Jahanzaib Sohail: Hello welcome everyone.
Jahanzaib Sohail: Welcome, and thank you for joining us for the session on implementing universal health coverage lessons learned from the other Asian countries for Pakistan organized by sustainable financing.
Jahanzaib Sohail: For health accelerator in Pakistan, in collaboration with the joint learning network, before we start, I would like to quickly share some useful information.
Jahanzaib Sohail: We showcase that the participants is stay on mute during the presentation finally rename your years yourself as last name first name organization.
Jahanzaib Sohail: Please submit your questions in the chat box, there will be answered during discussion part of this webinar are in the chat box itself and for any technical difficulties, please contact Michelle sacre using the chat box.
Jahanzaib Sohail: We have agenda, yes, so let's let's stop them and.
Jahanzaib Sohail: A sonically mistake good morning Good afternoon, good evening depending on your time this is Dr Joe has upsell.
Jahanzaib Sohail: And working as a health.
Jahanzaib Sohail: wellness at the World Bank best in slot today miss rational reasons advisor building for many of the finance department at the global fund investing in I our facilitator of this fit.
Jahanzaib Sohail: Just going quickly through this agenda and, before going decision that I would like to highlight that this webinar is a joint effort of government of Pakistan in particular set so that Program.
Jahanzaib Sohail: And partners who are part of the health enhancing working group in have been working together since beginning of 2020 to support implementation of UFC.
Jahanzaib Sohail: This includes the Global Fund World Bank GAVI global financing facility, who gets foundation UNICEF you sad FC do, and more recently CDC UN aids and publish.
Jahanzaib Sohail: So we can see that this is our agenda, unfortunately, we have to make very little changes in it, because.
Jahanzaib Sohail: Somehow the special assistant to Prime Minister for Health, Dr fessel so on, and along with the CEO of sets of the program and team.
Jahanzaib Sohail: have been called by Prime Minister and to discuss the UFC they might join us shortly, but meanwhile we can start a recession so going further.
Jahanzaib Sohail: Just to give you a little brief contextual information that the set so the program is a social, health prediction initiative of the Federal and provincial governments and which again.
Jahanzaib Sohail: Sorry, can can you put on mute please.
Jahanzaib Sohail: Thank you.
Jahanzaib Sohail: So this program is initiative of the Federal and muscatine provincial government sandwich program started from the below poverty families, based on national social economic registry, however, it was it is expanded enough a universal coverage in the province of Pakistan ever.
Jahanzaib Sohail: said solar program provides the health arts, to the global working families to always take any indoor hospitalization services to me know hospitals and program is overall designed to reduce the hospital position sorry, reduce the catastrophic health care expenditures in is not.
Jahanzaib Sohail: objective of this seminar on our webinar is to understand the sense of the program and also aims to draw lessons from elsewhere, like Indonesia.
Jahanzaib Sohail: India to inform the goal of Pakistan expansion of its sense of it, working on this note, as I just said that unfortunately set them a hasn't joined us yet, so I would suggest to Dr.
Jahanzaib Sohail: materia to do, discuss the UFC and global action and also come up with some opening remarks.
Jahanzaib Sohail: Dr a lot of material is director of universal health coverage health system that will who will office.
Jahanzaib Sohail: Dr medallia has more than 15 years of experience in health system, strengthening health economics and finance and for the last 10 years he has been supporting countries of the Eastern Mediterranean region to reform the health and nc systems to move towards the universal.
Jahanzaib Sohail: So over to you don't turn the time.
Awad MATARIA, WHO EMRO: Thank you, thank you very much for having me it's a great pleasure and honor to be connected, always with the colleagues from from Pakistan with partners working on the on the University of conflict in Pakistan.
Awad MATARIA, WHO EMRO: it's really also a great pleasure to see many great names.
Awad MATARIA, WHO EMRO: On the code, so I very much look forward to a great discussion, and also to have some updates on what has been happening in Pakistan, especially for the high level and mission that we organized.
Awad MATARIA, WHO EMRO: Earlier in today's into the year, working together with seven other development partners under the the the gap, the Global Action Plan for stg three three plus so I thought that I would start my.
Awad MATARIA, WHO EMRO: Presentation by giving you some overview on what we are thinking about universal health coverage globally and how that relates to the situation in baxter may I prefer that you can see my screen.
Faraz Khalid WHO EMRO: Yes, yes okay.
Faraz Khalid WHO EMRO: Wonderful.
Awad MATARIA, WHO EMRO: So briefly in my short presentation, I would like to call it for clarify some of the concerns about universal health coverage.
Awad MATARIA, WHO EMRO: I know we all have been working on this, I had coverage and many people on the call are really experts in the best I had published, however, we what I realized, is that we don't always have.
Awad MATARIA, WHO EMRO: We are not always talking about the same thing, so it is really clear to know what what is it that we are talking about, and what is it that we are trying to progress towards.
Awad MATARIA, WHO EMRO: Then I prefer to to to share with you the most up to date information but we're Pakistani stance with regard to invest, I have a couple.
Awad MATARIA, WHO EMRO: More updates will be made available in 10 days time at the time of the celebration of this year so universal health coverage day on Sunday at 12 will be publishing and sharing some updated information jointly produced by WHO and and the World Bank.
Awad MATARIA, WHO EMRO: And then I will share some of the findings from the highly of admission that worker nodes which I referred to, we had tied to.
Awad MATARIA, WHO EMRO: That at the time, PFC for UFC and it was organized by many partners that I would be acknowledging and defending to in the in the presentation.
Awad MATARIA, WHO EMRO: And last but not least, two to share some of the opportunities that we have realized that Pakistan is now benefiting from which would which, hopefully, would allow for changing the current status with regard to the progress towards innovation.
Awad MATARIA, WHO EMRO: So for us in who, and I can also mention that other development partners would agree with with this definition that when we talk about universal health coverage, we are really talking about old people.
