33pc health card holders paid from own pockets: report

ISLAMABAD: A third-party validation report about the Federal Sehat Sahulat Programme (SSP) commonly known as Health Card has showed that though it is a cashless programme, 33pc of the patients paid from their pockets.

This indicated the need for more effective enforcement of the programme policies to ensure that all services are fully covered under the benefit package. Although there were a few cases, complaints concerning cash demands in the empanelled health facilities needed to be urgently investigated.

While majority of respondents had knowledge about the diseases and services covered in the benefit package, a significant population – 38.7pc – did not have sufficient knowledge.

These were the crux of the report, “Third-party validation of the prime minister’s national health programme” released on Thursday.

Third-party validation report says complaints about cash demands in empanelled health facilities need to be investigated

The Health Services Academy (HSA) and Dopasi Foundation (DF) had formed a consortium to undertake the third-party validation. The HSA provided strategic direction and utilised its infrastructure while DF was responsible for employing field staff in five districts. To gather information regarding daily enrolments, usage patterns, feedback and complaints, the research teams accessed the programme’s centralised management information system (CMIS).

According to the report available with Dawn, the programme faced sustainability challenge due to the ever-increasing cost of healthcare, increasing population awareness and expectations and uncertain economic conditions. It suggested some cost contribution mechanism from affordable population segment.

It found that while a significant proportion of beneficiaries were aware of the health card, only one-third received awareness regarding the purpose and usage of the card. The report also suggested awareness rising efforts.

A small portion of the beneficiaries faced problems in services but majority of them did not launch formal complaint.

However, the report claimed that some plus points were also noticed such as the programme was found to be highly beneficial with the vast majority indicating that the government should launch more similar programmes on larger scale. The programme successfully enrolled the poorest 89pc of the projected population of target districts.

The vast majority i.e. 95.8pc were aware of the hospitals and health facilities where they could avail of the services using their health card. A high percentage i.e. 92.1pc of respondents was satisfied with the treatment.

The report claimed that in initial phase, 11pc families did not receive the health card due to multiple reasons. However, later the CNIC was declared as the health card.

The report recommended improving the secondary and tertiary care ceiling to mitigate the impact of inflation. Moreover, primary health should also be included in the programme.

Earlier, during an event in which the report was launched, Prime Minister’s Coordinator on Health Dr Malik Mukhtar Ahmad Bharath congratulated the SSP on unveiling its third-party validation report.

Vice Chancellor Health Services Academy Dr Shahzad Ali Khan and Kinzul Eman presented the report which highlighted significant strides in enhancing access to quality healthcare services and reducing out-of-pocket expenses for beneficiary families.

Dr Ahmad commended implementation partners, State Life Insurance Corporation of Pakistan and Nadra. He also acknowledged technical support from GIZ Pakistan and WHO in realising the vision of Sehat Sub Kay Liya Hai – Health for all.

Secretary Health Nadeem Mahbub, SSP Chief Executive Officer Mohammad Arshad, WHO representative in Pakistan Dr Luo Dapeng and others were also present.

Former prime minister Nawaz Sharif had launched the health card programme on December 31, 2015, for Islamabad and described it as the first step towards making Pakistan a welfare state. He had also announced that THE card will be expanded to all parts of Punjab, Balochistan, AJK, Gilgit-Baltistan and the then Fata. People of Sindh and Khyber Pakhtunkhwa (KP) could not benefit from the initiative at that time because their governments had declined to become part of the federal government’s programme in which they also had to contribute. Later, KP launched its own Sehat Insaf Card programme.

During the tenure of PTI, the programme was expanded across the country apart from most of the districts of Sindh. In April 2022, some of the hospitals had suspended the service as they feared that the PML-N government may discontinue the programme as the PTI promoted/marketed it as its initiative. However, the PML-N government announced that the programme will not be halted.

The programme covers open heart surgeries, insertion of stents, management of cancer, neurosurgical procedures, burn management, accident management, dialysis, intensive care management, deliveries, C-section and other medical/surgical procedures up to the limit of Rs1 million per family, per year. There is a facility of inter-provincial/inter-district portability for availing free-of-cost services from over 1,000 public sector and private empanelled hospitals in Pakistan.

Since its start in 2015, the State Life Insurance Corporation of Pakistan has been dealing with the card and in 2021 it again won the contract of insurance of health cards for the next three years (2022 to 2025).

Currently, 100pc population of Islamabad, KP, Azad Jammu and Kashmir, Gilgit-Baltistan and a few districts of Sindh are entitled to get free treatment of Rs1 million per family every year. In Punjab, the caretaker government had changed the policy regarding private hospitals.