Sehat Sahulat Programme is beyond politics, please

The Sehat Sahulat Programme remained one of my biggest worry during the last few months of political topsy-turvy in the country. This is Pakistan’s largest ever health initiative, and inarguably the most revolutionary one. It would be extremely unfortunate if such an epoch-making programme of public welfare was made a scapegoat to political vendetta. My request to all politicians: it is a programme for every Pakistani, poor or rich. It is for our children; our generations, not for a party.

Not long ago, we had just finished launching the Sehat Sahulat Programme when we were forced to quit in controversial circumstances. Given the political vengeance our political rivals are known for, I feared the programme future was uncertain auguring the return of the ordeal of costly treatment back to the life of a common man. Sadly, my apprehensions were very much real.

The “Second Coming” gave an opportunity to finish off the work left incomplete a few months ago. Within a short span of time, we have to put things together and see this programme achieve what we have envisioned it to achieve. We must remember that is the first-ever and the largest-ever health insurance programme in our region, and the only parallels we may draw are from developed nations. The system, if it survives, shall evolve, and put through tests and trials. Lessons will be learnt and it may take a decade to evolve an efficient and flawless system.

My three-and-a-half years as health minister were a roller coaster ride. The Sehat Sahulat Programme continued to progress at an impressive pace even though we had to battle human history’s largest pandemic that brought world’s largest economies to their knees, followed by the largest vaccination campaign of our history, not to mention the dengue pandemic of 2019. In the first phase of the programme, by December 2020 to be precise, we had covered our marginalised population, 5.3 million families below poverty line. In the next six months, we completed health insurance of 8.5 million permanent residents of Sahiwal and Dera Ghazi Khan. And within the next six months, by January 2022, we covered all 30 million families that is 100% population of Punjab.

The Sehat Sahulat Card provides freedom from financial worry to every resident of Punjab. Emergency services, hospitalisation in-patient services (all medical and surgical cases), fractures/injuries, referral maternity services are free-of-cost. In addition to the secondary care services, major diseases are covered that include Cardiovascular diseases, Diabetes Mellitus (complications necessitating hospitalisation), burns and road traffic accidents necessitating hospitalisation, end stage renal disease & renal dialysis, chronic diseases necessitating hospitalisation, organ failure, oncology (chemotherapy, radiotherapy, surgical treatment), and neurosurgery. Overall, every family may avail treatment up to PKR1 million and in case of any major disease which requires more, the treatment is not stopped due to exhaustion of insurance amount. It is further supported in public sector by Ehsas Tahaffuz initiative, which is a financing system which will complement the insurance-based Sehat Sahulat Programme to ensure universal health coverage and protect people from catastrophic health expenditure.

Dengue treatment has recently been added to the list of treatments as we face a resurgence of cases. Further, we are also working on all possibilities of enhancing facilitation for cancer patients.

The number of empanelled hospitals to this day is 799, with private sector hospitals accounting for 608 whereas 191 public sector hospitals have been made part of the empanelled list. To ensure quality treatment, stringent criteria for accountability and quality assurance have been introduced for empanelment. Private hospitals are queueing up in good numbers and are keen to meet standards. Before this Programme, the poor could not think of going to private hospitals, now these hospitals are shouldering the burden very well. As the treatment in government hospitals was either free or low cost, the patient load in government hospitals was already immense. The Sehat Sahulat Card has opened choices for public, now they can opt for any empanelled hospital, government or private. Contrary to early speculations, the inclusion of private hospitals has significantly reduced the burden on public sector hospitals resulting in improvement of quality in these hospitals.

Numbers over the past few months present a surprising picture. As of latest data, we have had 2,271,944 hospital admissions out of whom 1,637,229 were in the year 2022 alone. The data of treatment brings to limelight an interesting picture that needs to be analysed by researchers, public health experts and policy makers for preventive interventions. Dialysis, for example topped the list with 481,191 admissions, reflecting the need to work on prevention of renal diseases. Whereas Caesarean deliveries with 183,284 admissions accounted for a significant number, the data of Cataract with IOL Phacoemulsification with 143,963 admissions presented an insight on tendency of delaying a treatment which is not every expensive yet beyond the reach of a poor man. A couple of patients whom I called up to inquire about the reason for delay in seeking treatment, shared a common reason that they were not having enough resources for hospital admission. This reflects how big a barrier monetary constraint is for people, barring them from seeking timely treatment.

I must also mention that only a few developed nations in the world provide such blanket health insurance. Our programme, in terms of quality and scale is no less than those of the best global models. Our team of experts had thoroughly studied global models incorporating best practices from every successful model especially the French and the British ones. In Khyber-Pakhtunkhwa, the programme was launched in 2015, covering its poorest 21% in four districts. A year later, the KP government scaled it up to all 26 districts. Lessons learnt were incorporated in Punjab later. However, short the time may be, we have to give our best shot to the Sehat Sahulat Programme. In the longer run, it will lay the foundation of a fully integrated, fully digitalised national EMR paving way for a referral-linked robust primary healthcare system.

Let us remember that freedom from health worries is one of the biggest freedoms for a nation. This is a cause, a mission.