Awad MATARIA, WHO EMRO: And I may add, also all communities don't have access to their needed services and good the quality and with financial prediction.
Awad MATARIA, WHO EMRO: is important to realize, when we talk about health services, we are not only referring to one type of services, mostly people sometimes.
Awad MATARIA, WHO EMRO: connect this with a curative care, we are talking about the full spectrum, from promotion to prevention to curator but also very heavily and maybe palliative care could be also subsumed under that.
Awad MATARIA, WHO EMRO: And at the same time we want people to be financially protected, so if we look at the universal coverage From that perspective, one would.
Awad MATARIA, WHO EMRO: What one could attribute three goals for UNICEF covered the first one is equity in excess equity in service use the second one is the quality, because we want that these services that are being provided.
Jahanzaib Sohail: We, we are not getting you know.
Jahanzaib Sohail: Dr Pascal can you can you Stephen.
Faraz Khalid WHO EMRO: Yes, sure, so I got a message from a lot, he says that he got disconnected he is having an Internet problem I mean why what I can do is that, let me pull out just give me a few seconds to pull out the related presentation and share.
Faraz Khalid WHO EMRO: Suzy can you could farm if you can already see my slides i'm trying to make them slideshow mode.
Jahanzaib Sohail: Yes, we can we can see, and now it's in the slideshow can you can you make it bigger.
Faraz Khalid WHO EMRO: I have done them.
Faraz Khalid WHO EMRO: That okay now.
Lauren Oliveira Hashiguchi, WB: We can see the presenter view.
Lauren Oliveira Hashiguchi, WB: So if you switch screens will see that presentation.
Jahanzaib Sohail: lauren can you guys.
Lauren Oliveira Hashiguchi, WB: Yes, so if you go into presenter view you can share your screen for the presentation, rather than the presenter view which shows you the next slide upcoming.
Faraz Khalid WHO EMRO: yeah that's actually trying to do.
Lauren Oliveira Hashiguchi, WB: And if not, what you can also do which i'm sure will be fine for everyone is you can present off the view we see now, but you can just minimize the thumbnails on the left hand side and just make the presentation larger.
Lauren Oliveira Hashiguchi, WB: Because we can all read the words on the skew as well.
Faraz Khalid WHO EMRO: Is it any better now.
Lauren Oliveira Hashiguchi, WB: um it's yep that's perfect you got it.
Faraz Khalid WHO EMRO: Okay sorry.
Faraz Khalid WHO EMRO: But I think what a lot was referring to is.
Faraz Khalid WHO EMRO: The three goals of usc and coming out with this definition, when we say equity in service us, quality and financial protection for all.
Faraz Khalid WHO EMRO: So what university is and it's not, I think we have talked about what it is, but, but it is not so.
Faraz Khalid WHO EMRO: it's about covering key interventions that address the most important causes of morbidity and mortality for all it's not about the treatment on me as an idea pointed out that includes prevention promotion P and P habitation the whole spectrum.
Faraz Khalid WHO EMRO: And it involves all her system confidence and beyond, is just not about health financing.
Faraz Khalid WHO EMRO: And I think when we talk about health financing, an important point to clarify that it's not about just one screen one Program.
Faraz Khalid WHO EMRO: or one set of schemes, and now I think there has been a more and more realization that UFC it's a social, political, economic, agent.
Faraz Khalid WHO EMRO: it's just, not even the job of a health sector, as per se, the health sector takes the lead, but it's it's a social economic development agent.
Faraz Khalid WHO EMRO: And last and say it's not about providing limited minimum package of services, but about progressive realization of people's right to help, and I think when we made this document, the point here is that sometimes for policymakers.
Faraz Khalid WHO EMRO: When we come up with the holistic right comprehensive definition of unc something that looks daunting.
Faraz Khalid WHO EMRO: Not doable, but this is beer progressive realization comes there you start off with some essential basic entitlements, but yes, then, knowing that the bus does not stop here, it has to be comprehensive set of services for all.
Faraz Khalid WHO EMRO: And if I move forwards, this is something an implementation approach we have been encouraging from a religious perspective they're.
Faraz Khalid WHO EMRO: just trying to clarify that what we do and what we want to achieve so so that it makes clarity, so what we do is is have systems.
Faraz Khalid WHO EMRO: And it's really basic health system functions data governance financing.
Faraz Khalid WHO EMRO: Resources social issues which, which is around same thing health workforce medicines and suppliers and supply chain systems and service delivery is both a function and immediate.
Faraz Khalid WHO EMRO: output of a system so that's what we do, but while doing it, what we want to get is universal health coverage and health, security, and let me emphasize here the topic.
Faraz Khalid WHO EMRO: Is not today, bringing in health, security and go away, but I think in the current time, we cannot really miss them in our health system, strengthening efforts.
Faraz Khalid WHO EMRO: covert has taught us the importance of primary healthcare approach, so how system, strengthening should be configured around.
Faraz Khalid WHO EMRO: Baby at the foundation is time healthcare approach it ended when they were it's not only about integrated service delivery but also multi sectoral actions policies Community engagement and involvement and with that, yes, it is to.
Faraz Khalid WHO EMRO: get us in health, security, which would ultimately lead to health and well being and economic development there as you see here right from.
Faraz Khalid WHO EMRO: Action to go to results, there are certain set of action which are really enhances health system and it has sector to me, but there are others which are outside the health sector, to me, and they are health sector needs to ensure.
Faraz Khalid WHO EMRO: That relevant actors are as much part of the discourse as as as health system, as I say, is moving forward stand with stand with regards to UFC.
Faraz Khalid WHO EMRO: As a lot pointed out, I think the this 2019 monitoring report will be soon updated on UFC day we're up updated analysis and numbers.
