Oxford Policy Management demonstrates to be a Trendsetter in expanding the Universal Health Coverage in Pakistan.

In Pakistan, the cost of hospital care can exceed a family’s entire monthly income. For many households living in poverty, this meant facing impossible choices between lifesaving treatment and financial catastrophe. In response, the Government of Khyber Pakhtunkhwa launched the Social Health Protection Initiative, a bold step in health financing supported by KfW (Kreditanstalt für Wiederaufbau, is a German state-owned development bank) and implemented with the technical expertise of Oxford Policy Management Team (OPMT).

At the centre of the initiative was the Sehat Sahulat Program, a public health insurance model where the government paid insurance premiums on behalf of low-income families. With initial funding of €10 million from the German government in 2010, KfW partnered with OPMT to design a scalable approach that could evolve and grow. What began as a targeted pilot covering just over 20% of the province’s most vulnerable households has since expanded to provide province-wide coverage, helping millions access healthcare without the fear of financial ruin.

A fragile health system –

Prior to the programme, households in Khyber Pakhtunkhwa depended almost entirely on out-of-pocket payments to access medical care. Public hospitals were overstretched and underfunded, while private facilities remained out of reach for most people. With no financial protection in place, many families were one illness away from slipping deeper into poverty.

Pakistan did have poverty targeting data available through the Proxy Means Test scores from the Benazir Income Support Program, but this information was not being used to extend healthcare access to those who needed it most.

Designing a public health insurance model –

The initiative was launched in 2017 in four districts: Mardan, Kohat, Chitral, and Malakand. Eligibility was determined using the Proxy Means Test, allowing households to enroll up to eight family members for free inpatient care. The government paid premiums directly to the State Life Insurance Corporation, eliminating financial barriers for families seeking treatment.

The programme transformed into a full health insurance ecosystem, not just a card distribution scheme. Over 95,000 households living in poverty enrolled, covering around 800,000 people. A network of 44 hospitals, both public and private, was established to deliver care. Transparent benefit packages and claims processes were introduced, while funding from KfW supported hospital training, claims administration, and public awareness campaigns.

OPMT provided technical expertise to ensure the programme was financially sustainable and centered on people’s needs. This included actuarial pricing, financial modelling, and claims audits to protect the long-term viability of the scheme.

Real-world results for people and systems –

The programme processed over 50,000 hospital admissions. Around 57% of participants were women, reflecting improved healthcare access for groups often excluded. People sought treatment for a range of health conditions, including dialysis, childbirth, cancer care, cataract surgery, cardiac procedures, and abdominal surgeries.

Initially, private hospitals attracted most patients, partly due to perceptions of better care and administrative efficiency. However, public hospitals steadily improved their capacity, supported by programme revenue and focused training.

A key innovation was the introduction of financial autonomy for public hospitals. Traditionally, these facilities operated under strict financial controls, limiting their ability to invest in improvements. Under the initiative, hospitals retained 75 percent of the revenue generated from insured patients, while 25 percent went to the provincial health department to help expand the programme. This allowed hospitals to upgrade facilities, hire staff, and improve care, creating strong incentives for high-quality service delivery.

Lessons from real-world implementation –

Scaling the initiative revealed important lessons. In some districts, such as Chitral, early awareness and hospital utilisation were low. The COVID-19 pandemic further disrupted outreach and community engagement efforts. Isolated cases of data fraud required swift corrective action. Public hospitals also recorded longer average stays than private ones, pointing to the need for ongoing investment in hospital management.

A voluntary insurance option introduced during the pilot phase had limited uptake and was eventually phased out as the province-wide Sehat Card Plus programme was introduced.

A province-wide transformation –

Despite these challenges, the initiative laid the groundwork for far-reaching reform. By 2020, Khyber Pakhtunkhwa expanded coverage to more than 20 million people through the ‘Sehat Card Plus’ programme. In 2022, the model was further refined by shifting from a household-based system to a family-based one, broadening access.

More than a simple expansion of coverage, the programme demonstrated that public health insurance can succeed even in complex and resource-constrained settings — if it is thoughtfully designed, grounded in evidence, and flexible enough to adapt. By empowering hospitals, strengthening accountability through data, and embedding financial protection into the system, millions of people now receive essential care without fear of financial hardship.

Shaping Pakistan’s health system for the future –

The Social Health Protection Initiative changed the conversation around health financing in Pakistan. The question is no longer whether universal health coverage is achievable, but how it can be strengthened and expanded further. While challenges remain, the lessons from this work offer a pathway toward a stronger, more inclusive health system that protects everyone.

Team Maverick