By launching the National Health Insurance Scheme (NHIS) recently, Pakistan has become the first country of South Asia where the poorest of the poor will get a unique health insurance. About 100 million people will be entitled to benefit from this scheme.

According to Prime Minster Nawaz , the health insurance programme was the only way forward to provide health care protection to economically deprived people of the society

Nawaz Sharif, while chairing the meeting to give in principle approval to launch the health insurance programme, said that the government would leave no stone unturned to provide health facilities to the needy despite financial difficulties.

Sharif said the programme will not only give the vulnerable sections of the society an access to cash free health facilities but will also help to develop and revolutionise the health infrastructure across Pakistan.

The prime minister further said the scheme will also increase public-private partnership in Pakistan and will open up further avenues for investment.

The scheme would be completely apolitical and would provide a blanket for cash free treatment to the poor people of Pakistan for major diseases like cardiovascular diseases, diabetes mellitus and complications, burns and RTA (life and limb saving treatment, implants, prosthesis), end stage renal diseases and dialysis, chronic infections (hepatitis), organ failure (hepatic, renal, cardiopulmonary) and cancer treatment.

Under the NHIS, the federal government would append the health insurance premium for the tertiary-level health cover in addition to the secondary insurance cover provided by the provinces.

Cashless and superior tertiary health insurance cover would be provided by the federal government to the poorest of the poor across the country which would eventually cover more than 100 million people for intricate surgeries and the cure of life threatening diseases at the district level public and private empanelled hospitals in a phased manner.

According to Maryam Nawaz, Chairperson Prime Minister Youth Programme (PMYP) who developed the scheme, “a health insurance programme is the only way forward to provide health care protection to economically deprived people of the society. The scheme is the first of its kind to introduce a grievance redressal system as well as social security safety net for the poor people of Pakistan"..

The meeting also decided to establish the first ever public sector human organ transplant centre in Islamabad.

The prime minister directed the Ministries of Finance and Health to coordinate and finalise the technical modalities and implementation strategy in minimum possible time so that an early relief could be given to the people.

Plaudits from WHO
World Health Organization (WHO) has hailed and pledged its support to the country’s first-ever National Health Insurance Scheme. The WHO’s Country Representative to Pakistan, Dr. Nima Saeed Abid offered the commitment and assurance for providing technical support to the unprecedented NHIS in Pakistan.

WHO, while appreciating the approval of the NHIS by the Prime Minister has said that Pakistan has fulfilled its commitment by undertaking concrete actions to realize Universal Health Care including the introduction and expansion of equitable and efficient prepayment arrangements to all population groups through the NHIS.

Challenges of Pak healthcare system
Pakistan's health care system is a three-tiered health care delivery system: primary, secondary and tertiary care. Health system strengthening Mechanism Starting at grass roots level, health houses provide community health care services through lady health worker and are connected to basic health units with an upward referral pathway to rural health centres, tehsil hospitals and district hospitals. There are also well-equipped tertiary level teaching hospitals.

However, this extensive health care infrastructure has not been translated into optimal health care delivery due to a number of issues related to the health system. This includes the poor motivation of the health workforce due to lack of good career structures and work environments, maldistribution of resources between urban and rural areas, and the lack of a national human resources for health policy.

Pakistan spends only 0.5 per cent of its gross domestic product (GDP) on health, which is very low. This leads to an inability of the government to provide the required medicine and laboratory support to health care delivery resulting in an out-of-pocket expenditure on health of around 80 per cent.

Health care in Pakistan is identified as one of the country’s most corrupt sectors, according to surveys by Transparency International. General surveys suggest the majority of Pakistanis are unhappy with the health services they are offered.

This is just one of the many challenges facing Pakistan’s health system, as identified in the first ever comprehensive assessment of the sector, published in the medical journal The Lancet last year.

Entitled Health Transitions in Pakistan, the series of articles says Pakistan’s health sector lags behind 12 countries in the region with cultural, economic and geographic similarities.

Pakistan has no national health insurance system and 78 per cent of the population pay health care expenses themselves. It is the only country in the world without a National Health Ministry.