Faraz Khalid WHO EMRO: will be where we will happen, but as of now, since this is the one which is latest in public domain, so we know that usually, when the the indicators from quantitative aspects these stg 3.2 point, one which.
Faraz Khalid WHO EMRO: I mean we can see the values were barking Stan Stan for Alderman ch infectious diseases and see the service to the diversity.
Faraz Khalid WHO EMRO: And then from financial protection perspective to catastrophic expenditures, with our support sessions, so what we clearly see here is that.
Faraz Khalid WHO EMRO: If we see it from both in comparison with emr agent and globally, so pakistan's service coverage index value 45 is less than the regional leverage and certainly less than the global average.
Faraz Khalid WHO EMRO: And with regards to financial protection, we can clearly see the numbers and we understand that these financial protection estimates, they do not capture the unmet need.
Faraz Khalid WHO EMRO: Which when we see both sides so discouraged and financial protection, together, we can clearly see that there are certainly some unmet need and demand.
Faraz Khalid WHO EMRO: Moving further the key point coming out of this four quadrant graph here is.
Faraz Khalid WHO EMRO: Is some policy direction where pakistan's.
Faraz Khalid WHO EMRO: stands and discarded for their countries with no service coverage and no financial hardship for so so the key message for countries in this quadrant has been the need to build the foundations of health systems, including human resources supply chain and infrastructure.
Faraz Khalid WHO EMRO: wi fi about global action plan and in the PSC for you see my department mission to Pakistan, I think most of the participants in the webinar they know about the Global Action Plan for http plus 12 agencies came together and the idea behind here has been that how they could.
Faraz Khalid WHO EMRO: Further align and harmonize their efforts under these seven accelerator so out of the seven accelerators agencies, coordinating and participating into accelerators primary healthcare in sustainable financing health, the game together, and it was it started off.
Faraz Khalid WHO EMRO: With the Agency scheme together under 17 years and he led to actually here, which was referring to the Agency, which came together and even in our region of the Platform, we have been using his vision and health alliance which has managing the implementation.
Faraz Khalid WHO EMRO: So, so, as I said earlier, the mission happened in March 2021.
Faraz Khalid WHO EMRO: And these agencies came together and all the mission proceedings, they lead to a joint statement on PFC see.
Faraz Khalid WHO EMRO: And the key priorities identified for intensified support you can see, there were six, which included model of character service availability Magnus.
Faraz Khalid WHO EMRO: emphasizing primary healthcare workforce to focus on really have workers sustainable find super PAC strengthening coordination mechanisms board with regards to partner and also very provincial.
Faraz Khalid WHO EMRO: stenting monitoring and evaluation and focus on health management information systems community, and so a civil society engagement and that regards to sustain refinancing for for BSC.
Faraz Khalid WHO EMRO: This has been regularly.
Faraz Khalid WHO EMRO: Pre mission and post mission taken up by the relevant accelerator, as I must say that the relevant team has been quite regular interactions and this webinar is actually one of.
Faraz Khalid WHO EMRO: The outputs coming out of those regular interactions.
Faraz Khalid WHO EMRO: So when we say the potential opportunities for changing the status score so we all know, Pakistan indoors to exceed benefit package which was based on bcp three.
Faraz Khalid WHO EMRO: Several agencies, it was like a couple of agencies, including who and others, but other agencies now have been supporting both federal and provincial governments in prevention adaptation to us now already there has been some joint bergamasco.
Faraz Khalid WHO EMRO: case, there has been interested in implementing and scaling our family practice B and C family practice space PNC approach, in fact.
Faraz Khalid WHO EMRO: That has been now they have been we have we have heard that there was a couple of mistakes to type in paradise for.
Faraz Khalid WHO EMRO: PFC oriented models of care and then the mission also witness the impressive progress and scale of plans for sets on the Program.
Faraz Khalid WHO EMRO: And a the mission observed that how this program has been higher on political agenda, but also noting some areas where this program could be potentially strengthened.
Faraz Khalid WHO EMRO: Starting from how communities could be more empowered to do know about entitlements, they have, and also to navigate to the Program.
Faraz Khalid WHO EMRO: but also with regards to the design features of the program its scalability the sustainability and then how this program would would would also direct the other health system, the forms happening.
Faraz Khalid WHO EMRO: And then you all understand that there is an upcoming national health support project by World Bank and other agencies are also becoming part of it, God is upcoming.
Faraz Khalid WHO EMRO: Full portfolio planning, and then there is interest on seven partners with potential additional funding.
Faraz Khalid WHO EMRO: So this is what the mission, noting that these are some some practical things happening on ground and we're both government partners are coming together so with this.
Faraz Khalid WHO EMRO: High end this presentation on behalf of award and I think as, as highlighted on this slide the we will be zooming in on sets on the program participant and I give back.
Faraz Khalid WHO EMRO: To the floor to moderators, particularly for back to you.
Jahanzaib Sohail: Thank you very much, Dr for us pilot for stepping in and.
Jahanzaib Sohail: I would like to mention that doctor for us holidays and those who are they who has organized this and this webinar and.
Jahanzaib Sohail: he's a technical officer, the WHO and also party later, a few and seek so we might.
Jahanzaib Sohail: seek your support so in the in the upcoming session as well, and the segment as well, so now we are heading to the next part which is like.
Jahanzaib Sohail: We now invite particular episodes on keto to share the reflection sensor from the sustainable financing for health accelerator.
Jahanzaib Sohail: Dr Calypso is the director of health and dancing in the Global Fund to fight AIDS, TB and malaria and visiting professor of practice in global health imperial college London.
Jahanzaib Sohail: She has been helping government governments built technical and institutional capacity or improving the value for the money of their healthcare payments investments so over to you, Dr Phillips.
hi jeezy.
Breshna Orya, The Global Fund: has had some issues joining so i'm just trying to connect her.
Jahanzaib Sohail: I see this seems not a good day for us.
