and make more money than their salaries in the government sector.

Presently, there is no public sector hospital in KP where the patients can avail Sehat card for private facilities.

This correspondent spoke to officials of the three MTI hospitals in Peshawar and as per their view as compared to the private sector, they had to follow certain rules and regulations and that’s why they could neither implement Sehat card programmes nor attract Sehat card patients to generate revenue. Initially shares used to be paid to the IBP staff in the morning dealing with Sehat card patients. The doctors stopped handling the Sehat card patients in IBP after their shares were stopped. The Sehat card facility is needed to be made available for 24 hours as the staff is not available after 4pm.

Before the launch of the programme, the government would pay for any expenses such as medicines or consumables which were unavailable at government hospitals.

The programme also provided cover against diseases at private hospitals, treatment of which was not available at the public sector hospitals.

Universal health cover is the responsibility of every civilised country of the world and it was first launched in KP. This has been provided by the vast network of government managed primary care, secondary care and tertiary care hospitals in Pakistan.

Aga Khan Foundation had established the first private sector hospitals in Pakistan.

Government employees could avail services of these expensive private hospitals at government expense only if these services were not available at the state-run hospitals.

It has been a common practice that politicians and high-ranking officials would seek medical treatment in the United States and European countries by getting non-availability certificates from these government hospitals on the basis of their influence.

Some of the specialties including radiology and pathology used to draw risk allowance for its personnel.

Almost two decades ago, the government made a policy of introducing new diagnostics and procedures to government hospitals. However, it started charging a very small amount for these procedures called “user charges”.

A fraction of this was paid to the doctors and technicians involved in performing these procedures involving risks to their health.

When the Medical Teaching Institution Reforms Act MTI Reforms Act, commonly referred to as MTI Act, was promulgated in 2015, Prof Nausherwan Burki took charge as the chairman of the Board of Governors (BoG) of Lady Reading Hospital, Peshawar.

One of his first few decisions was to abolish the share of doctors and paramedics in lieu of user charges.

When introduced at government hospitals, the Sehat Card started providing for the procedures/consumables which used to be covered by Zakat and/or Tanzeem Wasail Al Mahroom programme previously.

Initially, Sehat Card patients were also treated in the morning at LRH.

However, Prof Nausherwan Burki stopped Sehat card patients being operated on in the morning as they were being given preference over other deserving patients who did not have Sehat cards.

According to senior officials, the proposal being reviewed as a previous plan had been made without a costing exercise and would have resulted in loss instead of income to LRH.

Sehat Sahulat Programme provides services covered under two distinct benefit packages i.e. priority / tertiary care package and secondary care package.

Priority / tertiary care benefit package covers all significant high-cost critical treatments such as cancer management, cardiology, accidents, ventilator support, burn, renal dialysis (renal transplant in KP only). while the secondary care benefit package covers all the remaining medical and surgical treatments, including abdominal surgeries, medical conditions, deliveries / C-sections etc. Sehat Sahulat Programme has technical partners in World Health Organisation (WHO) and GIZ (German Development Agency).

However, it is funded by the national exchequer, i.e. tax payers’ money. The empaneled health care facility gets a package rate for each procedure, which in addition to the operational expense also includes the fee of the surgeons.

The idea of creating competition amongst private and public sector hospitals is being touted as a means of improving health care in Pakistan.

The government has no doubt created competition, but it seems it is filling the pockets of the doctors instead and that too with taxpayers’ money.

Furthermore, many empaneled private centers do not have specialists of a particular specialty or have untrained so-called specialists.

But surprisingly, these centres are carrying out these very specialised procedures and submitting bills for reimbursement in this regard.

The government would need to justify why SSP is being implemented in private hospitals for procedures which can be carried out at public sector hospitals.

And to get maximum benefits from the programme, most of the private hospitals had set up a cath lab for cardiac procedures such as angiography and angioplasty. “If the government is serious in improving cardiac services, it should make it mandatory for every Sehat card based cath lab to set up cardiac surgery department and start primary PCI facility,” a senior cardiologist opined in HMC.