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Pakistani Program Offers Affordable Health Insurance to Help Urban Poor

May 23, 2011 at 12:00 AM EST
One program in Pakistan is attempting to combat urban poverty, the root of many Pakistanis' problems, by providing affordable health insurance. Special correspondent Saima Mohsin reports from the nation's largest city, Karachi.
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GWEN IFILL: Next, combating the poverty that’s at the root of many of Pakistan’s problems, in this case by providing affordable health insurance.

NewsHour special correspondent Saima Mohsin reports from the nation’s largest city.

SAIMA MOHSIN: Walayat Khan has just got back to work at an upmarket hotel in Karachi, where he stands guard as a member of the security team. He was hit by a car on his way to work one morning. Two months later, the severity of his injuries came to light.

WALAYAT KHAN, security guard (through translator): I had a brain hemorrhage and collapsed. My son rushed me to the hospital, and I had an emergency operation.

SAIMA MOHSIN: An operation Walayat could not have afforded on his 13,000-rupee- — or $150 — a-month salary.

WALAYAT KHAN (through translator): I’m the sole breadwinner. And my sons are very young, while I have grown-up daughters. This operation and treatment was beyond my means.

SAIMA MOHSIN: But Walayat Khan and his colleagues have been covered by an innovative health insurance plan for the urban poor.

DR. ASHER HASAN, Naya Jeevan: Naya Jeevan provides access to quality care for three types of groups. The first is low-income families who are making less than 20,000 rupees per month who are domestic household staff, drivers, maids, et cetera. The second group are uninsured contract workers or workers who are working in factories with corporations, schools or any other organization. And the third group are NGO kids and their families, so, kids who are studying in NGO school systems and their families.

SAIMA MOHSIN: The private sector serves nearly 70 percent of Pakistan’s population. Yet, out of the estimated 40 million low-income families here, 99.3 percent of them don’t have health insurance.

The introduction of Naya Jeevan in Pakistan hopes to change that. This new program is simple and affordable for employers, sponsors and beneficiaries. The equivalent of just $2.50 a month provides access to private health care and, crucially, regular health checks for contagious or infectious diseases as a preventive measure for a country that is still battling polio, malaria and hepatitis.

And hundreds of local companies, restaurants and multinational corporations are signing up for the plan for their low-income employees.

SIKANDER RIZVI, Cafe Flo: It has made a huge difference, because before we even had health insurance we would be responsible for our staff and their wives and this — and their children.

So, every time they fell sick, we would either give them a loan or, as a gesture of goodwill, we would pay for them, because we knew they wouldn’t be able to afford it. Now — now, since we do have health insurance, we have peace of mind, because we pay a small amount every month and they all — the entire family is covered.

So, every time we fall sick, we — whether it’s children or anyone completely unrelated to the business, we don’t have to do anything. It’s been taken care of. And they have peace of mind. They have no burden of paying lack loans.

SAIMA MOHSIN: And the scheme is already paying off for staff members.

NAVEED KARIM, Cafe Flo (through translator): My wife was six months pregnant, and she suffered complications. She was rushed to the E.R., and they said she would have to have an operation. It was a really difficult time. It was costing 45,000 rupees, which I couldn’t possibly afford. So, we turned to the health center through our insurance and they really helped us.

ASIF AZIZ, Cafe Flo (through translator): I have a 4-year-old daughter. She was diagnosed with Typhoid. We took her to the hospital. And when we got the hospital bill, it was very expensive. We were very worried about how we would pay it. Then we remembered we had health insurance. We showed them our card and she was admitted into hospital immediately. Thank God she’s much better now.

NAILA ISMAIL, CSR Unilever Pakistan: This is the first time that Unilever has engaged in such a program. And there are no programs like this globally, neither in South Asia. And we’re hoping to set a precedent, not just for Unilever global, but for other companies within the country, too.

SAIMA MOHSIN: Naya Jeevan says medical calamities can lead to generational poverty among millions of vulnerable people in Pakistan. Low-income families in urban centers are particularly at risk of being trapped in a cycle of poverty and debt because of medical expenses.

SIKANDER RIZVI: Public health care system in Pakistan leaves much to be desired, to be honest. And many of our staff members would go to hospitals where they wouldn’t be properly diagnosed and their health would deteriorate even further.

And as a result they would see unqualified doctors on the sidewalk, to be honest. Now with Naya Jeevan, they have a toll-free number, direct telephone line to a qualified surgeon or a doctor who directs them to the proper clinic, proper hospital, where they are met by a doctor who will treat them and diagnose them appropriately.

As a result, we have staff members who will be sick for the normal amount of time, as compared to before, they would be absent for two or three weeks also.

SAIMA MOHSIN: Public expenditure on health care across South Asia is as low as 3 percent of total expenditure.

DR. SHERSHAH SYED, Pakistan Medical Association: Pakistan has a very well-organized public health care system on paper. Provided the system is working, more than 70 percent of basic health seats are empty. There is no doctor. There is no nurse. There is no midwife. So, how will it work? More than 50 percent of the rural centers are empty.

SAIMA MOHSIN: And although, in theory, this public health care system is free, there are plenty of add-ons like X-rays, blood tests and of course medicines, making affordability a huge concern.

So, is private health care the way forward for Pakistan?

DR. SHERSHAH SYED: No. Private health care is never a way forward. No. I will say again, primary health care, basic health care and emergency health care is the right of every citizen of Pakistan, free of cost. And the private sector cannot provide it. It is the government. I mean, two things in the world, education, basic education and the basic health care, it’s not private business. It’s serious business. And it should be done by the government.

SAIMA MOHSIN: The Naya Jeevan plan has been recognized by the Clinton Global Initiative and is becoming popular amongst employers.

But the plan does have some limitations. It is specifically targeted for the urban poor, is only currently available in three major cities, and is reliant on the cooperation of conscientious employers. It’s this very conscience that Dr. Asher Hasan says needs to be tapped into. He says the program on offer is not just about health care, but about helping low-income families in a developing nation rise up from poverty.

DR. ASHER HASAN: First of all, we’re trying to introduce a paradigm shift. Pakistan is a post-colonial country. And there’s a mind-set that has existed here which is a master/slave mentality, which is, you know, extortion of low-income people and low-income labor.

We’re really beginning to try and flip that on its head, to say every employee, whether they work in a home, whether they work in a factory, a school, a corporation, each one of them is entitled to quality health care and a number of other services and benefits: education for their children, socioeconomic opportunity, vocational training, skill development.

So over time, as this paradigm or as this thinking begins to pervade and percolate into society, hopefully, we will begin to see that other — you know, that these low-income people will emerge into the middle class. And that can only be a good thing for Pakistan.

SAIMA MOHSIN: And his plans don’t stop there. Naya Jeevan is now spreading through schools and slums and being offered to people in flood-affected areas, providing health insurance, health care workshops and preventive checks.