Jahanzaib Sohail: And for sadly.
Jahanzaib Sohail: Over.
Jahanzaib Sohail: Special assistant to Prime Minister has been called, along with the senior officials of sales of the program and we had some connectivity issue, but no problem, we can wait for for 30 seconds and.
Jahanzaib Sohail: In.
Jahanzaib Sohail: Meanwhile, I can share some some information like related to the set so the program that the which obviously the team from the sense of the program from the Federal as well as.
Jahanzaib Sohail: As well as the kp would be sharing us justin just a brief information that sets of the program is based on my insurance model actually in which public sector procures the services of.
Jahanzaib Sohail: insurance company through nationwide competent to bidding process on a fixed benefit package on a fixed health insurance premium rate, so the insurance company is hired by CS older program and which is the state life.
Jahanzaib Sohail: Insurance corporation in 2018 from 2018 till now, the sli see is implementing.
Jahanzaib Sohail: ssp in focus district.
Jahanzaib Sohail: Recently agapi has started new procurement of these programs, and we have the team from the kp.
Jahanzaib Sohail: ever been to America is one of the province of Pakistan and, in short, we actually said the kp so the kp team is going to share with us the more details and definitely from the Federal side as well as the presenter would share that the how did procurement system.
Jahanzaib Sohail: Going back to your question again to you.
Breshna Orya, The Global Fund: uh maybe we can just ask GAVI to step in, maybe for the sfo side.
Breshna Orya, The Global Fund: To speak on behalf of the SF he.
Jahanzaib Sohail: Yes, sure so different that we can we have someone who.
Jahanzaib Sohail: I will.
Jahanzaib Sohail: Ideally we'll just take it for for the closing remarks, but if we can have someone from candy to share some of the.
Jahanzaib Sohail: Overall Max.
Jahanzaib Sohail: Yes, Hello.
Juliette Puret (Gavi): yeah unfortunately we're supposed to be, in the end, so I don't think you're disconnected so that like gimme.
Juliette Puret (Gavi): gimme like.
Juliette Puret (Gavi): 15 seconds to maybe.
Juliette Puret (Gavi): i'm.
Emmanuel Bor - Gavi: Yes, i'm connected and i'm happy to step in and.
Juliette Puret (Gavi): I couldn't see.
Great.
Jahanzaib Sohail: So.
Jahanzaib Sohail: As you are there, let me, let me quickly give the brief introduction that the from your side, the manual is actually the.
Jahanzaib Sohail: head of international board is immunisations head of the immunization financing sustainability, the vaccine alliance and we Lucas did him to give us the closing remarks but happy to have him now and over to us.
Emmanuel Bor - Gavi: yeah thank, thank you very much and very happy to be.
Emmanuel Bor - Gavi: To be with you today.
Emmanuel Bor - Gavi: So actually at GAVI we.
Emmanuel Bor - Gavi: really very much welcome this event and and we believe it's really one one concrete benefit and action of of the SF ha, as you know, the SF cheese.
Emmanuel Bor - Gavi: is really about ensuring that.
Emmanuel Bor - Gavi: Our support can be aligned to national priorities and, such as the implementation of universal health coverage in a coordinated and efficient manner.
Emmanuel Bor - Gavi: So this is why it's it's really great to be to be part of these women are today.
Emmanuel Bor - Gavi: The prioritization of.
Emmanuel Bor - Gavi: Universal.
Emmanuel Bor - Gavi: Health coverage places equity concerns front and Center and it seeks to address.
Emmanuel Bor - Gavi: persistence iniquities.
Emmanuel Bor - Gavi: It was actually.
Emmanuel Bor - Gavi: mentioned in.
Emmanuel Bor - Gavi: In the previous presentation among the three brodie objective of have you achieved equity and that's really what also for gaddy is at the Center of some of our strategy and in Pakistan, providing financial protection, which is another key objective of UFC as it was.
Emmanuel Bor - Gavi: As our colleague from who reminded us, he is also key and and we know that there are millions of Pakistani or actually introverts by out of pocket spending annually.
Emmanuel Bor - Gavi: So gabby can can only welcome initiatives like this and it serves also our key objectives in our what is called our GAVI 5.0 strategy to leave.
Emmanuel Bor - Gavi: No one behind and and and following the the positive results over the last strategy in terms of immunization coverage and vaccine production.
Emmanuel Bor - Gavi: Worldwide, we have developed a strategy which really puts the focus on filling the gap and reducing the number of children, we do not get access to immunization services.
Emmanuel Bor - Gavi: And in Pakistan, there are close to 800,000 02 children we mean by that the children, we do not even get the first dose of the fantabulous vaccine.
Emmanuel Bor - Gavi: And that represents 14% of the borough's court in Pakistan, so this is actually putting Pakistan at the top among the top four priority countries for gathering in terms of.
Emmanuel Bor - Gavi: The root being able to reduce the high number of do those children in the world and in clearly.
Emmanuel Bor - Gavi: It for us to do that.
Emmanuel Bor - Gavi: We mean implementing a very strong equity.
Emmanuel Bor - Gavi: strategy and and in the 70s, saving clearly.
Emmanuel Bor - Gavi: As a platform for the implementation of universal health coverage in Pakistan.
Emmanuel Bor - Gavi: and India, the munitions service itself can serve as a as a very strong platform before implementing the universal health coverage agenda in Pakistan.
Emmanuel Bor - Gavi: The gabby's mission is very closely linked to the universal health coverage mission.
Emmanuel Bor - Gavi: Human ization routinely reaches more children and how and households than any other outside intervention and making it indeed a very solid and robust platform from which to build to achieve universal health coverage and and and one example as as all of you are aware, is that.
Emmanuel Bor - Gavi: immunization will actually bring the major radio households into contact with the healthy stems.
Emmanuel Bor - Gavi: five.
