State Life Insurance Corporation (SLIC) - the largest life insurance company in the country - will be awarded the contract of multi-billion rupees Prime Minister's National Health Insurance Programme. However, the Minister of State for National Health Services, Sara Afzal Tarar, has sounded a note of caution. According to her, the `flagship programme' of the PML(N) government must not meet the fate of Waseela-e-Sehat programme of Benazir Income Support Programme (BISP). Further, she has attributed the failure to SLIC's modest capacity and asked for its enhancement. We, however, differ with the junior minister's judgement: SLIC alone did not contribute to its failure. Waseela-e-Sehat programme failed because opposing politicians wanted it to fail. There was the PPP-led government at the centre and a PML(N)-led government in the Punjab. The Punjab government wanted the programme to fail so that the credit for its success should not go to People's Party since the BISP was led by PPP's Farzana Raja. The government-owned and managed hospitals in Faisalabad did not participate in the model pilot project awarded to SLIC, forcing BISP to seek participation and help from private sector-owned hospitals; so the failure can be attributed to political ambitions overriding economic and social concerns for the weak and disadvantaged. SLIC now has trained manpower, a proper computer programme and has also gained some experience. And, with government's full support can hopefully do a better job than what it did last time with regard to a model pilot programme under Waseela-e-Sehat.
The State Minister is right in saying that 50 percent of the people of Pakistan are poor because of health issues and hoped 3.1 million families in 23 districts having income of less than Rs 200 per day would be provided with health coverage. We pray the officialdom finds success as monitoring or keeping a tab on outpatients is extremely difficult. SLIC does have countrywide coverage and its staff have obtained training in Berlin, Germany. How much of Europe's universal health schemes can be replicated in Pakistan is yet to be tested. The country's Privatisation in-charge, Mohammad Zubair, who co-chairs the National Steering Committee of the Health Insurance Programme, has rightly observed that success of the Programme is on the ability of the insurance company to deliver. SLIC has to identify around 10 million individuals earning less than Rs 200 per day in 23 districts using BISP's assessment data of poor and needy. The programme was aided by the World Bank. These poor families will be entitled to Rs 500,000 per year in secondary health services. And Rs 250,000 against seven serious diseases including cardiovascular ailments, diabetes, burn injuries, kidney treatment excluding its transplant and cancer. It is envisaged that the federal government will bear the cost of tertiary care while the provincial authorities will fund the secondary care.
There will be a comparative advantage this time as well because PML(N) is in power both in Islamabad and Lahore. Thus, public hospitals in Punjab may be ordered this time to fully participate in this seemingly noble venture. But PPP has its government in Sindh and PTI in KPK - thus, the success of the Prime Minister's National Health Scheme would depend on the attitude of these two parties. We pray and hope they would cooperate in districts identified by them for sake of the poor. There is technical help available from German Development Co-operation and the World Health Organisation. But the programme's overall fate is dependent on the local people. Obviously, SLIC can offer better rates (Rs 1300 per family) - much less than the private sector's best offer of Rs 2449 per family. The motives for the objective between public and private sector are different. SLIC representative at the bidding process said his Corporation has made an offer on `no-profit no-loss' basis. Expecting the private sector to do the same is being unrealistic. However, SLIC now needs to be as efficient as the private sector in its coverage of the poor. That would be the real test. Support for political ambitions without efficiency on the part of SLIC may backfire. There will be leakages and corruption but the system needs to minimise them. There has to be a check on certificates and bills issued. But a commission or speed money reimbursement needs to be avoided.