Covering for the poor

Health care coverage is fast becoming the need of the hour

HEALTH care and education are universally recognised as essential needs, the provision of which is the basic responsibility of the state towards its citizens. The constitutions of most of the countries also recognise them as basic rights of the citizens, making the adequate provision of these facilities obligatory on the state, within its available resources. The Constitution of Pakistan, under article 25 A, also recognises free and compulsory education for the children of the age from 5 to 16 as a fundamental right, whereas Article 38 (d) - under the Principles of Policy – stipulates that “The state shall provide basic necessities of life, such as food, clothing, housing, education and medical relief for all such citizens, irrespective of sex, caste, creed or race, as are permanently or temporarily unable to earn their livelihood on account of infirmity, sickness or unemployment”. The Quaid, while delivering Presidential address to the Constituent Assembly of Pakistan on 11th August, 1947 said “Now if we want to make this great state of Pakistan happy and prosperous we should wholly and solely concentrate on the well-being of the people, especially of the masses and poor”.

Since the domain of the current discourse pertains basically to health cover and medical facilities, I would like to focus on Article 38 (d) (concerning health care for the poor), which obligates the government to take care of the poorer sections of society and promote their well being.

Unfortunately, with regards to percentage of GDP spent on health, Pakistan is amongst the lowest in the world. In the developed world the percentage of GDP spent on health care ranges between 1017.9 %. Pakistan is spending 2.2% of its GDP on health care - which is far less than what its regional neighbours spend. For example China, Afghanistan, India, Sri Lanka and Iran respectively spend 5.1%, 7.6 %, 4.1%, 2.9 % and 5.6 % of their GDPs on health care. This testifies to a most sordid reality: that, since independence, health care has invariably remained a low priority of all successive governments, which in turn adequately explains our inability to keep pace with other developing countries which attained independence roughly when we did.

Whatever public sector facilities have been created are poorly managed, and the standard of healthcare is abysmally low. This sector is also afflicted with all permeating corruption. As a result that the people are forced to depend on the private hospitals and private medical practitioners who have mushroomed during the last two decades and are fleecing the public at will without any check on their machinations. The result is that medical health care is fast growing out of reach for the common man, particularly the poorer sections of the society and those living in the far flung areas of the country.

Viewed in the back drop of the foregoing facts the National Health Insurance Scheme introduced by the PML-N government to provide health care to poorer sections of the society, is indeed a commendable step in conformity with its constitutional obligations and the command of the Quaid. The first phase of the scheme which envisages to issue health cards to poor families to enable them to have free treatment in the hospitals on the panel of the government, was launched on 31st December 2015 by the Prime Minister under which based on the data compiled by BISP 1.2 million families were to be brought under the new health care system in Punjab, Balochistan, FATA and AJK. Unfortunately Sindh and KPK government refused to join the scheme as they did not want to share the expenditure with the federal government as envisaged under the scheme. The scheme is the first of its kind purported to set up a system to address the grievances of the poor as well as to provide a social safety net for them. It is basically for the people with daily income of less than Rs 200. Under this scheme the families would be provided with health insurance cover of Rs. 50000 per family for secondary health annually and Rs. 300,000 for tertiary health respectively which will cover serious disease like heart attack, diabetes, burn injuries, kidney treatment excluding its transplant and cancer. The cost of secondary treatment will be borne by the provincial governments while the tertiary treatment would be the responsibility of the federal government. In case the cost of treatment exceeded Rs. 300,000 the excess expenditure will be borne by Bait ul Mal. The second phase of the scheme was launched by the Prime Minster on 22nd October at Rahim Yar Khan. Addressing the audience he revealed that the scheme aims to target 3.2 million families and under the first phase 0.39 million had already got themselves registered under the scheme.

It would be pertinent to recall that the financial bids to execute the three-year targeted free health insurance scheme were opened on 16 September in the presence of all the stake holders and the media after a thorough evaluation of the proposed scheme in the light of the criteria prescribed by Public Procurement Regulatory Authority, which was won by State Life Insurance on the basis of lowest bid, which incidentally was 50% less than the threshold envisaged by the government. The Insurance Company has been tasked to enroll the families, taking hospitals on the panel and providing health insurance services to the enrolled families.

The scheme as envisaged by the government on the face of it looks quite impressive, beyond reproach and an imaginative step towards providing health care to the deprived and poorest of the poor segment of the society and above all a tangible effort to fulfill the constitutional obligations of the state. Its success will largely depend on follow up actions in regards to monitoring of the implementation process and ensuring transparency in the selection of the deserving families. The government, nonetheless, deserves appreciation for the initiative.

The government is also under obligation to provide affordable health cover to other segments of the society. When its talks about public-private partnership in regards to investment in the health sector it must also make sure that the cost of health cover remains within the reach of the larger chunk of the population and the private hospitals are also properly regulated to plug the avenues of rip off.

The second phase of the scheme was launched by the Prime Minster on 22nd October at Rahim Yar Khan. Addressing the audience he revealed that the scheme aims to target 3.2 million families and under the first phase 0.39 million had already got themselves registered under the scheme. The Quaid, while delivering Presidential address to the Constituent Assembly of Pakistan on 11th August, 1947 said “Now if we want to make this great state of Pakistan happy and prosperous we should wholly and solely concentrate on the wellbeing of the people, especially of the masses and poor”.