Project Details

Keeping in view the role of Social Health Protection in reducing poverty as well as its role in the improvement of health status of the people, the government of Khyber Pakhtunkhwa has decided to extend the coverage of the Social Health Protection Initiative to the entire province.

Over all Goal of the programme is to improve the health status of the targeted population through increasing access to quality health services and to reduce poverty through reduction of out of pocket payments for health expenditures.

The premium for up to 51% of the population will be paid by the government of KP for Secondary and Tertiary Healthcare services. Per year cost of the programme is Rs. 2.7 million including premium and administrative cost.

Program Objectives

Keeping in view the role of Social Health Protection in reducing poverty as well as its role in the improvement of health status of the people, the government of Khyber Pakhtunkhwa has decided to extend the coverage of the Social Health Protection Initiative to the entire province.
Over all Goal of the programme is to improve the health status of the targeted population through increasing access to quality health services and to reduce poverty through reduction of out of pocket payments for health expenditures.
The premium for up to 51% of the population will be paid by the government of KP for Secondary and Tertiary Healthcare services. Per year cost of the programme is Rs. 2.7 million including premium and administrative cost.
Following are the key features of the programme:

  • It is a Health Insurance Scheme aimed at the costs of hospitalization ;
  • It is an adaptation of the experience of existing Social Health Protection Scheme for the poor in KP;
  • It is a household premium product with a household, for the purpose of working out the premium, consist of eight members. The head of the household, spouse and children will be enrolled for the scheme as priority, followed by dependent parents living in the same house. Additional members of the household would be covered by paying additional pro rata premiums;
  • The household members enrolled for payment of this scheme by the government for the poorest households will be on the basis of ‘priority’ BISP criteria. Beneficiaries whose PMT Score is 24.51 are below, will be targeted. Benefits up to a minimum of Rs 240,000 per household per annum for Secondary care and up to 300,000 per household for tertiary care
  • The services covered in the scheme will be the hospital services normally provided at the secondary and Tertiary level such as Medicine, General surgery, Gynae & obstetrics, ophthalmology and ENT etc.
  • Pre and post hospitalization care up to 1 day prior to hospitalization and up to 5 days from the date of discharge from the hospital shall be part of the package rates;

The percentage of the population whose premiums will be paid by the government is expected to be approximately 51% (14,000,000 individuals) of the whole province including around 1,800,000 households.