Emmanuel Bor - Gavi: More five more times during the first year of a child's life so that's really unique opportunity to reach communities with additional primary healthcare services.
Emmanuel Bor - Gavi: And, and I would like to add also that that.
Emmanuel Bor - Gavi: Over 90% of children globally are reached by the first those of the DTP vaccine so that really makes unionisation a universal and accessible health service and.
Emmanuel Bor - Gavi: And that's why it's it's for us absolutely critical to to support these universal has coverage and agenda, but in doing these we should aim at.
Emmanuel Bor - Gavi: getting better value for money from from our investments and, and I mean I mean, first, obviously in terms of resources more resources remain needed.
Emmanuel Bor - Gavi: In Pakistan in 2018 only 5% of the general government expenditure was allocated to help, so there are there is a potential to to increase the mobilization of of domestic resources for health and.
Emmanuel Bor - Gavi: and investing in primary healthcare series.
Emmanuel Bor - Gavi: is clearly a way, a good way to effectively and efficiently invest domestic resources if we.
Emmanuel Bor - Gavi: Obviously.
Emmanuel Bor - Gavi: Again, I like this example of of the.
Emmanuel Bor - Gavi: The cost effectiveness of investing in primary risk or through the example of immunization we have rarely rubbish studies that that country and.
Emmanuel Bor - Gavi: That investing $1 minimisation generates a return of $54 in broader benefits for the society, so enabling revered their choices cycle off.
Emmanuel Bor - Gavi: of economic growth and and social girls and then you Pakistan invents investment in preventive healthcare currently represents only 1% of current Ellis expenditure.
Emmanuel Bor - Gavi: Compared to 28% to charity healthcare so clearly investing further in universal health coverage, with a low these gains in reaching a better we think better I look at efficiency of public health expenditure so.
Emmanuel Bor - Gavi: This is to confirm that add GAVI really commit to work closely with you and align.
Emmanuel Bor - Gavi: As far also have.
Emmanuel Bor - Gavi: These SF change initiative that is being implemented and, as you know, Pakistan is one of the priority countries for this really aligned with the government of Pakistan and and with our partners on these universal health coverage priority and.
Emmanuel Bor - Gavi: One concrete way for us of doing this is by engaging in this agenda through also the full portfolio planning the ftp process that GAVI.
Emmanuel Bor - Gavi: As.
Emmanuel Bor - Gavi: progressively rollout across country and it's it's really with the aspiration of one engaging very closely with all partners and not having.
Emmanuel Bor - Gavi: A fragmented approach and that's I think really at the core of what the universal health coverage principle on approach is about and but also.
Emmanuel Bor - Gavi: Having a really providing more space for broad consultation with all types of stakeholders to better inform also.
Emmanuel Bor - Gavi: The investment that will be supported by gabby and to make sure that those are really strongly aligned with both domestic investment and other partners investment with a view to contribute to the national strategy.
Emmanuel Bor - Gavi: For equity and and better health services with a strong.
Emmanuel Bor - Gavi: Universal universal approach, so I will, I will end those remarks about by.
Emmanuel Bor - Gavi: reiterating that as gabby as one of.
Emmanuel Bor - Gavi: The Global Action Plans signatory agency, and also as a cool leader of the.
Emmanuel Bor - Gavi: sustainable financing.
Emmanuel Bor - Gavi: Palace accelerator.
Emmanuel Bor - Gavi: Is.
Emmanuel Bor - Gavi: Our it's really for us.
Emmanuel Bor - Gavi: At testimony that.
Emmanuel Bor - Gavi: The any progress in terms of.
Emmanuel Bor - Gavi: Of immunization can actually only be achieved if it's aligned to national priorities and really strongly coordinated with with other partners, and we really believe that the these SF ha.
Emmanuel Bor - Gavi: initiative and platform has been a great way and a very concrete way to actually further align and improve our coordination among among partners and with a view to to contribute to.
Emmanuel Bor - Gavi: To this.
Emmanuel Bor - Gavi: aspiration towards universal health coverage, thank you very much.
Jahanzaib Sohail: Thank you very much.
Jahanzaib Sohail: For sharing your thoughts I can see, Dr Lisa has joined as well and.
Jahanzaib Sohail: Welcome to the club, so it would be great to have you here and.
Jahanzaib Sohail: Looking forward to getting some reflection essentially from your side as well.
Kalipso Chalkidou: Thank you, thank you very much.
Kalipso Chalkidou: And, and thank you to the organizers and to model, our colleague from from Gary for the comments just now so well, let me start by.
Kalipso Chalkidou: Talking about the Global Fund and its contribution so far and Pakistan we've invested over $700 million in Pakistan, since 2003.
Kalipso Chalkidou: And we are the biggest stoner for HIV mtb and I think these these are resources well spend, if we look at the significant progress.
Kalipso Chalkidou: Pakistan has made in fighting the disease is with the almost 60% reduction in malaria cases 71% reduction in malaria deaths between 2012 and 2018 and a high to be treatment success rate over 90% for first line treatment and 64% for MTV So these are really encouraging figures.
Kalipso Chalkidou: At the same time, like is that has an estimated 510,000 new TB cases every single year and 15,000 people develop drug resistant TB every year, so it's ranked fifth amongst the high burden disease.
Kalipso Chalkidou: gate countries worldwide and accounts for roughly two thirds of the TB burden in the emr region and our colleagues from the bank.
Kalipso Chalkidou: Their analysis suggests that the economic costs have to be through to 2030 will be almost $15 billion for for Pakistan, so this is a big figure in terms of.
Kalipso Chalkidou: The cost of human capital and also the economic costs now, as I heard my colorful garvey say significant progress investment are needed.
Kalipso Chalkidou: To to improve these these figures to the cheaper, the impact of the three diseases.
Kalipso Chalkidou: And at the same time, these are investments that support health systems and investments in health, security and but then preparedness, energy, the devastating.
