POLITICAL ARCHITECTURE AND LEGAL FRAMEWORK RELATED TO SOCIAL HEALTH PROTECTION SCHEMES IN PAKISTAN: QUALITATIVE INQUIRY OF POLICY MAKERS’ VIEWPOINT
AbstractBackground: Pakistan is a federal state with three tiers of government. Following contentious general elections in 2013, ever first democratic transition took place in Pakistan. Subsequently, two social health protection schemes were launched. Current paper’s objective is to understand the political context in which these schemes were launched and to explore the constitutional position of access to healthcare in Pakistan. This paper also explores the legal protection/ sustainability with regards to these schemes. Methods: We used qualitative research techniques with interpretivist paradigm and case-study approach. In-depth interviews were conducted, followed by content analysis. Triangulation and data saturation were observed to guide our sample size. Officials involved with these schemes at policy and implementation level were interviewed. Ethical approval was taken from ethics board of Khyber Medical University. Based on purposive sampling, in-depth interviews were conducted and thematic analysis was performed. Results: We identified two themes in response to question-1 of our interview, asking about the cause of action behind starting these schemes and their legal protection. These themes were: (i) [initiation of] Social Health Protection as democratization of healthcare, and (ii) [initiation of] Social health protection in legal void. Implicitly, these schemes are a product of grass root political activism and health found berth in election manifestos recently. Also, we deduce that health is not a constitutional right in Pakistan. These schemes lack constitutional guarantee and ensued in absence of overarching legal framework. Conclusion: These social health protection schemes are high on political agenda but lack constitutional and legal protection.Keywords: Universal Health Coverage (UHC); Sustainable Development Goals (SDGs); healthcare financing; health insurance; social health protection; Sehat Sahulat; Prime Minister National health program
UNDP. Analysis: Five Years of the 18th Constitutional Amendment: Federalist Imperatives on public policy and planning. 2015. [Internet]. 2016 [cited 2016 Nov 13]. Available from: http://www.pk.undp.org/content/dam/pakistan/docs/DevelopmentPolicy/DAP%20April%202015%20ENGLISH.pdf?download
PMNHP. Prime Minister National Health Program. [Internet]. 2016 [cited 2016 Nov 13]. Available from: http://www.pmhealthprogram.gov.pk/about-us/
Government of Khyber Pakhtunkhwa. Sehat Sahulat Program. [Internet]. 2017 [cited 2017 Apr 10]. Available from: http://www.sehatsahulat.com.pk/
Nishtar S, Bhutta ZA, Jafar TH, Ghaffar A, Akhtar T, Bengali K, et al. Health reform in Pakistan: a call to action. Lancet 2013;381(9885):2291–7.
Atun R, de Andrade LO, Almeida G, Cotlear D, Dmytraczenko T, Frenz P, et al. Health-system reform and universal health coverage in Latin America. Lancet 2015;385(9974):1230–47.
Cotlear D, Gómez-Dantés O, Knaul F, Atun R, Barreto IC, Cetrángolo O, et al. Overcoming social segregation in health care in Latin America. Lancet 2015;385(9974):1248–59.
PTI Official. PTI manifesto 2013. Islamabad; 2013. [Internet]. 2017 [cited 2017 Mar 23]. Available from: http://insaf.pk/public/insafapr18/content/manifesto
PML(N). Pakistan Muslim League (N), Manifesto 2013. [Internet]. 2017 [cited 2017 Mar 23]. Available from: http://pmo.gov.pk/documents/manifesto.pdf
Giunchi E. Democratic transition and social spending: the case of Pakistan in the 1990s. Democratization 2011;18(6):1270–90.
National Assembly Pakistan. The Constitution of the Islamic Republic of Pakistan. Pakistan: National Assembly; 2012.
Department of Health KPK. Social Health Protection Initiative. [Internet]. 2013 [cited 2016 Jan 12]. Available from: http://www.healthkp.gov.pk/SHPInitiative.asp
The Oxford Dictionaries. Democratization. [Internet]. 2017 [cited 2017 Mar 23]. Available from: https://en.oxforddictionaries.com/definition/democratization
Tang PC, Smith MD. Democratization of Health Care. JAMA 2016;316(16):1663–4.
Sindh Provincial Assembly. Sindh: Government Alliance. [Internet]. 2016 [cited 2016 Nov 13]. Available from: http://www.pas.gov.pk/index.php/members/govt_n_opp/en/0
KP Provincial Assembly. Cabinet Composition. [Internet]. 2016 [cited 2016 Nov 13]. Available from: http://www.pakp.gov.pk/2013/about-assembly/an-overview/
Punjab Provincial Assembly. Leader of the House. [Internet]. 2016 [cited 2016 Nov 13]. Available from: http://www.pakp.gov.pk/2013/about-assembly/an-overview/
AJK Assembly. Legislative Assembly of Azad Jammu & Kashmir. [Internet]. 2016 [cited 2016 Nov 12]. Available from: http://www.ajkassembly.gok.pk/primeminister.htm
World Bank. Seguro Popular: Health Coverage For All in Mexico. [Internet]. 2015 [cited 2017 Jan 11]. Available from: http://www.worldbank.org/en/results/2015/02/26/health-coverage-for-all-in-mexico
Frenk J, Gómez-Dantés O, Knaul FM. The democratization of health in Mexico: financial innovations for universal coverage. Bull World Heal Organ 2009;87(7):542–8.
La Forgia G, Nagpal S. Government-sponsored health insurance in India : Are you covered? World Bank Publications; 2012.
Nishtar S, Boerma T, Amjad S, Alam AY, Khalid F, ul Haq I, et al. Pakistan’s health system: Performance and prospects after the 18th Constitutional Amendment. Lancet 2013;381(9884):2193–206.
Sojo A. Health benefi ts guarantees in Latin America: equity and quasi-market restructuring at the beginning of the Millennium. Estudieos y Perspectivas Series. Mexico; 2006.
De Vos P. “No one left abandoned”: Cuba’s national health system since the 1959 revolution. Int J Health Serv 2005;35(1):189–207.
Cooper RS, Kennely JF, Ordunez-Garcia P. Health in Cuba. Int J Epidemiol 2006;35(4):817–24.
Muntaner C, Salazar RMG, Rueda S, Armada F. Challenging the neoliberal trend: the Venezuelan health care reform alternative. Can J Public Health 2006;97(6):I19–24.
Wasti S. Pakistan Economic Survey 2014-15. Islamabad Govrnment Pakistan; 2015.
Pan American Health Organization. Health in the Americas: regional outlook and country profiles. Washington, DC; 2012.
Iwami M, Petchey R. A CLAS act? Community-based organizations, health service decentralization and primary care development in Peru. Local Committees for Health Administration. J Public Health Med 2002;24(4):246–51.
Levino A, Carvalho EF. Comparative analysis of health systems on the triple border between Brazil, Colombia, and Peru. Rev Panam Salud Publica 2011;30(5):490–500.