Naya Pakistan Sehat Card: saving lives

The person behind most of the major institutional changes in the public healthcare system of Punjab is the woman with an exemplary work ethic: Punjab Minister for Health Dr Yasmin Rashid.

I asked Dr Rashid a few questions about the Sehat Card:

How was the Sehat Card conceived?

Sehat Card was started as a healthcare initiative in Khyber Pakhtunkhwa in October 2015, focusing on people who were living under the poverty line. At that time, 35-40 percent of the population received the card. Following its success, the Nawaz Sharif government in the centre replicated the programme in December 2015. In 2016, the then Punjab government of Shehbaz Sharif initiated the programme in some of the districts of Punjab.

When our party formed government in 2018, 25 percent of Punjab’s population living under the poverty line in 13 districts had health cards. Functional only in nine districts, the scope of the card was Rs 350,000. We started giving health cards in January 2019. By January 2020, 5.2 million families of Punjab had received the health card worth Rs 750,000.

In 2020, Khyber Pakhtunkhwa took the initiative of health cards for their entire population; the programme was implemented in December 2020. Following the success of that programme, Prime Minister of Pakistan Imran Khan asked Punjab to replicate it.

The commitment of the Government of Punjab was to ensure universal healthcare insurance for our entire population. Irrespective of the material status of an individual, the head of every family will be eligible for the card.

Work started in May 2021 in the divisions of Dera Ghazi Khan and Sahiwal, with seven districts receiving the facility of universal health insurance. By December 2021, 8.5 million families have the Sehat Card that covers all expenses during a patient’s treatment in a hospital. From January 1, 2022, the facility of Sehat Card for the rest of Punjab’s population will be initiated. Thirty million families, inshaAllah, will be covered by end-March 2022.

The cost of the project is, approximately, Rs 390 billion. The State Life Insurance Corporation of Pakistan (SLIC), having won the bid, will start providing the service from January 1.

What are the key aspects of the Sehat Card?

Sehat Card, worth one million rupees, will be given to the head of a family. The important part to understand is that Sehat Card can only be utilized once the patient is admitted in a hospital for treatment or surgery. It will cover most of the major healthcare issues of Punjab. A woman’s normal or cesarean section delivery; dialysis for kidney patients; laparotomy; herniorrhaphy; treatment of Thalassemia patients; lung problems; renal and gastrointestinal issues; neurological disorders, brain or head injury; coverage for cancer surgeries, and partial coverage for chemotherapy; accident injuries; surgery of injured limbs; coverage of Rs 400,000 for cardiac diseases, including stenting and CABG.

If the entire amount [of one million] is used during the treatment, and more treatment is required, backup support of additional Rs 300,000 is an option. All medical investigations related to a patient’s surgical procedures and essential medicines are covered by the card.

Sehat Card covers the travel expenses of three hospital visits. God forbid, if a patient doesn’t survive, and the family cannot afford the burial expenses, the amount of Rs 10,000 is allocated for that purpose.

Sehat Card will be functional, staggered, in all of Punjab starting 1 January 2022 and continue until 31 March 2022. Starting with the Lahore division, it will later be implemented in Rawalpindi, Faisalabad, Multan, and other divisions.

Undoubtedly, Sehat Card is a very important facility. There is 97 percent satisfaction rate in the reports that we have received from the people who have used it. So far, more than 600,000 people have benefited from the Sehat Card.

In view of the struggling economy of Pakistan, how is the Punjab government funding the Sehat Card programme?

Sehat Card is supported by Prime Minister Khan and Chief Minister Usman Buzdar. Our entire cabinet and government machinery supports it for being a revolutionary step taken in the right direction. During the COVID-19 pandemic, the losses have been colossal, resulting in inflation and joblessness. It was, therefore, extremely important that the government provided a social support system. Our government is in a comfortable position to support the Sehat Card. The viability of the programme was analyzed in full, for several months, by the finance department, which provided the assurance of our capability to have the requisite funds spread over three years.

Another good thing is SLIC is a government owned enterprise. What is left from the funds allocated for patients will be returned to the government treasury. Money being secure with SLIC is also guaranteed. We have been given the commitment that SLIC will be sharing their profit with the government. Government and SLIC will work in a very close and secure collaboration to maintain a healthy balance—return of the unused funds and reassurance of proper treatment given to all patients.