Kalipso Chalkidou: Effects of course have covered that's continuing to afflict everybody, so we look forward to be led by the government of Pakistan moving forward towards achieving these goals and and driving forward important initiatives such as the the benefit packages, with the disappear three inputs.
Kalipso Chalkidou: Together with gabby with the billing with the Gates Foundation, we are supporting the national health support project in Pakistan, and we are very, very.
Kalipso Chalkidou: happy that we've been able to propose and hope we see this materialize the inclusion of the lie on specifically on TV, I think it would be wonderful to see this.
Kalipso Chalkidou: stay and be driven implemented on the ground and, of course, as a manual said we've been working very closely with different partners on the health and seo strategy and support sustainable health systems i'll finish just by reiterating our.
Kalipso Chalkidou: how important it is to is to engage continue to engage with.
Kalipso Chalkidou: The sustainable financing health accelerator, which is which will call leading together with our partners World Bank who and davi and it's part of the Global Action Plan.
Kalipso Chalkidou: The World Health Assembly, so the gap agencies, with support from the government of Pakistan have contacted the Joint Commission on.
Kalipso Chalkidou: Prem healthcare earlier this year and in support of the countries you'd see efforts and investment in how the stronger health systems and we've all agreed, together with a government.
Kalipso Chalkidou: That there ought to be a commitment and investment for strengthening UFC and developing and implementing a national health enhancing strategy.
Kalipso Chalkidou: That will ultimately lead the more sustainable approach to financing and efficient and equitable health system in Pakistan.
Kalipso Chalkidou: The accelerator will continue to support the government and.
Kalipso Chalkidou: Its partners through the platform and will continue to be active members of the accelerator and use it to drive change at a country level.
Kalipso Chalkidou: And and aim to be integrated, to the national health platform, one that is put in place.
Kalipso Chalkidou: And so, just to reiterate how committed we are to coordinating with partners to working to following the lead of the Pakistani Government, with the ultimate objective of stronger and financing approach to health system reform or health system, strengthening and.
Kalipso Chalkidou: With that I look forward to the rest of the day, and thank you very much for for having us here and allowing us to ask the Global Fund allows me to make these comments on behalf of the Global Fund, thank you.
Jahanzaib Sohail: Thank you very much structure clips for sharing sections from yesterday fishing.
Jahanzaib Sohail: And now, for an overview upset so that program we turn over to Dr Sonia riaz, who is the deputy director technical battles over the summer program Ministry of national health services and regulation she's a medic medical doctor and public health specialist and.
Jahanzaib Sohail: have been breaking and governments are past eight years, and under the Health Minister been getter and overlooking the sense of the program at the federal so over to you, Dr Sonia for a presentation.
Dr Riaz Sonia - SSP Pakistan: Okay, thank you very much josie.
Dr Riaz Sonia - SSP Pakistan: i'm just sharing my screen and do let me know now.
Lauren Oliveira Hashiguchi, WB: We see the presenter view so if you start the presentation and share the presentation panel on your desktop perfect.
All right.
Dr Riaz Sonia - SSP Pakistan: First of all, I want to say hi and hello to everyone, and I would like to say thank you to the.
Dr Riaz Sonia - SSP Pakistan: Doc Jones a band the team for inviting us here to represent government of Pakistan and obviously the same sort of Program.
Dr Riaz Sonia - SSP Pakistan: Well, this is Dr Sonia and I will quickly give the overview about the program some of the main points traffic is already mentioned about the Program.
Dr Riaz Sonia - SSP Pakistan: program is a function program of government of Pakistan, right now, and is our social health production initiative, and it is working as the federal and the participating provincial governments.
Dr Riaz Sonia - SSP Pakistan: They decided to provide the financial health prediction for the new families means catastrophic health care expenditure.
Dr Riaz Sonia - SSP Pakistan: requiring the hospitalization it is putting into mention here that this is a main theme of our national health patient comes in 2025 where it is eaten that government of Pakistan is committed to achieve universal health coverage for the 26.
Dr Riaz Sonia - SSP Pakistan: To start, I want to see that a universal health coverage for us the definition is a bit different or we can see that we have customize this definition.
Dr Riaz Sonia - SSP Pakistan: Basically, when we talk about universal health coverage, so there is one important point that we are providing only indoor hospitalization.
Dr Riaz Sonia - SSP Pakistan: those cases where the patients into a hybrid in the hospital and burn very turned my question is that we are not providing outpatient services.
Dr Riaz Sonia - SSP Pakistan: Up till now, but we are having an intervention and disregard everything UNITA.
Dr Riaz Sonia - SSP Pakistan: mean because we're focusing on into hospitalization and then we talk about universal health coverage, that means that government has decided to give.
Dr Riaz Sonia - SSP Pakistan: This access to everyone in the country, or have any particular area initially when we started from the program has evolved in this vein that we, starting from the fool people or the people who are living below poverty line.
Dr Riaz Sonia - SSP Pakistan: So audience for national social commerce registry those people who are falling below the pmt score consuming test test to modify these will be having.
Dr Riaz Sonia - SSP Pakistan: Less than $2 to $2 so you should have to from that population and, while on and in the directions of the Prime Minister of Pakistan, we.
Dr Riaz Sonia - SSP Pakistan: start to to expand each to associate editors so now the event is committed to providing University of Michigan everyone.
Dr Riaz Sonia - SSP Pakistan: I would we go through the savings, which is of the program what we're doing here, providing the dashes in good health care services and it started, as I mentioned earlier, the world marginalized and vulnerable families.
Dr Riaz Sonia - SSP Pakistan: But now we're going towards a permanent resident, like, for example, if somebody that territory is a.
Dr Riaz Sonia - SSP Pakistan: Capital of Pakistan so everybody who are living in somebody has a permanent resident.
Dr Riaz Sonia - SSP Pakistan: could have been the national.
