Main Article Content
OBJECTIVES: To describe the evolution of the Sehat Sahulat Programme (SSP), a large-scale health insurance scheme launched by the provincial government of Khyber Pakhtunkhwa, Pakistan and to contextualise it in the national discourse around Universal Health Coverage (UHC).
METHODS: This review was based on peer-reviewed publications and publicly available grey literature over the last five years (2016-2020). We employed a combination of deductive and inductive approaches informed by the World Health Organisation's (WHO) UHC box framework.
REVIEW: SSP was launched on 15 December 2015. It has been implemented in four phases, with a gradual expansion in the population, services and cost coverage. In 2015, SSP covered the poorest 21% of the population in four pilot districts. On 20 August 2020, the coverage was expanded to 100% of the population of Khyber Pakhtunkhwa. SSP conferred free access to an expanding list of inpatient, secondary and tertiary care services. The scheme covered all expenditures during hospital admission, with a defined upper ceiling. The ceiling for secondary and tertiary care has improved, with marked changes in tertiary coverage, from PKR 0 in Phase1 – PKR 400,000 in Phase 4. Despite the progress, SSP did not cover key health-related targets under Goal 3 of the Sustainable Development Goals (SDGs) and partially covered Pakistan's UHC benefits package.
CONCLUSION: SSP coverage of population, disease and financial protection has expanded over five years. However, SSP coverage was not aligned with the national UHC priorities and the SDGs.
Work published in KMUJ is licensed under a
Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
2. Malik MA. Universal health coverage assessment Pakistan 2015. Accessed on: November 19, 2019. Available from URL: https://ecommons.aku.edu/cgi/viewcontent.cgi?article=1203&context=pakistan_fhs_mc_chs_chs
3. Nishtar S, Boerma T, Amjad S, Alam AY, Khalid F, Ul Haq I, et al. Pakistan’s health system: Performance and prospects after the 18th Constitutional Amendment. Lancet 2013;381(9884):2193-206. http://dx.doi.org/10.1016/S0140-6736(13)60019-7
4. Finance Division; Government of Pakistan. Pakistan Economic Survey 2019-20. Islamabad, 2020. Accessed on: November 19, 2020. Available from URL: https://www.finance.gov.pk/survey/chapter_20/PES_2019_20.pdf
5. Pakistan Bureaue of Statistics. Pakistan National Health Accounts 2013-14. Islamabad; 2016. Accessed on: November 19, 2019. Available from URL: https://phkh.nhsrc.pk/sites/default/files/2020-12/National%20Health%20Accounts%20Pakistan%202013-14.pdf
6. Government of Khyber Pakhtunkhwa. Revised PC 1: Social Health Protection Initiative Khyber Pakhtunkhwa (Phase–II). Peshawar; 2017. Accessed on: October 14, 2020. Available from URL: https://phkh.nhsrc.pk/sites/default/files/2019-06/Integrated%20PC-1%20Khyber%20Pakhtunkhwa%202012-15.pdf
7. Planning Commission G of P. Prime Minister’s National Health Program. Islamabad; 2016. Accessed on: October 14, 2020. Available from URL: https://www.nadra.gov.pk/local-projects/social-protection/prime-minister-national-health-program/
8. Government of Khyber Pakhtunkhwa. PC-1: Social Health Protection Initiative for Khyber Pakhtunkhwa (KfW assisted). Peshawar; 2013. Accessed on: October 14, 2020. Available from URL: https://www.opml.co.uk/projects/social-health-protection-initiative-in-pakistan
9. Ministry of National Health Services Regulation and Coordination. Action Plan: National Health Services, Regulations and Coordination Division 2019-23. Islamabad; 2018. Accessed on: October 14, 2020. Available from URL: https://phkh.nhsrc.pk/sites/default/files/2019-06/Action%20Plan%20NHSR%26C%202019-23.pdf
10. Ministry of National Health Services Regulation and Coordination. National Health Vision Pakistan 2016-2025. Islamabad; 2016. Accessed on: October 14, 2020. Available from URL: https://phkh.nhsrc.pk/sites/default/files/2020-12/National%20Health%20Vision%20Pakistan%202016-2025.pdf
