Utilisation Challenges of Public Health Insurance Initiatives: Evidences from Sehat Sahulat Programme (SSP) in Pakistan
Authors: Nayab Durr-e , Farooq Shujaat , Kunwal Nabila 
Published: July 2024

EXECUTIVE SUMMARY
Healthcare utilisation largely depends on both demand and supply-side factors. On the supply side, health infrastructure could be better to serve the population’s needs, whereas, on the demand side, affordability is the main challenge, especially for poor households. Health insurance provides an opportunity to avail of decent health facilities. The government of Pakistan launched the Sehat Sahulat Programme (SSP) to provide equitable and affordable indoor health services through public-driven health insurance.
The current study has analysed the SSP by focusing on the factors that may reduce the in-door utilisation of health services. Besides secondary analysis, we have managed the qualitative and quantitative field survey by conducting in-depth interviews with all the supply and demand side stakeholders. A household survey is also carried out with the beneficiaries.
Our analysis found that the programme has been facing the issues of lower utilisation due to various factors, including lack of awareness and a limited number of empanel hospitals. In some districts, there is only one hospital to cater to the needs of 73,000 families. The programme also requires focus to ensure 100 percent enrolment of all the eligible families, as in study districts, the pending cases range from 22 percent to 74 percent, with an average of 39 percent. Around 7 percent of the inpatients are deprived of seeking indoor treatment, either due to lack of hospital or lack of facility in the hospital or denial of services by the empanel hospital.
The programme requires improving the environment of the empanel hospital by ensuring the availability of communication material, the 24/7 presence of a front desk person (HFO), and the availability of the operational manual. On the demand side, we found that most beneficiaries need more proper knowledge about various programme features, including where they should go for treatment, package amount, type of treatment covered in the package, and whom to contact for information.
Despite the low utilisation rate, a heartening element is the high satisfaction level of the beneficiaries who had received treatment. As a way forward, we recommend the following:
First, the programme may ensure every citizen receives in-door health treatment by improving accessibility and availability of health services and easing the documentation requirement.
Second, there must be a sufficient number of empanel hospitals, and offered packages against a treatment must be attractive to avoid the ‘pick and choose’ option by the hospitals. The entire government health infrastructure must be on the pool of SSP. It should be mandatory that all private hospitals be a part of the SSP.
Third, the authorities must ensure that HFOs should be available in hospitals 24/7. The hospital list should be publicly available through various sources, including the website and dedicated SMS service. Moreover, the programme should introduce some Android applications to find the nearest hospital to a patient.
Fourth, there is a need for a grassroots-level communication strategy, especially in districts where the programme is universal. The key messages must be disseminated at the doorsteps of beneficiaries. For this, the programme may involve local notables, education and health departments, and other social safety net departments having a ground-level presence (i.e., BISP, Zakat, Pakistan Bait-ul-Mal, and various provincial social protection/security authorities). Overall, the communication strategy must be heterogeneous, considering the population’s needs.