SEHAT SAHULAT PROG

2. PRIVATE OUT OF
POCKET
PRIVATE POOLED
PRIVATE OUT OF
POCKET
PRIVATE OUT OF
POCKET
GOVERNMENT
PRIVATE POOLED
PRIVATE POOLED
GOVERNMENT
GOVERNMENT
LOW INCOME
COUNTRIES
(GNI 1035 US $ per
MIDDLE INCOME COUNTRIES
(GNI 1036 -12616 US $ per capita/year
HIGH INCOME COUNTRIES
(GNI above 12616 - US $ per
capita/year)
GLOBAL FINANCING OF HEALTH CARE

3. HIGH INCOME COUNTRIES
LOW AND MIDDLE
INCOME COUNTRIES
HIGH INCOME COUNTRIES
GLOBAL HEALTH
SPENDING
GLOBAL DISEASE
BURDEN
LOW AND MIDDLE
INCOME COUNTRIES

4.  Article 38 of the Constitution of Islamic Republic of
Pakistan
 Pakistan is a signatory of SDGs
 Goal 3 Target 8 of SDGs - Universal Health Coverage
 Country Vision – To improve the health of all Pakistanis,
particularly women and children by providing Universal
Access to affordable, quality, essential health services
through a responsive health system
 Health Policy Outcome 5- Enhanced Health Financing
for efficient service delivery & Financial Risk Protection
for people of KP

6.  Brand Name of the Programme
 Slogan
 Logo
 Districts of Implementation
 All districts of the province

8. 1
Phase I
(KfW assisted)
• 16th December 2015
2
Phase II
• 31st August 2016
3
Phase III
• 30th November
2017
• 12th January 2018
– Inclusion of
Transgenders
4
Phase IV
• 20th August
2020-
Coverage of
all population

9. PHASE PMT SCORE
TARGETED
HOUSEHOLDS/FAMILIES
% OF POPULATION
PHASE I 16.17 100,000
3 %
(4 districts only)
PHASE II 24.51
1,791,930
(Including Phase I)
51%
(All districts)
PHASE III 32.50
2,461,114 (3,200,000)
(Including Phase I & II)
64%
(All districts)
PHASE IV NA 3,845,168 (6,059,023) 100%
Merged
Districts
NA 1,211,420 100%

10. PHASE I PHASE II PHASE III PHASE IV
3%
51%
64%
100%
97%
49%
36%
0%
POPULATION COVERED POPULATION REMAINING

11.  Goal: To incrementally achieve Universal Health
Coverage by enhancing access of the poorest
population of the province to quality healthcare
services
 Objectives:
 Reduction of out of pocket payment
 Improve the quality of healthcare services
 Enhance stewardship role of Department of
Health

12.  It is a Health Insurance Programme, implemented
by State Life Insurance Corporation of Pakistan.
 Period of contract is 5 years starting from 1st July
2020.
 More than 6.5 million families of KP would get free
inpatient healthcare services.
 Annual cost of the programme is approximately 18
billion.
 Services will be provided through a network of
Public and Private Hospitals.

13. DOH
Regulation
INSURANCE
COMPANY
Purchasing
HOSPITAL
Provision of
Healthcare
Services
PEOPLE OF
KP
Beneficiaries

14.  Oversight of the programme.
 Payment of premium.
 Provision of data of beneficiaries.
 Approval of recommended service providers.
 Monitoring & Evaluation.

15.  Establishment of required offices and recruitment of
necessary staff.
 Establishment of Central Management Information
System (CMIS).
 Enrollment of beneficiaries.
 Assessment and Empanelment of hospitals
 Service provision through empanelled Hospitals.
 Awareness of beneficiaries and distribution of
necessary documents.
 Grievance redressal.

16. Facilitation
Disk
In
Empaneled
Hospitals
PATIENT
DISCHARGED
DIDICATED FILTER CLINIC
ADMISSION
&
TREATMENT SPECIALIST OPD
FACILITATION DESK
IN HOSPITAL
PATIENT
DEDUCTION
FROM
THE
ACOUNT
OF
USER
PMU AT
PESHAWAR
PROVINCIAL
OFFICE OF
SLIC

17.  Previously beneficiaries were targeted on the basis
of BISP Poverty Score Card.
 In 2012 BISP conducted door to door survey to
determine the poverty status of the people.
 Based on proxy indicators all the households are
given a poverty score which is called Proxy Mean
Testing (PMT) score.
 PMT score starts at zero and reaches to 100.
Lowest is the PMT, poorest is the family.
 There are two cut off lines at PMT 16.17 (poorest
of the poor) and PMT 32.49 (poor).
 Average income of Households at PMT score 16.17
or below is $ 1 per day and at PMT 32.50 or below
it is $ 2 per day per household

18. 0
16.17
32.5
50
100
0.2
21
60
85
100
0
10
20
30
40
50
60
70
80
90
100
110
PMT Score
Population%

19. Premium
Rs. 2849/-
(+ Rs. 40)
per
Family/Yea
r
Secondary care
Package
Rs. 200,000/Family
(40,000/member)
Tertiary care Package
Rs. 400,000/Family
(+ R. 400,000)
85 % of unutilized
premium to be
returned

20. Maternity
Transportati
on
Rs. 1,000
Tertiary care
Transportati
on
Rs. 2,000
Burial
Rs. 10,000

21. Secondary Care Services
 All the secondary health care services normally provided at
secondary level private and public sector hospitals
including DHQ and THQ hospitals
 The services may include but not limited to:
 Accidents and emergencies
 General Medicine
 General Surgery
 Orthopedics
 Gynae and Obstetrics
 Paediatrics
 Ophthalmology and
 ENT etc.

22. Tertiary Care Services
 Accident and Emergency (All the medical/surgical
emergency care which can’t be provided in secondary care
hospitals)
 Cardiovascular problems
 Complications of Diabetes
 Management of all type of Cancers
 Management of Genito-urinary diseases including Dialysis
and Transplant
 Management of Neurosurgical diseases
 Complications of secondary care diseases/procedures
needing referral to tertiary care hospitals
 Artificial limbs (Prosthetics)
 Breast Cancer Screening

23. DISTRICT NAME TOTAL FAMILIES
Peshawar 625,476
Swat 508,008
Mardan 472,733
Mansehra 444,394
Abbottabad 367,977
Swabi 353,145
Charsadda 328,727
Nowshera 270,024
D.I. Khan 268,477
Haripur 261,850
Lower Dir 261,041
Bannu 217,004
Kohat 208,647
DISTRICT NAME TOTAL FAMILIES
Upper Dir 184,176
Buner 183,032
Shangla 163,649
Karak 157,698
Lakki Marwat 149,997
Malakand 145,359
Battagram 121,455
Hangu 110,869
Chitral 97,783
Kohistan 69,657
Tank 68,239
Torghar 19,606
TOTAL 6,059,023

24. Implementation Capacity
Advocacy and Public Information Campaigns
Ensuring sustainability of the initiative
Outpatient benefit