If I were asked to pick one, I would say that the most important achievement of Pakistan Tehreek-e-Insaf (PTI) government in Khyber Pakhtunkhwa (KP) is the successful implementation of the Sehat Insaf Card, now named Sehat Card Plus. This is healthcare that is life changing, lifesaving. Literally.
The KP Sehat Card was launched on September 1, 2016 during the PTI’s first governmental tenure in the province. On November 1, 2020, starting with the Malakand Division, it became the Sehat Card Plus. On February 1, 2021, the facility was expanded to the entire province.
On the inauguration of the Sehat Card on August 20, 2020, Prime Minister Imran Khan’s words reiterated the power of one of the most expansive people-focused steps of the PTI government: "You [KP government] don't know [the significance] of the step you have taken. You will realise when people send prayers your way.”
On February 1, 2021, KP Chief Minister Mahmood Khan announced: “With the launch of the Sehat Card in the southern districts, we will become the first province to have universal coverage of health insurance for hundred percent population [of our population].”
The KP Sehat Card Plus website describes the facility as a “micro-health insurance programme for all the citizens of Khyber Pakhtunkhwa. It is implemented through an insurance company selected through national competitive bidding. Under the programme, more than 7.2 million families are getting free inpatient healthcare services.”
Predictably, multiple questions and myths encircle a programme of the magnitude of the Sehat Card Plus. To have some ambiguities cleared, I contacted KP Minister of Finance and Health Taimur Khan Jhagra, the person whose contribution to the success of the Sehat Card Plus is empathetic yet realistic, constant yet pragmatic, optimistic yet truthful.
For Gulf News, I asked KP Minister for Finance and Health Taimur Khan Jhagra a few questions:
What is the range of the services provided by the KP’s Sehat Card Plus?
Minister Taimur Khan Jhagra: KP’s Sehat Card includes emergency as well as in-patient services for all citizens of the province, up to a general limit of Rs 1,000,000 per family per year. The health coverage includes general medicine, surgery, orthopaedics, ENT, paediatrics, neurosurgical diseases, gynae issues, urinary diseases, diabetes, artificial limbs, and ophthalmology. All types of cancer, Hepatitis B and C, and cardiovascular treatments are comprehensively included. In certain cases, the coverage exceeds the limit of Rs 1,000,000. Kidney transplants are covered up to Rs 1,500,000, and liver transplants are covered up to Rs 5,000,000, which is the latest addition. Covid treatment services were also added.
The only limits are elective services, OPD, and OPD medicine. These are not included because they would make the programme unaffordable, although a new top-up programme that is even more ambitious than the original programme will attempt to include them.
How do you refute the misconception that free treatment should only benefit the very poor?
Covering everyone without excluding a single person was a deliberate decision for a few reasons. First, no one will argue with the fact that health is a universal basic right for every citizen of a country. Second, the shock of exorbitant health costs, say, for a heart surgery or a liver transplant, hits not just the poor but the middle class as well. Third, the ‘haves’ in Pakistan, with the income of over Rs 100,000 per month, include perhaps less than 10 percent of the labour force. The cost of exclusion would, therefore, far exceed the benefits of universal coverage. The ultra-rich are likely to turn to private treatment in any case. And fourth, public hospitals are already free for everyone, which means that we have already accepted the principle of free healthcare for all.
Given that, over time we would have to increase health spending from $20 per head per year to $40 per head per year to meet the benchmarks of a developing country. The Sehat Card becomes a great tool to do so in an effective manner.
However, it is important to remember that programmes evolve. We are in the advanced stages of working on paid top-up insurance programmes to which we believe public servants and the middle class working in the private sector will graduate, with basic coverage remaining free for everyone.
What is your response to the cost of the KP’s Sehat Card Plus to be unsustainable for the government—PTI until 2023 and whichever party comes into power after next year’s general elections—in the long term?
It is not unsustainable. For KP, it is twenty billion rupees out of a budget of 1.1 trillion rupees. Less than two percent of the budget, less than one/seventh of the health budget that needs to increase anyway, so why not through a mechanism that promotes choice, competition, and investment.
I believe that the health card will be the lynchpin of our health system—as PM Imran Khan likes to say so himself—and that no government will dare to step back from it because free healthcare is something the public will continue to demand. We will need to make other decisions though to protect the Sehat Card.
First, top-up programmes will graduate the middle classes out of free insurance, on a voluntary basis, for significantly improved packages. Second, the Sehat Card can be used as a tool to promote private sector investment in healthcare, as well as public-private partnerships, minimising the need for government to continue to invest in large capex projects in health. This is happening as we speak because the Sehat Card is facilitating and reducing the cost of running hospitals through an outsourced model, and making greenfield hospitals built through the public-private partnership law more attractive across KP. Third, it will signify that through the Sehat Card and additional spending on health, increased spending should and will go to operational improvements and service delivery in the existing hospitals.
We are also bringing in legislation to protect the universal health insurance to ensure that no one tries to harm or impede the programme in any way.
How do you assess the veracity of patient satisfaction in terms of the quality of services provided under KP’s Sehat Card Plus?
We have a number of tools to assess the quality of service, patience satisfaction, and complaint levels. There is data from our partner insurance company [State Life Insurance Corporation of Pakistan], which shows an exceptionally high satisfaction level. We have also recently conducted a third-party survey on public perception on the Sehat Card, which showed 97 percent approval and 95 percent satisfaction with the services that were offered to patients. However, this is not the whole of it.
We have also put in place a continuous third-party audit mechanism and have involved the Agha Khan University (AKU) to do an overall evaluation of the programme. The audit mechanism will work on a quarterly basis to show us the weak areas that we can improve. AKU, which is the most prestigious medical university in Pakistan, will give us their feedback on how the programme is running and where it can be improved.
So far, we are exceptionally proud of the impact that we have had. However, that is not the reason for us to keep the programme static, and it is something that we will continue to try and improve as time moves on.