Social health insurance: can we ever make a case for Pakistan

Social Health Insurance has been used as an approach to increase efficiency of healthcare system and consumer satisfaction in provision of healthcare services. Many developed countries have successfully planned and implemented insurance models which provide almost universal coverage and addresses issues of equity. The phenomenon is established however, developing countries especially Eastern Mediterranean region is still struggling to present one successful model of social health insurance which can be compared with European or Scandinavian countries. Pakistan likewise faces huge challenges in public sector healthcare provision and considerable proportion of population prefers to go to private sector. Quality of care, access and rising costs make healthcare, somehow, a luxury. Rising national economy, political will to carry out health sector reforms and the creation of district health system after devolution presents an opportunity to launch at least some pilot initiatives of social health insurance. This will give us some food for thought to further up scale and replicate the model all over the country

ICPD to MDGs: Missing links and common grounds

The ICPD agenda of reproductive health was declared as the most comprehensive one, which had actually broadened the spectrum of reproductive health and drove the states to embark upon initiatives to improve reproductive health status of their populations. However, like all other countries, Pakistan also seems to have shifted focus of its policies and programs towards achieving MDGs. As a result, concepts highlighted in the ICPD got dropped eventually. In spite of specific goals on maternal and child mortalities in MDGs and all the investment and policy shift, Pakistan has still one of the highest maternal mortality ratios among developing countries. Lack of synchronized efforts, sector wide approaches, inter-sectoral collaboration, and moreover, the unmet need for family planning, unsafe abortions, low literacy rate and dearth of women empowerment are the main reasons. Being a signatory of both of the international agendas (ICPD and MDGs), Pakistan needed to articulate its policies to keep the balance between the two agendas. There are, however, certainly some common grounds which have been experimented by various countries and we can learn lessons from those best practices. An inter-sectoral cooperation and sector wide approaches would be required to achieve such ambitious goals set out in ICPD-Program of Action while working towards MDGs. There is a need of increasing resource allocation, strengthening primary health care services and emergency obstetric care and motivating the human resource employed in health sector by good governance. These endeavors should lead to formulate evidence based national policies, reproductive health services which are affordable, accessible and culturally acceptable and finally a responsive health system