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

Following the experience of many low- and middle-incomecountries (L&MICs),1 there has been a gradual transition inPakistan towards public sector financed health insurance,primarily for providing in-patients care. This change hasparticularly been seen in the provinces of Punjab and KP aswell as at the federal level.2 Historically, public sectorfinancing in health has predominantly relied on tax-basedfinancing in Pakistan.3 The health system has remainedchronically underfunded with public sector fundinghovering around 1% of the GDP and financing has largelyrelied on direct out of pocket (OOP) payment by thehouseholds.4Khyber Pakhtunkhwa (KP) province embarked on a healthinsurance reform in 2013, starting in four districts,targetting people living below poverty line as defined byBenazir Income Support Programme (BISP) criteria.5 In2015, it evolved into a flagship publicly funded socialhealth insurance scheme, Sehat Sahulat Programme,implemented through the State Life Insurance Corporation(SLIC), providing inpatient services, free at point of care, atempanelled hospitals. This was a move away from OOPpayments, and promised enhanced financial protection forthe beneficiary households.4 In April 2020, the KPgovernment extended the coverage to all households inthe province, irrespective of poverty status, and renamedit the Sehat Card Plus (SCP) programme. SCP claims toprovide an annual cover of up to PKR 1 million per familywith over 7 million enrolled households.5On the request of the KP government, the Aga KhanUniversity accepted to undertake an independentevaluation of the SCP in 2022-23, which comprised a threetieredassessment supported by GIZ.6 This special issue ofJPMA presents a series of 8 papers that summarize theresults of the SCP Programme evaluation. To the best of ourunderstanding this is the first comprehensive evaluation ofany health insurance programme in Pakistan. Continued...