Role of social health insurance in improving financial access to health care : a qualitative appraisal of the situation in district Thatta Sindh, Pakistan

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Title: Role of social health insurance (SHI) in improving financial access to health care: A qualitative appraisal of the situation in District Thatta, Sindh, Pakistan 1. What does Pakistan need to start SHI? 2. Can social health insurance improve financial access to health care for the rural vulnerable population, (women and children) of Thatta Health care cost is one of the major causes that forces people into catastrophic expenditure, people are forced to reduce expenditure on necessary items such as food, education of children and clothing. Pakistan has been suffering from low human development for decades. The vulnerable poor population has been dealing with the expensive, unresponsive health system for years now. The socioeconomic conditions of Pakistan, its agricultural economy and presence of poverty have made it important for the Government to reconsider its health care financing. The objectives of the study are • To analyze the literature to identify main challenges for social health insurance(SHI) in developing countries • To describe social health insurance experience from selected developing countries and social protection programmes in Pakistan • To identify the challenges for Pakistan to launch social health insurance(SHI) • To identify issues in the current financial assistance schemes for health in Thatta The study uses dual methodology for effective triangulation. The first two objectives are achieved by literature review, to develop a framework for social health insurance in developing countries by analyzing the literature and to describe experience from different countries. Since Pakistan does not have an experience with social health insurance experience, developing countries experience can been utilized to identify the challenges and to find ways to deal with these challenges. To achieve the later three objectives, the study utilizes qualitative exploratory approach. To achieve these objectives participants from government and NGOs were identified based on their involvement with social protection programmes for health. Participants from the community were identified based on their involvement in existing social protection run by Government or NGO in District Thatta. Purposive and convenience sampling strategy was used to recruit the study participants. In-depth interviews and focus group discussions (FGD), using the interview guidelines were used as data collection methods. In-depth interview were conducted with Government and Nongovernmental organizations (NGOs). Focus group discussions were conducted with the community participants. A total of 10 in-depth interviews, 5 from Government and 5 from NGO sector (one insurance company and one donor agency) were conducted. 6 FGD with 4 females groups and 2 male groups were conducted with the community. • To explore the perceptions of stakeholders on social health insurance(SHI) on improving financial access to healthcare The data analysis was done manually and with NVivo 2.0. The nodes, sub nodes and themes were identified based on the framework. The framework is based on the literature, based on challenges for SHI in developing countries. The qualitative data related to identifying the challenges for Pakistan to launch SHI is analyzed using this framework. Lack of political commitment and corruption were identified as the two major challenges by all stakeholders. Community showed a preference for pre-payment schemes, showed willingness to participate and pay for SHI. All stakeholders were of the opinion that SHI can improve people financial access to health care. The study concluded that SHI can be implemented in Pakistan in the long term. Epidemic of poverty and poor access to health care makes it important for Pakistan to consider an alternative financing mechanism and improve people's access to health.SHI is one such mechanism which is fair and equitable.

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