Sehat sahulat: A social health justice policy leaving no one behind

Elsevier, The Lancet Regional Health - Southeast Asia, Volume 7, December 2022, 100079
Rebecca Forman, Faiza Ambreen, Syed Shakhar Ahmed Shah, Elias Mossialos, Khurram Nasir

The World Health Organization states “[Universal Health Coverage] UHC means that all individuals and communities receive the health services they need without suffering financial hardship.”1 In Pakistan, where it is well-documented that healthcare expenditures are responsible for aggravating economic shock in poor families (see Box 1), the room for population health improvements is clear.2,3 In recent years, Pakistan has joined the likes of emerging markets in pushing towards UHC.4 While simultaneously grappling with the COVID-19 pandemic, since late 2020 the Khyber Pakhtunkhwa (KPK) province expanded coverage for all its 30.5 million residents5 for inpatient care up to 1 million Rs per family each year in over 500 public and private hospitals across the country through its Sehat Sahulat program (SSP).6 The program, first adopted by the provincial government in 2016 to cover its population living below the poverty line, aims to transform healthcare in the country and progress towards UHC in recognition of the importance of health and wellbeing to the functioning of society. Former Pakistani Prime Minister Imran Khan commended the SSP, and efforts to expand healthcare coverage for residents of other provinces, including Islamabad Capital Territory (ICT), Punjab, Azad Jammu Kashmir (AJK), Gilgit Baltistan (GB), and Tharparkar-Sidh are underway.7 Endeavors to improve coverage in the region are laudable, and have helped segments of the population in getting the care they need: as of 1 July 2022, 35,866,110 families had been enrolled under the program and 4,392,734 hospital visits had been covered since the SSP's establishment.7 However, coupled with the successes of the program, there are a number of challenges that have arisen – especially with the change in administration in Pakistan in April 2022.8 In this commentary, we aim to outline both the progress of the program thus far and the opportunities for improvement in the future; in particular, we ask whether the benefit package can better set the foundation towards UHC?