Fixing health

It is far too early to predict national health insurance programme's success or otherwise — but we wish it good health

As a nation, Pakistan is in chronic poor health. Primary healthcare services delivered by the state or provincially, fall far below the needs of the populations they serve, and private healthcare is the first port of call for those who can afford it. Many millions cannot. Rural areas are particularly poorly served (as they are with every other public amenity). Thus we welcome the rollout of a national health insurance programme that will target the poorest of the poor, those living on $2 a day or less which is around 60 per cent of the population — at the same time recognising that this is a very small beginning.



Initially, the scheme will cover around three million families who will get health insurance in 23 districts, and the ultimate goal is to cover 22 million households countrywide. There are already subsidies for healthcare in many public hospitals, but health professionals acknowledge that patient loads are often beyond capacity and even modest public health targets cannot be met. The government has already admitted that it has missed by a mile the UN targets for mother and child mortality rates that were part of the Millennium Development Goals that culminated in 2015. The reasons for the failure stem from poor service management and abysmally low spending on health services generally. Between July 2014 and March 2015, the government spent a miserly 0.42 per cent of GDP on health.

On a possibly positive note, the scheme is to spread across both the public and private sectors and will be run in partnership with provincial governments, an arrangement that is as yet untested. Elsewhere in the world, public and private healthcare rarely form synergetic relationships, the American healthcare system being an example of that. That said, something is better that almost nothing and any programme that expands the envelope of public healthcare has to be positive. None of this is going to happen at the flick of a switch and the system will take time to come on stream and it is far too early to predict its success or otherwise — but we wish it good health.

Published in The Express Tribune, January 2^nd, 2016.

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