Health insurance for the poor

Prime Minister Nawaz Sharif launched the first-ever public sector health insurance programme for the poor on Thursday, describing it as a first step towards making Pakistan a welfare state. It is to be implemented in two phases starting with Islamabad and later expanding to Punjab, Baluchistan and Fata, and headed most probably by the Prime Minister's daughter, Maryam Nawaz, whom he gave credit at the launch ceremony for her efforts alongside Minister of State for National Health Services (NHS), Saira Afzal Tarar. The insurance scheme is to cover a wide range from child delivery to treatment of 'priority diseases' like cancer, accidents, burns, heart bypass and infectious diseases. Each family would be entitled to treatment worth Rs 300,000 per year, and in the case of emergency additional money is to come from the Baitul Maal to double the amount.
The scheme can only be welcomed in a country where there is no social security net for the poor. Even white collar families ill-afford treatment for serious ailments. As the PM noted, people sell their properties or other valuables for the treatment of their loved ones. The government is already supposed to provide free medical service to patients from disadvantaged families, but there are not enough government-run hospitals, and the existing ones are too crowded to tend to all the needy. It is good to note therefore that under the insurance programme people living below the poverty line will be able to receive treatment in public hospitals as well as private medical facilities. Considering that such benefits are usually misappropriated by undeserving people, NHS is to identify deserving families using data from the Benazir Income Support Programme. And a separate monitoring system is to ensure transparency.
On the face of it, the scheme looks great. But the two provinces ruled by parties other than the PM's own Nawaz League have refused to join in. Cynics too may have their reservations about the motive behind the initiative in view of the fact that Maryam Nawaz is seen managing important federal initiatives like the recently launched education reform programme for Islamabad and now the health insurance scheme - apparently, aimed at building her public image. For Sindh and Khyber Pakhtunkhwa though the obvious reason to refuse becoming part of the health insurance scheme is that post the 18th Amendment, health is exclusively a provincial subject. Any interference in provincial affairs is unwelcome, which is perfectly understandable. But these governments ought to introduce their own plans to fulfil their respective responsibilities for the provision of health cover to all. They need also to apply the devolution idea to the newly-elected local governments, which in fact are best placed to address basic health issues. In particular, this third tier of government has an important role to play in the field of preventive health. Considering the rising incidence of life threatening but preventable diseases local governments must be empowered to act as the first line of defence.