Dr Riaz Sonia - SSP Pakistan: Identity power so to be eligible to receive this course, and the definition is husband wife and our marriage children and for the management and financing as you're working without other provinces as well, so promises having their cultural autonomy and.
Dr Riaz Sonia - SSP Pakistan: As far as the portability is concerned, so we have very distinctive feature that we have interesting and intercultural portability of power and you saw the people working in somebody from book to be in the dishonor you can go to.
Dr Riaz Sonia - SSP Pakistan: Heaven to buy and they can utilize our juicer your services over here.
Dr Riaz Sonia - SSP Pakistan: Here comes our insurance company and, like to mention here that the national national health program the essence of the program is based on.
Dr Riaz Sonia - SSP Pakistan: The insurance model, basically, what we have done, we have hired the services of an insurance company.
Dr Riaz Sonia - SSP Pakistan: To give the healthcare services to our beneficiaries and we have hired that means for nationwide bidding process and it was very operating bidding process and we have given them the ISP and given them our.
Dr Riaz Sonia - SSP Pakistan: Designed benefits package and, on that first benefit package being hired their services on a fixed premium and up to now, we are paying them.
Dr Riaz Sonia - SSP Pakistan: rupees 1998 or seven or a year by insurance in premium and after that we are getting the venture package i'm sure let.
Dr Riaz Sonia - SSP Pakistan: me provide for people right now across box on you have 550 percent penalty public and private hospitals and since, after December it's about.
Dr Riaz Sonia - SSP Pakistan: preschool reversal entire Province of Punjab is going to be universal and digital dishonest.
Dr Riaz Sonia - SSP Pakistan: Universal so definitely are going to increase the number of invalid hospitals and they will jump up to them thousand hospitals are expecting I would explain about the existing benefit package we have bifurcated our benefits package into two.
Dr Riaz Sonia - SSP Pakistan: packages on is a priority for us package and the answer is as an annual basis.
Dr Riaz Sonia - SSP Pakistan: For it is this package are covering those is this year, which are actually hypotheses, like the cardiology interventions like.
Dr Riaz Sonia - SSP Pakistan: treatment and management for the cancers bonds Reno three years drop below the diseases which are costing very high and the push people into below the poverty line, and then we have this country here that feature here, although tutorial medical and surgical.
Dr Riaz Sonia - SSP Pakistan: treatments are given on little bit over in the sense.
Dr Riaz Sonia - SSP Pakistan: Like in 20,000 per family per here, but after generally after December, from January 2022 our benefits package is also going to be enhanced, and with this.
Dr Riaz Sonia - SSP Pakistan: afternoon of the words he will provide them the mental picture for peace, for me and my family per year, and definitely and, and that is also has to be included.
Dr Riaz Sonia - SSP Pakistan: On our extramarital package we have focused on a post here as well, and it is putting a dimension here that I have a separate maternity care package.
Dr Riaz Sonia - SSP Pakistan: And in separate maternity care package, we are also focusing on the health of.
Dr Riaz Sonia - SSP Pakistan: The child and we are providing the services for anomaly and C section along we're focusing on the foreign key to visit and you're also ensuring that you're giving them to counseling for the family planning for the demonization of the children and the nutritional a mother and child.
Dr Riaz Sonia - SSP Pakistan: move on, I would like to tell you about the coverage, it has to not be having grown.
Dr Riaz Sonia - SSP Pakistan: Almost, at least in the industry and innocent ma ma GE is already tired peterson and it will be useful in Germany, I would like to mention it that.
Dr Riaz Sonia - SSP Pakistan: is of course province and partisan start with that you're providing universal health coverage and focus on, and I would say that.
Dr Riaz Sonia - SSP Pakistan: They initiated this landmark and the program is also going very successfully worthy and you're also having very good successful series, as well as the lessons learned and i'm sure Dr ramesh from Federal Government will share because.
Dr Riaz Sonia - SSP Pakistan: We are already the families after December, I would like to tell you that 40 million families will be covered with this universal health care package.
Dr Riaz Sonia - SSP Pakistan: Including Pakistan is having this three four provinces and the two regions so after the capital will among the four provinces.
Dr Riaz Sonia - SSP Pakistan: I would like to say that three professors will be on already covered their investment and each as well, you can progress of burgess.
Dr Riaz Sonia - SSP Pakistan: has also said, they are willing to do the University has published their entire population of the province so john.
Dr Riaz Sonia - SSP Pakistan: Lewis on and have it will be covered are they providing the fluency and we might one promises to be kind of your also they're also thinking to loosen up those issues in the federal government, and they also want to continue it for their problems as well.
Dr Riaz Sonia - SSP Pakistan: As far as we started the program and a tree now, we have reached your program has been evolving and revolving around medications since it started and i'm glad to say that you face any challenges you face any gaps when they see.
Dr Riaz Sonia - SSP Pakistan: Your health care system and your health sector is entirely different and when we're coming towards our insurance and then you are coming to.
Dr Riaz Sonia - SSP Pakistan: implement something so definitely free certain changes, and I would interest in that.
Dr Riaz Sonia - SSP Pakistan: box on is knowing the transformation fees as well you're also focusing to bring more public sector hospitals on our panel being face any challenges and gas in certain geographical, as well as an accessibility issues with or if we don't have the hospitals in every yard in.
Dr Riaz Sonia - SSP Pakistan: mine.
Dr Riaz Sonia - SSP Pakistan: We, and we have faced certain service delivery issues in some very hard to go areas, the moment, there is one very important issue, I MC or the gap i'm saying, that is, we do not have the standard treatment protocols so.
Dr Riaz Sonia - SSP Pakistan: If the people around us, who they are beside the people around us and they have successfully implemented their insurance partners, so I would request that we would meet the technical support from your side on, let me just add it to my protocols, I think it will be again.
