Implementation and utilization challenge of health insurance sector in Pakistan

Health insurance is a mechanism for spreading the risk of incurring health care cost over a group of individuals or household protecting the individual from the catastrophic financial loss in the event of serious illness. The major components of health insurance is to revenue collection, risk pooling, prepayment, or purchasing health care services. In many countries including Pakistan has fewest resources with malicious cycle of poverty that cause ill health and in turn illness of people sustains poverty. The quote is remarkable “health is wealth”. Therefore health insurance not only provides medicine but also purvey comprehensive care package. Many countries formulate policies and develop scheme or program to address health financing issue for citizens.

Government of Pakistan initiative of health care is micro health insurance (MHI) that is providing eight district of Sindh with the collaboration Sindh Union Council and Community Economic Strengthening Support (SUCCESS), funded by of European Union (EU). MHI is a part of global sustainable Goals-3 too. MHI support directly or indirectly NHI (National Health Insurance) program or play role when NHI is absent.

Since 2005 following health insurance scheme has been implementing all over the Pakistan such as, “Adamjee health micro insurance” RSPN 2008-09 was aim to provide accidental health coverage, “First micro insurance Agency FMi” 2007 established for Agha Khan health development system in Northern Areas ,”Naya Jeevan Health micro insurance, 2011″ (Naya Jeevan)” worked for poor households in Karachi that guide quality health facilities and provided hospitalization and outpatient services for 20 days before and after hospitalization “Waseela-e-Sehat, 2012” (Waseela-e-Sehat, Government of Pakistan) for Faisalabad city with BISP Collaboration and provided health insurance of 6 member in family, “Social health protection initiative (SHPI), 2011 (Government of Khyber Pakhtunkhwa)” for KPK province with special care of cancer along transport facility, “Sehat Sahulat Program (SSP), 2015” (Government of Pakistan) rolled out by federal government ordain health facilities for needy people , transgender and disabled people.

European Union supportsMHI Scheme with the help of national NGOs “Rural Support Program” (RSPs) which functioning in rural areas of Sindh such as Larkana, Dadu, Kambar shahdad kot, Jamshroo, Maitairi, Sajawal, Tando Allah yar Tando Muhammad Khan, in 2017- 2018. Currently we are listening a Sehat Sahulat program is top of the list of PM Imran Khan and under the umbrella of Health Ministry. The beneficiaries of program are selected through BISP and then verified by NADRA. Moreover total cost of Sehat Sahulat program is 8 billion and registered 14 million families is being implemented through Life Insurance Cooperation of Pakistan. The registered people are mostly extremely poor, land less lives in slum, not literate, daily wagers and worked in agriculture and farming job. Many owned cattle livestock and enabled to get birth certificates for further treatment.


Government have invested large amount that would relief people to health issue but crux of the question is to ensure proper implementation of insurance facilities. Proper implementation and utilization brings fruitful result. Sehat Sahulat program or health insurance program is seems not as effective as it would be. Main reason is people would not aware about actual policies and restriction of insurance sector. Numerous factors are countable, which is responsible for utilization concern. The payment or amount people is getting they use in daily life or served in all household activities. Similarly, another issues that is obstacle the utilization of insurance program is hospital and clinic minimum service, delivery as per standard specification, fewer opportunity to admit at the hospital at least 24 hour due to sickness and accident, normal delivery, surgical delivery, doctor fees, medicine, doctor absentees, laboratories tests, transport allowance, long distance travel required to reach the hospital from localities, unfriendly hospital staff, cleanliness and sanitation.Therefore it is said muddled thinking brings muddled result.

When government designs any program they should be aware of ground realities of implementation the complexity of problems. These days stakeholders and administration are busy to feathering their own nest. Fewer paramedic staff management health officer of hospital are busy to grease the palm. Government should strict built check and balance system and accountability mechanism which covers all domain of any program. Pakistan must be implemented policies ensure strong implantation circle despite some sort of tiger force. Whatever kind of health facility a country decides to adopt the transition of universal standard may require not several time or decade. “Be creative while inventing ideas but be disciplined while implementing them”.

The writers is a M.Phil in research – student of Karachi University

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