When history looks back at Imran Khan’s tenure from 2018-2023, few initiatives will stand out more starkly than Khyber Pakhtunkhwa’s (KPK) Sehat Sahulat Health Insurance Program. By announcing the expansion of KPK’s flagship health system to all residents of the province, the provincial government has undertaken a revolutionary feat in the larger context of Pakistan’s history. However, to ensure that this program is implemented and sustained along global standards, it is important to compare it with similar health insurance programs currently operational in different countries. One nation that is renowned for providing this sort of service to its citizens is Canada. A comparison between the Sehat Sahulat Program in KPK and Canada’s Medicare would be highly useful in gauging the effectiveness of the former system. Using the metrics of population size, penetrability of the program and overall costs, a detailed analysis of both programs can be undertaken.
Firstly, the populations of both regions are comparable which allows an accurate method of analyzing the different elements of each program. Canada’s overall population of 37.59 million people is in the same ballpark as the 35.53 million residents of KPK allowing us to better assess each program from the get-go. With Canada’s GDP of $1.713 trillion vastly outweighing KPK’s of $27 billion, the quality of both programs would naturally be quite different. Taking into consideration both population sizes and their respective GDPs, the KPK government deserves all the accolades since they have prioritized healthcare when they could have implemented it at a later stage once the provincial GDP reaches a healthier level, as is the case with most welfare programs around the globe.
Canada’s Medicare system is a system of 13 provincial and territorial health insurance plans that come under the overall fiscal responsibility of the federal government. According to Canada’s constitution, the systems are administered by the provinces themselves while the guidelines are set by the federal government under the Canada Health Act of 1984. This Act constituted of 5 founding principles: “Firstly, public administration on a non-profit basis by a public authority; (b) comprehensiveness – provincial health plans must insure all services that are medically necessary; (c) universality – a guarantee that all residents in Canada must have access to public healthcare and insured services on uniform terms and conditions; (d) portability – residents must be covered while temporarily absent from their province of residence or from Canada; and (e) accessibility – insured persons must have reasonable and uniform access to insured health services, free of financial or other barriers.” These guiding principles are imperative in providing a far-reaching program that can penetrate all levels of Canadian society no matter the socio-economic background of the citizen.
Using the five principles that constitute the Canada Health Act of 1984, KPK’s Sehat Sahulat Program seems to tick off all the boxes required to considered as a bonified universal healthcare system. Firstly, this program is indeed rooted in the idea that is a public service constituted by the government and not a profit-making enterprise. Secondly, all medically necessary procedures are covered by the program. For example, a family can use up to 300,000 PKR for priority health services and 60,000 PKR for secondary health services with the remainder being ear-marked for emergency and life-threatening treatments. Thirdly, this program extends to all residents of KPK without any form of discriminatory procedures in place. Fourthly, residents are covered by the Sehat Sahulat program even if they are absent from their place of residence since applications can be submitted electronically. Lastly, financial and other socio-economic barriers have been removed to allow uniform access to healthcare for all residents of KPK as shown by the fact that all those living under the poverty line (earning less than $2 per day) are eligible. Thus, taking these metrics into account, one can surmise that KPK’s Sehat Sahulat Program and Canada’s Medicare are formulated on the same foundations thereby better positioning the former for success.
However, healthcare in Canada is not free by any means. According to a recent study by the Fraser Institute in 2018, the average annual cost per citizen to bank-roll Medicare amounted to $4640 which was collected through federal taxes.
In the case of KPK’s Sehat Sahulat program, the funds for this are raised through provincial taxes thus giving the federal government far less administrative control over financing the program. This healthcare system is administered a little differently than Medicare in Canada in the sense that it is administered through the State Life Insurance Corporation (SLIC) in Pakistan with funding from the provincial government. The government, through taxpayers’ funds, pays a premium to SLIC to cover all eligible families of the province. If a family does not claim any health expenses for that fiscal year, 90% of the government-paid premiums are reimbursed back into the national exchequer. Therefore, while the funding for this program in KPK comes from the taxpayer’s pocket, the federal government has less oversight and administrative control than their counterpart in Ottawa.
Having compared both programs, it is pertinent to mention that both countries have the enviable tag of being the only nations in their continent, or sub-continent in the case of Pakistan, to have implemented universal healthcare in their societies. In Pakistan’s case it is limited to one province however the following map reflects the fact that Pakistan has been able to put in place a universal healthcare system that reaches the highest number of people in the region since Sri Lanka too has achieved this feat but with a lower population of around 20 million people:
Map of South Asian Countries that have some sort of universal healthcare in place:
Source: Tramcomic – from Pharexia – https://commons.wikimedia.org/wiki/File:Universal_Healthcare_by_Country_20191229.svg
With a pandemic raging, geopolitical battle-lines being drawn, an economic depression looming and the effects of climate change becoming ever starker, initiatives such as the Sehat Sahulat Program implemented by the PTI-led government are even more revolutionary. In a world that is increasingly indifferent to the plight of the downtrodden, Imran Khan’s war against inequality can act as a guiding light for other nations in the region and beyond. Rather than facilitate a world in which Pakistanis flee the nation for a better quality of life, KPK’s universal healthcare program is one major step in providing alternatives to the people of Pakistan. Alternatives that allow them to live a life of dignity, respect and productivity.