Taimur Khan Jhagra of Pakistan: the minister extraordinaire

I noticed Taimur Khan Jhagra on Twitter in 2018. The electoral success of Imran Khan’s party Pakistan Tehreek-e-Insaf (PTI) in the general elections of 2018 resulted in the PTI coming into power in the centre and the provinces of Punjab and Khyber Pakhtunkhwa. Minister of finance in the government of Khyber Pakhtunkhwa, Jhagra with his impeccable linguistic, argumentation and persuasion skills was a rarity–he still is–in terms of his stark honesty vis-à-vis expectations versus reality, the paradigm in which his party re-formed government in Khyber Pakhtunkhwa.

In his tweets and his responses to people who asked him hard questions or harshly criticised his government even at its nascent stage, Jhagra’s calmness and patience were visible in his carefully posted words. He answered, he debated, he presented facts and figures, he pushed his point with empirical evidence, he was open to feedback and suggestions. And he worked.

Taimur Khan Jhagra in 2021 is still the same man. He seems calmer than ever. And stronger. As he took the reins of the ministry of health in addition to his first portfolio of finance in February 2020, the world changed. Coronavirus happened. It is still a deadly reality. The last one year has been a rollercoaster of uncertainties, grappling with the unknown, planning for the unpredictable, and implementation of new protocols of personal, professional and medical imperatives. The pandemic deconstructed the existing way of life. The governments of Pakistan and the four provinces refocused their attention and resources. But despite the appearance of new dynamics of human existence the old issues persisted in their trademark rigidity. One being the cost of public healthcare.

The Khyber Pakhtunkhwa government looked beyond the pandemic, and amidst the destruction of the coronavirus continued the work on a reformatted health insurance project. Working under the leadership of Prime Minister Khan and Khyber Pakhtunkhwa Chief Minister Mahmood Khan, Taimur Khan Jhagra and his team made the apparently impossible a reality. The Sehat Sahulat Program became a reality.

The “Sehat Sahulat Program is a milestone towards social welfare reforms, ensuring that the identified under-privileged citizens across the country get access to their entitled medical healthcare 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.”

At the end of February, as a resources-strapped Pakistan like many of the countries of the world continue its battle with the pandemic, the Sehat Sahulat Program is not just a silver lining, it is every colour of the rainbow. There is no time better than now to ask Khyber Pakhtunkhwa’s Minister of Finance and Health Taimur Khan Jhagra about his ministry’s magnificent work.

Mehr Tarar: What were the biggest challenges, besides the herculean one of the coronavirus pandemic, in the healthcare sector of Khyber Pakhtunkhwa when you took the additional charge of the ministry of health one year ago?

Taimur Khan Jhagra: Over the last few years of the PTI government, huge investments have been made in the healthcare sector: bigger budgets; doubling of doctors and healthcare staff; autonomy to tertiary hospitals. Healthcare is such a complex ecosystem, there is still so much to do to get it to the level that we want. The biggest challenge when I took over, as we worked on tackling the long-term challenges, was to implement the big ideas fast, ideas that could have an immediate impact, and that could quickly enhance the confidence of people in the healthcare sector. And that’s where the concept of universal health insurance came in.

How would you define the scope of public healthcare facilities in Khyber Pakhtunkhwa in 2018? And in comparison, in 2021.

TKJ: If we look at the state of the healthcare system when we took over in 2013, it was completely dysfunctional, ravaged by a decade of militancy and corruption. Also, a healthcare system for 30 million people cannot be run in a completely centralised manner.

A lot has changed. Our nine MTIs, self-governing tertiary hospitals, run autonomously, and see more than twice the throughput they did just a few years ago. There are almost 30 major facilities completed, the last of which is the province’s first cardiology institute, which we will get JCIA accredited and make Pakistan’s best. Thousands of doctors have been hired, and healthcare services in the periphery work much better than they did. Salaries have been improved. Staff attendance and medicine availability in the primary healthcare sector is a lot better.

However, what we need to recognise is that this is still a system that needs a lot of work. As standards improve so do people’s expectations, and on an absolute level, we are determined to be much much better.

What is the genesis of the Sehat Sahulat Program?

TKJ: Personally, after living in the UAE for 10 years, one of the things that affected me the most returning to Pakistan to a political career, was when people came to me in my capacity as a politician for urgent medical help. I will never forget the look in the eyes of one particular gentleman who needed his daughter to get a liver transplant to live. There was no way to help her, and an application had to go all the way to the PM office to get help. She didn't make it.

The Sehat Card was launched by the last PTI government, but it only covered about a quarter of the population. At one meeting with the chief minister in the early 2019, we agreed that we wanted to think big, and cover every person in the province. No one should be denied basic healthcare. Ever since then, it became a mission, and the chief minister’s leadership has been stellar.

We redesigned the programme, enhanced it, and tendered it out. After completing the contracting process in late 2020, the programme was launched on November 1, 2020. Just 90 days later, we can say that each one of the 40 million residents of Pakhtunkhwa are covered. It’s a proud moment because we can see the impact every month. Over 60,000 people have availed it, primarily for complex procedures, such as heart surgery. My friends in the US keep saying to me in their phone calls how we in Pakistan could have done what the US has failed to do so far. It shows that we can effect a big change in our country.

What are the key aspects of the Sehat Sahulat Program?

TKJ: Every family in the province has an insurance package of Rs 1 million a year, just under $7000, for in-patient secondary and tertiary care. This is up from Rs 600,000 previously. People are covered not just in Khyber Pakhtunkhwa but in 450 plus public and private hospitals across the country.

We’ve also tried to make the programme as simple as possible, linking it to the national ID card that most people already have, and by eliminating the need for referrals.

Because so many of its aspects have been enhanced, we call it the Sehat Card Plus. We have ambitious plans to further improve it.

In your capacity as Khyber Pakhtunkhwa Minister of Finance, how do you evaluate the long-term viability of the Sehat Sahulat Program?

TKJ: Not only are we saving hundreds of thousands of lives, but we are also giving 40 million people significant peace of mind with the knowledge that critical healthcare costs are covered.

It's also creating opportunity for healthcare professionals, making additional money available to public sector hospitals, and improving standards in private sector hospitals. If anything, it’s bringing private sector healthcare in the government set-up, and incentivising investment in healthcare. It’s creating scale in the insurance industry as well as benefiting the pharma industry.

At the moment, the scheme costs us Rs 20 billion a year, around four percent of our annual budgetary expenditure. We are going to introduce a universal healthcare bill in the provincial parliament. But think of it this way: it will be the best 20 billion we ever spend.