InshaAllah, if all goes well things will move forward as planned. The best way to increase the number of beds in hospitals is by involving the private sector and without investing any more in brick and mortar. As the population of Pakistan grows, more and more hospitals are required, but instead of spending money on building new hospitals and employing more people, it was considered more feasible to invest in insurance and empanelling private hospitals that would, in turn, allocate their beds for public healthcare patients. We pay SLIC, SLIC pays the hospitals, and hospitals look after the patients. This is the best way to outsource. You invest in insurance, and the private sector becomes interested to invest.

So far more than 300 hospitals have been empanelled, and the number is constantly increasing—60 empanelled hospitals are working in Lahore. Some private medical college hospitals that used to be mostly vacant now have patients who are paying through their Sehat Card. The Punjab Institute of Cardiology, along with some private hospitals that are empanelled, is treating cardiac patients. Private hospitals are now sharing the burden of public healthcare by treating patients that until now could only afford government sector hospitals.

It is a win-win situation. Utilizing our development fund, we are now able to provide more services; 30,000 beds have been added by our uninterrupted empanelling of hospitals. We are planning to empanel all our public sector hospitals. With a more robust involvement of the private sector, the system will further improve.

Sehat Card has already produced very positive results in Khyber Pakhtunkhwa. It was not a one-day process; everything has been implemented in phases. From 30 percent, it moved to about 45 percent of the population. Now gradually we are having the entire population insured, and the results that we have had from Khyber Pakhtunkhwa are quite encouraging.

How would you define the scope of public healthcare facilities in Punjab in 2021 in comparison to 2018?

From 2018 to 2021, there has been a marked improvement. If that wasn’t the case, it would have been extremely difficult for us to cope with the pandemic. Alhamdullilah, Pakistan, and particularly Punjab, has dealt with the pandemic quite successfully. Diagnosis, treatment, vaccination. In the first 100 days we did a gap analysis focusing on the main factors: increasing the physical capacity and human resource. Hospitals were working at fifty percent capacity. Secondly, the total number of beds available in Punjab in the public sector hospitals was about 55,000, clearly not enough for Punjab’s burgeoning population.

The Punjab health department has recruited more than 48,000 people in two and a half years—doctors, nurses, paramedical staff, technologists, pharmacists, and for the first time, male nurses. A huge asset, particularly during the pandemic.

Punjab’s maternal and infant mortality ratio was quite dismal; one of our Sustainable Development Goals is to reduce that by half by 2030. Seven new hospitals are being constructed, four of which will be ready by 2022. A 600-bed mother-and-child hospital in Lahore, 250-bed mother-and-child hospital in Mianwali, and 500-bed mother-and-child hospital in Multan. Mother-and-child hospitals are also being built in Attock, Layya, Rajanpur, and Bahawalnagar.

One of the major factors that we have worked on—and I think the pandemic put us on a fast track—is diagnostics. In my primary healthcare department, we had only one BSL 3 lab, capable of performing about 500 tests per day. Today, we have 23 labs, functional in all of Punjab in one and a half year, and in a position to perform 25,000-30,000 tests per day. Our testing capability is one of the major factors that has helped us to control the pandemic.

A cardiology hospital is being constructed in Dera Ghazi Khan.

If I compare the human resource to 2018 numbers, vacancies are down to twenty percent from fifty percent. Now we are in a position to employ 15,000 more healthcare personnel.

Overall, our preventive programmes are quite successful. With our polio prevention programme, there hasn’t been any positive polio case in 2021, a plus point for Punjab. In our extended immunization programmes, more than 91 percent of the population have been immunized. In our measles and rubella campaign, we have vaccinated 48 million children.

Regarding the COVID-19 vaccination, more than 50 percent of Punjab’s 110 million population has been vaccinated. The first vaccine has been given to more than fifty million people. Second dose has been completed for thirty million people. These huge numbers are a testament to the successful running of the Punjab health department.

We are also working on a very large-scale programme for school health nutrition. We have, so far, screened more than ten million children. Currently, we also have a programme for thalassemia, one of the largest province-based programmes in the world. In the last three years, we have screened more than 290,000 people.

I believe we are on the road to progress, and that our focus is clear and in the right direction. Our health sector strategy guides us all the time while we remain focused on the SDGs. Hopefully, in the next one and a half years, a more noticeable improvement will be visible in the health status of the people of Punjab, and all of Pakistan.