11. Ministry of National Health Services Regulation and Coordination. Towards Universal Health Coverage: Interventions’ Description of Essential Package of Health Services (EPHS)/ UHC Benefit Package of Pakistan based on Disease Control Priorities – Edition 3. Islamabad; 2020. Accessed on: January 14, 2021. Available from URL: http://dcp-3.org/sites/default/files/resources/Interventions%20Description%20of%20Essential%20Package%20of%20Health%20Services%20UHC%20Benefit%20Package%20of%20Pakistan%20WHO%202020.pdf
12. Ministry of National Health Services Regulation and Coordination. Review of essential health services in pakistan based on disease control priorities-3. Islamabad; 2019. Accessed on: October 14, 2020. Available from URL: http://dcp-3.org/sites/default/files/resources/Review%20of%20Essential%20Health%20Services%20Pakistan%20based%20on%20DCP3%20WHO%202019_web.pdf
13. Government of Khyber Pakhtunkhwa. PC-1: Social Health Protection Initiative Phase - II for Khyber Pakhtunkhwa. Peshawar; 2016. Accessed on: October 14, 2020. Available from URL: https://socialprotection.org/sites/default/files/publications_files/Joint%20Progress%20Review%20of%20Social%20Health%20Protection%20Initiative%20in%20Khyber%20Pakhtunkhwa_Pakistan.pdf
14. Social Health Protection Initiative KP. Hiring insurance company; Request for proposal (RFP). Peshawar; 2020. Accessed on: January 14, 2021. Available from URL: http://healthkp.gov.pk/news/view/15
15. Holst J. Progress review of Social Health Protection Initiative (SHPI) in Khyber Pakhtunkhwa, Pakistan. 2017. Accessed on: October 14, 2020. Available from URL: https://socialprotection.org/discover/publications/joint-progress-review-social-health-protection-initiative-khyber-pakhtunkhwa
16. Shafi U. Epidemiological and Geographical profiling of beneficiaries treated under the Social Health Protection Initiative of Khyber Pakhtunkhwa [disertation]. Khyber Medical University; 2018.
17. Qazi AI, Khattak FH. Sustainability of Social Health Insurance. Islamabad; 2019. (2019). Report No.: 3. Accessed on: October 14, 2020. Available from URL: https://www.pide.org.pk/pdf/HealthEconomics/Sustainability-of-Social-Health-Insurance.pdf
18. Siddiqui H, Khattak FH, Khan MI. Role of social health protection in universal health coverage: a case study of Rawalpindi, Islamabad. Health Econ Working 2019:1-35. https://doi.org/10.13140/RG.2.2.10205.36324
19. Khan SA. Pakistan’s march towards Universal Health Coverage. J Ayub Med Coll Abbottabad 2017;29(4):533–4.
20. Savedoff WD, de Ferranti D, Smith AL, Fan V. Political and economic aspects of the transition to universal health coverage. Lancet 2012;380(9845):924-32. https://doi.org/10.1016/s0140-6736(12)61083-6
21. World Health Organization. Universal coverage - three dimensions . Accessed on: October 14, 2019. Available from URL: https://www.who.int/health_financing/strategy/dimensions/en/
22. Schnitzer P. How to Target Households in Adaptive Social Protection Systems? Evidence from Humanitarian and Development Approaches in Niger. J Dev Stud. 2019;55(sup1):75–90. http://dx.doi.org/10.1080/00220388.2019.1687877
23. GoKP and SLIC. Agreement between the Government of Khyber Pakhtunkhwa and the State Life Insurance Corporation of Pakistan. Peshawar; 2016. Accessed on: October 14, 2019. Available from URL: https://statelife.com.pk/index.php/component/content/article?id=377
24. Health Department Khyber Pakhtunkhwa. Hiring of insurance company: Request for proposoal (RFP). Peshawar; 2020. Accessed on: January 20, 2021. Available from URL: http://healthkp.gov.pk/news/view/15
25. Ministry of National Health Services Regulation and Coordination. Situation Analysis 2020 - Towards Universal Health Coverage in Pakistan [draft]. Islamabad; 2020.
