The challenges of success

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The current government has the avowed mission of making Pakistan a welfare state. To this end, during his three years in power, he launched a number of actions aimed at promoting the socio-economic well-being of the population and in particular of the most disadvantaged. These include, among others, the Ehsaas program (the renamed and expanded BISP), the Kamyab Jawan program, the Panahgahs (shelters), the financing of low-cost housing and the Sehat Sahulat program.

Even a little thought will clearly show that for a welfare state to be established, a government will require considerable financial expenditure. As such, developed countries with strong economies are much better placed to establish welfare states, with other aspects also providing vital support, such as relatively smaller populations, higher levels of literacy, and higher levels of education. advanced industrial base. Nevertheless, developing countries like Pakistan must also aim to establish welfare states, even if it takes longer and the task is considerably more difficult. To that end, we must salute the mission of the current government to pursue this objective.

Many, if not all, of such ambitious public welfare-driven programs look brilliant on paper, peppered with numerous statistics on the very large number of people who will benefit, the impact on the economy, and more. While the government’s mission can be altruistic and with all good intentions, it is imperative for such a large-scale program to succeed that certain critical factors that will ensure the desired results receive full attention from the conceptualization phase of the program. . These goals may or may not be realistic, but even achieving goals to a significantly high extent if not entirely, factors in success. As mentioned before, sufficient funding must of course be available for the implementation of the program in stages. What are the other factors? Let us consider them in relation to the Sehat Sahulat program as an example.

As described on its website, the Sehat Sahulat program “is an important step towards social protection reforms; ensure that identified disadvantaged citizens across the country have access to the health care to which they are entitled in a timely and dignified manner without any financial obligation. The objective of the PHC program is to improve the access of the poor population to good quality medical services, through a system of health microinsurance. ‘ Leaving aside the availability of funding for the program, the first obvious question that comes to mind is how is the program going to be implemented?

The simply stated answer to this question is that targeted and predefined beneficiaries will be issued health insurance cards of a certain value, which they will use for the medical treatment of patients (hospitalization). A red flag can be seen here. Does the insurance company responsible for issuing and managing the health cards have both the capacity (experience and expertise) and the ability to first issue millions of cards in a short period of time , then process all transactions in a timely, efficient and fully accountable manner on an ongoing basis?

It should be noted that the Sehat Sahulat program has already been launched in KP province with the State Life Insurance Corporation (SLIC) being exclusively the implementing agency. It is too early to empirically assess the results, but there are certainly many questions that can be raised. What is more worrying, however, is the possibility that the government may hand the execution of the much larger program in the Punjab, estimated at Rs 100 billion, to SLIC exclusively, totally excluding the participation of private sector insurance companies on questionable technicality? The government needs to seriously reassess the wisdom of this.

For starters, private sector insurance companies have a much longer experience with health insurance than SLIC, especially in key areas such as the client management system and the claims management system. Second, it is highly doubtful that SLIC on its own can effectively manage the scale of the Punjab program. Here it should be noted that SLIC’s exposure to health insurance is around Rs 25-27 billion and the value for all private sector companies is similar. It is therefore evident that neither SLIC alone nor private sector companies alone without SLIC can support the Punjab program and ensure the desired success. And remember, giving SLIC a monopoly position is not only unfair, but also very damaging to the entire private sector insurance industry, which has really put in a lot of effort and investment over the decades to make it happen. of the sector what it is today. .

As previously stated, the government’s vision of providing free health care to the needy first and eventually to all citizens deserves the highest praise. But the government must be extremely careful that bureaucratic procedures and a blind approach to project implementation do not cause the program to fail. As Nobel Prize-winning economist Milton Friedman once said: “One of the big mistakes is to judge policies and programs by their intentions rather than their results.

The writer is a media practitioner


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