Assessing readiness of health facilities for implementing a social health insurance programme in Khyber Pakhtunkhwa, Pakistan

Abstract

Objective: To assess the readiness of empanelled health facilities, encompassing secondary and tertiary care hospitals
under the SCP Programme, to effectively implement the benefits package.
Method: A cross-sectional survey was conducted in 38 public and private hospitals providing services under the SCP
Programme across 10 districts of KP. The study utilized a Health Facility Assessment tool adapted from WHO's Service
Availability Readiness Assessment and other frameworks. The readiness was measured across 8 domains including
Infrastructure, Governance, Health Information System, Infection Control, Sehat Card desk services, Billing & Reimbursement,
Clinical Services, and Clinical Support Services. Data was collected from October 2022 to February 2023.
Results: Based on our assessment, tertiary hospitals generally demonstrated a higher level of readiness compared to
secondary hospitals across various domains. Tertiary hospitals demonstrated better readiness for access and infrastructure
(92%), governance and leadership (97%) and infection prevention (79%). Secondary hospitals showed lower readiness
scores in areas like HMIS (65%), billing & reimbursements (75%), and infection control (64%). The tertiary facilities
outperformed secondary ones in clinical and support services, including emergency rooms, intensive care, surgery,
obstetrics, laboratory services, blood banks, radiology, and pharmaceutical services. The overall preparedness was
significantly higher in urban, relative to rural, hospitals across most indicators.
Conclusion: The study underscores the need for targeted capacity building in KP's health facilities, particularly secondary
and remote hospitals. These improvements are crucial for successful implementation and expansion of the SCP programme.
Keywords: Health Facility Readiness, Social Health Insurance, Sehat Card Plus Programme, Khyber Pakhtunkhwa, Health
Services Evaluation.