Transitioning to social health insurance in Pakistan: The experience of Sehat Card Plus in Khyber Pakhtunkhwa province

Abstract

Following the experience of many low- and middle-income
countries (L&MICs),¹ there has been a gradual transition in
Pakistan towards public sector financed health insurance,
primarily for providing in-patients care. This change has
particularly been seen in the provinces of Punjab and KP as
well as at the federal level.² Historically, public sector
financing in health has predominantly relied on tax-based
financing in Pakistan.³ The health system has remained
chronically underfunded with public sector funding
hovering around 1% of the GDP and financing has largely
relied on direct out of pocket (OOP) payment by the
households.⁴
Khyber Pakhtunkhwa (KP) province embarked on a health
insurance reform in 2013, starting in four districts,
targetting people living below poverty line as defined by
Benazir Income Support Programme (BISP) criteria.⁵ In
2015, it evolved into a flagship publicly funded social
health insurance scheme, Sehat Sahulat Programme,
implemented through the State Life Insurance Corporation
(SLIC), providing inpatient services, free at point of care, at
empanelled hospitals. This was a move away from OOP
payments, and promised enhanced financial protection for
the beneficiary households.⁴ In April 2020, the KP
government extended the coverage to all households in
the province, irrespective of poverty status, and renamed
it the Sehat Card Plus (SCP) programme. SCP claims to
provide an annual cover of up to PKR 1 million per family
with over 7 million enrolled households.⁵
On the request of the KP government, the Aga Khan
University accepted to undertake an independent
evaluation of the SCP in 2022-23, which comprised a threetiered
assessment supported by GIZ.6 This special issue of
JPMA presents a series of 8 papers that summarize the
results of the SCP Programme evaluation. To the best of our
understanding this is the first comprehensive evaluation of
any health insurance programme in Pakistan.

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