Pakistan has made encouraging progress with UHC over the last few years, especially in targeting the most vulnerable sections of the population, but it still has a long way to go if UHC is to become truly ‘universal’ across the country, and not just confined to a few provinces.

One example of success is the country’s Sehat Sahulat Program (SSP), an initiative of the Federal and Provincial Governments of Punjab and Khyber Pakhtunkhwa. This program currently provides secondary and tertiary healthcare facilities, except transplants, for all admissions for 5.7 million vulnerable households in more than 100 districts. And it won’t stop there. The plan is to expand coverage to around 11 million families across Pakistan, providing access to healthcare for nearly 50 million people in total.

However, according to experts involved in the roll-out of UHC in Pakistan, the various schemes run by the federal and provincial governments will need to broaden their membership bases, increase disease coverage, and be underpinned by institutional reform.

Muhammad Uzair Afzal, a technical advisor for Social Health Protection at the German development agency GIZ, is confident that all of this can be achieved but it will take time.

“At the moment, federal and provincial governments’ schemes are mainly targeting the poorest of the poor, meaning those households living on under $2 a day are covered,” he says.

“These schemes are being run in a phase-wise manner, with around 8.5 million families or households covered so far, with a target of reaching 14 million households by the end of 2020. However, currently, only IPD (hospital inpatient) coverage is provided at a secondary and tertiary level. There is no OPD (outpatient) coverage at all.”

“Nevertheless, coverage has recently been extended to other vulnerable members of society such as the transgender community and people with disabilities,” adds Mr. Afzal. “It has also recently been extended to all permanent residents of the Newly Merged Districts of Khyber Pakhtunkhwa, as well as district of Tharparkar in Sindh, and Azad Jammu and Kashmir, regardless of households’ poverty. So, there is room for optimism.”

He also believes there is political will to make the various schemes a success, reflected in recent discussions to set up an institution responsible for implementing the schemes more efficiently. “All this is contributing to a faster rate of roll-out of coverage than we expected but reaching the full targets will take time,” he says.

One of the main challenges in achieving country-wide UHC is that health and other public services, such as education, have been devolved to the provinces under the 18th Amendment, meaning that progress is likely to vary by province, depending on their degree of political commitment and financial resources.

“In Pakistan, health is a provincial matter,” explains Dr. Faisal Rifaq, the CEO of the Sehat Sahulat Program (SSP). “Each province has complete autonomy over its health-related matters, both administratively and financially. This is the reason Sehat Sahulat Program is only working in two out of the four provinces. The others are not investing in health insurance at this time and are instead spending on strengthening their existing health facilities.”

“Currently in the constitution, health is not a right,” Dr. Rifaq adds. “We have to change it. Changing it will need significant financial and political support.”

Mr Afzal also believes that the government has to change how it delivers health if total coverage is to be achieved. “For instance, public hospitals should be made autonomous while private hospitals should be encouraged to be part of the schemes,” he says. “In addition, government must increase its efforts in terms of communication. Currently, we see low utilization. Ownership is missing sometimes at the health care facility level, mostly with the public.”

Pakistan is an L4UHC participant, and currently implementing a series of collective action initiatives. Find out more here >

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