26. Watkins DA, Jamison DT, Mills A, Atun R, Danforth K, Glassman A, et al. Universal health coverage and essential packages of care. In: D. T. Jamison, H. Gelband, S. Horton, P. Jha, R. Laxminarayan, C. N. Mock RN, editors. Disease Control Priorities. 3rd ed. Washington, DC: World Bank; 2017. p. 43-68.
27. Khan I. Twitter. Accesed on: August 22, 2020. Available from URL: https://twitter.com/ImranKhanPTI/status/1296475387552239620
28. Jamal S. Pakistan: Khyber Pakhtunkhwa becomes first province to introduce universal health coverage for all residents, Pakistan, Gulf News. Accessed on: August 22, 2022. Available from URL: https://gulfnews.com/world/asia/pakistan/pakistan-khyber-pakhtunkhwa-becomes-first-province-to-introduce-universal-health-coverage-for-all-residents-1.73333156
29. KP govt launches Sehat Sahulat programme for all residents of province, Dawn News. Accessed on August 22, 2020. Available from: https://www.dawn.com/news/1575463/kp-govt-launches-sehat-sahulat-programme-for-all-residents-of-province
30. Thiede M. Guiding document for the development of a roadmap towards achieving universal coverage. 2017. Accessed on: January 02, 2021. Available from URL: https://socialprotection.org/discover/publications/guiding-document-development-roadmap-towards-achieving-universal-health
31. World Health Organization and the World Bank. Tracking universal health coverage: 2017 global monitoring report. Geneva, Switzerland; 2017. Accessed on: January 02, 2021. Available from URL: https://apps.who.int/iris/bitstream/handle/10665/259817/9789241513555-eng.pdf
32. Lozano R, Fullman N, Mumford JE, Knight M, Barthelemy CM, Abbafati C, et al. Measuring universal health coverage based on an index of effective coverage of health services in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020;396(10258):1250-84. https://doi.org/10.1016/s0140-6736(20)30750-9
33. Government of Khyber Pakhtunkhwa Finance Department. Annual Budget Statement 2020-21. Peshawar; 2020. Accessed on: January 15, 2021. Available from URL: https://www.finance.gkp.pk/article/annual-budget-statement-2020-21
34. Finance Division; Government of Pakistan. Pakistan Economic Survey 2018-2019. Islamabad; 2019. Accessed on: August 22, 2020. Available from URL: https://www.finance.gov.pk/survey/chapters_19/Economic_Survey_2018_19.pdf
35. United Nations General Assembly. Political Declaration of the High-level Meeting on Universal Health Coverage, 2019, NewYork. Accessed on: August 22, 2020. Available from URL: https://www.un.org/pga/73/wp-content/uploads/sites/53/2019/05/UHC-Political-Declaration-zero-draft.pdf
36. Lagomarsino G, Garabrant A, Adyas A, Muga R, Otoo N. Moving towards universal health coverage: health insurance reforms in nine developing countries in Africa and Asia. Lancet 2012;380(9845):933–43. https://doi.org/10.1016/s0140-6736(12)61147-7
37. World Health Organization. The World Health Report 2010. Health systems financing: the path to universal coverage. Geneva; 2010. Accessed on: January 15, 2021. Available from URL: https://apps.who.int/iris/handle/10665/44371
38. World Health Organization. Financing for Universal Health Coverage: Dos and Don’ts [Internet]. 2019. Accessed on: January 15, 2021. Available from URL: https://p4h.world/en/node/8598
39. Campbell J. Towards universal health coverage: a health workforce fit for purpose and practice. Bull World Health Organ 2013;91(11):887-88. https://doi.org/10.2471/BLT.13.126698
40. Silfverberg DV. PhilHealth coverage in the informal sector: Identifying determinants of enrollment. Policy Notes 2016;2:1-6. Accesed on: January 10, 2021. Available from URL: https://think-asia.org/handle/11540/6441
41. White F. Primary health care and public health: foundations of universal health systems. Med Princ Pract 2015;24(2):103-16. https://doi.org/10.1159/000370197