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What will make national health insurance scheme a success story?

In the third world country like Pakistan, no one can deny the importance of health insurance scheme for the poor and down-trodden sections of society who cannot afford costly treatment for deadly diseases like cancer. Most of third world countries have started health insurance programmes on the recommendation of the World Health Organization (WHO). About 55 percent of Pakistanis earn less than $2 a day and the present government has decided to provide health insurance cover to all such people in phases and the data of the Benazir Income Support Programme will be used for the purpose. Last year, former Prime Minister Nawaz Sharif launched health insurance scheme for the people in different parts of the country including Islamabad, Quetta, Gilgit Baltistan Muzaffarabad, Rahim Yar Khan, Narowal, Khanewal and Sargodha. The scheme had been launched in 15 districts of Islamabad in the first phase and will be expanded to 23 districts in the second phase. Around 1.2 million families will get free healthcare facilities in the first phase. The people of Sindh and Khyber Pakhtunkhwa will however not benefit from the initiative because their governments have declined to become part of the federal government programme.

The wider coverage of poor sections of society under health insurance scheme will be a great step towards making the country a welfare state. Under the scheme, people living below the poverty line would be able to get best possible treatment at government’s expense. Under the programme, the treatment of cancer, heart disease accidents, burns and other chronic disorders will be insured under the priority diseases category. According to one estimate, each family will get treatment of Rs300,000 per year and the amount will be doubled in case of emergency. The programme would benefit 3.2 million families living in Punjab, Balochistan and FATA in its two phases and a social mobilization campaign would be launched to ensure registration of all deserving people under the scheme. Similarly, the ‘education for all’ type of schemes can contribute a lot to make Pakistan a welfare state.

No doubt, the National Health Program is a milestone towards social welfare reforms. It ensures poor and under-privileged citizens across the country get access to their entitled medical health care in a swift and dignified manner without any financial obligations. The program offers free of cost treatment for ailments such as cardiovascular diseases, Diabetes Mellitus, Burma and RTA (life and limb saving treatment, implants, prosthesis). Under the programme health care cards will be issued to the beneficiaries on which they will get free medical treatment of seven diseases. Around 63,000 people will be issued health cards through 300 centers in Islamabad and Lahore which have initially been established for the distribution of health cards. Every card holder will be able to avail health facilities worth Rs0.3 million per year.

Though health sector remained the focus of welfare programs launched by every government in the past, but the leakage, misuse of public funds and irregularities in this sector caused no relief to the people in the most backward province. The government hospitals remain as the only option for the poor and downtrodden segments of society, who are compelled to face the arrogant behavior of the hospital staff, as they cannot afford the high expenses of private treatment and costly medication. There have been wide complaints about the shortage of medicines at the government hospitals and the poor patients have to purchase the costly medicines from the market.

The non-availability of medical staff, medicines and necessary facilities is the tragedy of the government hospitals in different districts of the country. Most of the doctors serving in the Government hospitals have their private clinics as part time job. They earn a handsome amount as checkup fee at their clinics. Most of these doctors do not pay due attention to the patients who come to them in hospitals for treatment. There have been public complaints about shortage of drugs in government hospitals, lack of public health facilities, questionable doctor’s behavior with poor patients, and duty dereliction and absence of staff. The public complaints about dispensation of substandard medicines to the patients in government hospitals are common. Medicine Store Depot (MSD) provides the medicines of low standard companies. The purchased medicines are dumped in the go-downs and disposed of at a time when the medicines are about to expire. There is no doubt that most of the time medicines expire in these go-downs and are not delivered for the poor patients in the government hospitals in time.

Ironically, most of the public sector hospitals do not even qualify for the health insurance scheme and ultimately the government will have to rely on private hospitals if it wants to make the scheme a success story. There are many doctors who have opened their private hospitals where the patients are treated as scapegoats in accordance with their financial positions. The patients are looted through high room-charges at these hospitals. It has been observed that doctors unnecessarily recommend the patients to be admitted at the hospital for earning a healthy amount in the form of room charges and other services.

The government must focus on setting up the state of the art hospitals across the country or at least upgrade and improve the existing public health infrastructure in the best interest of the lower and middle class families, who cannot afford costly treatment at private hospitals for the deadly diseases. There is a dire need for launching the up-gradation projects in public health sector in order to equip the government hospitals with all the necessary facilities and qualified medical staff. No national health insurance scheme can succeed without improving the state of hospitals and health care centers in public health sector.

The PML-(N) government has paid more focus on road infrastructure in last four years instead of on human development. It launched billions of rupees road and energy projects across the country. On the other hand, poor state of government hospitals and educational institutions continues to create problems for the poor. The infrastructural projects however must go together with the human development projects. The funds allocated for infrastructure development do not match the meager amount allocated for human development. Ironically, a mega development process is underway in the country, while the citizens are still deprived of the quality health facilities in the public sector.

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