The Constitution of Pakistan lays down that it is the responsibility of the state to provide for the basic needs of the people, especially in the sectors of health and education. But successive governments in Pakistan failed to carry out this constitutional obligation. Some half-hearted attempts were made in the past to provide health care services to the people but they were not successful.

Health is an important component of the Sustainable Development Goals (SDGs). The SDG 3.8 specifically aims to “achieve universal health coverage, including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all.” Pakistan lags on all the sustainable development goals except climate action and environment. The situation has further deteriorated during the last two years amid the global pandemic.

In fulfilment of its promise to turn Pakistan into a welfare state, the PTI government has launched a number of initiatives, including a substantial increase in the health budget. The health budget has been increased from Rs169 billion to Rs399 billion by the PTI government. A huge sum has been allocated for the health sector in Punjab for the first time as eight mother-and-child hospitals are being completed in Lahore and backward districts. Multan Nishtar-II, DG Khan Institute of Cardiology, Institute of Urology in Rawalpindi, Shaikh Zayed Hospital-II in Rahim Yar Khan and dental colleges are being built in Rawalpindi and Bahawalpur. Similarly, a new 1,000-bed hospital in Lahore is planned along with the construction of new emergencies in three hospitals having the capacity of 400-beds.

As part of its vision to make Pakistan a welfare state, the federal government has now launched the Sehat Sahulat Programme whose main feature is a Sehat Card which is a combination of health coverage and micro health insurance scheme. The concept of Sehat Card was first implemented in KP in 2020, and after its success, it was announced by the Prime Minister to be implemented across Punjab.

The Sehat Card provides critical healthcare cover worth up to 1 million rupees per family per year and it has 100 per cent coverage in Khyber Pakhtunkhwa province since late 2020. It has quickly grown in popularity and is now being used by one-in-12 families there.

The State Life Insurance Corporation has been selected as the principal health insurance provider. After covering over 6-7 million families in KP, the health card will now be covering over 30 million families in Punjab by March 2022. Other provinces are also expected to be added soon to the programme.

Prime Minister Imran Khan, while launching the Naya Pakistan Sehat Card scheme in Lahore, said, “This is a defining moment towards our course to make Pakistan a welfare state.” The scheme’s architects claim it has the power to quickly transform healthcare in a country which has long lagged behind other developing nations.

According to media reports, patients using the scheme say that it has delivered them from the worry of medical debt, where serious illness often means having to sell land or livestock, or take loans to pay for medicines and doctors’ fees. Previously, it was very frustrating for children and adults, who did not have enough money to pay and the government did not have the resources to fund public hospitals. Families out of desperation would end up selling their land or cattle or home to be able to afford emergency surgeries and they would go deeper into poverty. Economically, they were ruined. Against this background, the Sehat card has come as a great savior for the poor families.

There is no doubt that the provision of free medical service is a historic initiative of the PTI government but the key question is whether the scheme can be sustained in the long run. There are public-private sector models with varying degrees of state participation for providing free healthcare facilities at the point of delivery. In Western countries, the principle of providing free health facilities to all is well established though the extent of private sector healthcare providers’ participation varies from country to country. The US, Japan and other Asian countries have evolved their unique systems to suit their conditions.

In 2019, an actuarial analysis of the Sehat Sahulat Card was commissioned by the GIZ undertaken jointly with the International Labour Organisation’s Impact Insurance, a facility that enables insurance companies, governments and partners to embrace impact insurance to reduce households’ vulnerability.

Experts have pointed out that the government should seek support from the taxpayers for this programme or else there is danger that like the massive rise in outlay on pensions with no contribution from the employees this commendable programme too may become unsustainable, requiring the government to borrow ever larger amounts to pay for it. Such a slippage must be avoided at all cost.