The report authors say the recently elected government has a unique opportunity to push through reforms and take advantage of recent constitutional changes that devolve health care to the provinces.

The findings are not entirely negative. Progress has been made on all health indicators in the past 20 years. The rates of child deaths and maternal mortality have fallen, and the community-based Lady Health Workers programme is singled out for praise.

But improvements have been much slower coming than in other similar countries. According to IRIN the four major challenges from the health assessment include child and maternal mortality, lack of adequate nutrition,lifestyle diseases and low public spending

High child and maternal mortality
The assessment’s authors describe Pakistan’s progress towards meeting the Millennium Development Goals for reducing child and material mortality as “unsatisfactory”.

Pakistan, with its population of 180 million, has more child, foetal and maternal deaths than all but two of the world’s nations.

The report calls child survival “the most devastating and large-scale public health and humanitarian crisis Pakistan faces”.

An estimated 423,000 children under-five die each year, almost half of them new-born babies. Family planning options are also limited and nearly a million women attempt unsafe abortions each year.

Simple measures like training more nurses and midwives could save more than 200,000 women and child lives in 2015, the report’s authors say.

Lack of adequate nutrition
A lack of adequate nutrition for children contributes to the high number of child and maternal deaths. Nearly 40 percent of children under-five are underweight and more than half are affected by stunting. Poor nutrition weakens the body’s natural defence mechanisms.

But the report also says that malnutrition affects the Pakistani economy, with estimates that it costs the country three percent of GDP every year, particularly through reduced productivity in young adults.

Lifestyle diseases
In Pakistan, as more widely throughout South Asia, non-communicable diseases like cancer, diabetes and heart problems have replaced communicable diseases like malaria and diarrhoea in the past two decades as the leading causes of death and morbidity.

This general trend has not been matched by an adaptation in the Pakistani health system or government policy. Poor road safety, cheap cigarettes and high-levels of obesity (one in four adults) all lead to preventable deaths.

So-called “lifestyle diseases” could cost the country nearly US$300 million in 2025, according to the report’s authors.

They say the right government action, including higher excise taxes on cigarettes, new legislation, and information campaigns could cut the premature mortality rate from cardiovascular diseases, cancers, and respiratory diseases by 20 percent by 2025.

India offers help to eradicate polio
Offering a helping hand to Pakistan government in its fight against polio virus,

 India’s Minister for Health and Family Welfare Dr Harsh Vardhan recently said Pakistan could draw on the Indian experience and learn from the challenges that were faced while transforming India from a country with 60 per cent of the world’s polio cases to a certified polio-free nation.

“This particular model would stand Pakistan in good stead. Unless all stakeholders, most importantly its religious clergy, are involved, it would be impossible to achieve total polio eradication”, he added.

Dr Vardhan pointed out that though India was polio-free now, there was always the danger of the virus resurfacing as Pakistan accounts for 85 per cent of the world’s polio cases. He said it was imperative the two countries cooperated to permanently eliminate this threat.

“We have extended co-operation to Pakistan in the past as well. Prime Minister Nawaz Sharif has issued some reasonable statements about rooting it out and we want to assure him of our support,” Dr Vardhan said. Nawaz had announced a ‘National Emergency Action Plan-2014’ to take steps for polio eradication on a war footing.

“I have been through the plan and find that the script is perfect. Pakistan has resolved to set up monitoring cells at the grassroots.

They are also talking of involving social groups, a strategy which worked wonderfully in India,” the minister said.

The IMB report
In the meanwhile terming Pakistan’s polio eradication efforts ‘a disaster’, the Independent Monitoring Board (IMB) has recommended that the charge of wiping out the crippling virus be immediately handed over to the National Disaster Management Authority (NDMA).

In a report , the IMB – which independently assesses the progress of the Global Polio Eradication Initiative – put aside the Pakistan government’s claims of undertaking ‘all-out efforts’ to eradicate polio and noted that fewer children were being vaccinated in key areas of the country compared to two years ago.