Dr Riaz Sonia - SSP Pakistan: great achievement in the event that somehow we are working on it like how to have that and also to all is get into the challenge of a program.
Dr Riaz Sonia - SSP Pakistan: It is also in the bands, that was a decision of how to do the optional food moreover uniformity of packages, is also a bit.
Dr Riaz Sonia - SSP Pakistan: challenging situation, sometimes, because women have an hour two hours having that enhanced package, then the federal government and other conferences, so people and who are losing the letter F G sometimes they get confused, so I.
Dr Riaz Sonia - SSP Pakistan: have two boys and a higher packages and other government entities, so we also need to discuss how we can.
Dr Riaz Sonia - SSP Pakistan: invoke to better to have these beautiful mental energies forward integration with other currencies is.
Dr Riaz Sonia - SSP Pakistan: tasked to do so that we can have the better analysis and we can have better trends, to see that beer.
Dr Riaz Sonia - SSP Pakistan: Which is going higher and but how we have to work with the hospitals and people walking around, particularly the hospitals and always.
Dr Riaz Sonia - SSP Pakistan: Do that you're focusing on the sector, hospitals, hospitals, is very important, and they do not have much knowledge about the insurance and about.
Dr Riaz Sonia - SSP Pakistan: The certain financial advisors TV view about this program and the change management and change inverse Square, so the activity sizes also.
Dr Riaz Sonia - SSP Pakistan: need to be done and what prevents having a long term vision and La or you told you that ability for healthcare services so in the long term vision, we are going to include primary health care options, because unless to launch another PC run, we have here, we cannot go further and.
Dr Riaz Sonia - SSP Pakistan: I would like to mention here that Federal Government has also taken a step and we have.
Dr Riaz Sonia - SSP Pakistan: started one pilot study, with the support of mutual and our implementing partner is myself society with this and we have decided in samba we have hired.
Dr Riaz Sonia - SSP Pakistan: GPS general practitioners on application model, and this is a one year study and to the study we're planting the WHO sexual health care.
Dr Riaz Sonia - SSP Pakistan: Services so let's see after the violent and after our LM survey, it will do the analysis to you after that, whether we are going to include the openness in our program model and.
Dr Riaz Sonia - SSP Pakistan: Remember we're thinking to now as you want to lead scoring for adversity, so we, this is plan actually that from the world marginalized and relevant in the social.
Dr Riaz Sonia - SSP Pakistan: Media for you and for the associate editors in Pakistan, but very important work that.
Dr Riaz Sonia - SSP Pakistan: needs to do is that now the solution have production initiative has been established, and it was going on, and it is on the government stop.
Dr Riaz Sonia - SSP Pakistan: agenda, but now the institutionalization opposition and progression is very important, and there must be the health insurance law.
Dr Riaz Sonia - SSP Pakistan: which needs to be developed and she needs to be implemented so policymakers, are working to develop an insurance call and they are looking for the institutionalization of social pressure initiating a federal level and a.
Dr Riaz Sonia - SSP Pakistan: lie he gave him also prepare the law, and they are about to develop it, and again in the long term project was created a question of the hospital insurance company program managers is.
Dr Riaz Sonia - SSP Pakistan: Important and what we are expecting that, overall, while protecting people advice, giving them the financial protection there will be production to the.
Dr Riaz Sonia - SSP Pakistan: RT and we can see that interface, I was we improve, and we will be having access.
Dr Riaz Sonia - SSP Pakistan: Now to be services, it will also enhanced equity in the social development around which we promote peace.
Dr Riaz Sonia - SSP Pakistan: It will also help health systems by clearly bar for getting the purchaser provider and regulated and or all it will be a big contribution to the audience creation and, above all, I would like to say that we're all it will give the people the sense of right.
Dr Riaz Sonia - SSP Pakistan: Now there has protected and there Steve is.
Dr Riaz Sonia - SSP Pakistan: i'm willing to give them the right.
Dr Riaz Sonia - SSP Pakistan: to access the services free apostles is healthcare services, on behalf of the government so that's all.
Jahanzaib Sohail: Thank you very much, Dr Sonia for sharing the details are federal said so that program and also highlighting the parents, so the program is expanding services tours the BSC as well.
Jahanzaib Sohail: There are a couple of questions related to that as well, we will be exploring in the discussion part but for now quickly, we would like to get some idea that what the kp government is doing, because what I see that out of.
Jahanzaib Sohail: provinces kp is exemplary in terms of offering social, health protection initiatives, so I would like to request Dr.
Jahanzaib Sohail: rafi cuttack working as a deputy director its social protection initiative Baba Baba he's a maybe a structure with post graduation in public health having.
Jahanzaib Sohail: 17 years of work experience in different audition national, international presently he looks after the administration of health insurance services in session sensible program over to you, Dr.
Dr Amir Rafiq Khattak: safar.
Jahanzaib Sohail: A minute presentation, thank you.
Dr Amir Rafiq Khattak: Thank you very much josie.
Dr Amir Rafiq Khattak: And, good evening from Tyler political one.
Dr Amir Rafiq Khattak: Let me start sharing my screen, you can.
Dr Amir Rafiq Khattak: Thank you very much, can you hear me.
Lauren Oliveira Hashiguchi, WB: Yes.
Yes, we can hear you.
Dr Amir Rafiq Khattak: Thank you everyone, as we are.
Dr Amir Rafiq Khattak: sonja said that we have started have started this social hand protection initiative, first in the region or in the in the Pakistan more or less our program is like the same as that of the federal Program.
Dr Amir Rafiq Khattak: But with the little bit enhanced package and service coverage in the province of the help of Tupac.
Dr Amir Rafiq Khattak: Let me share some policy contraction rationale of this program as the article 38 of the constitution of Islamic Republic of Pakistan says that state will provide the health care for every citizen of the Pakistan.
Dr Amir Rafiq Khattak: And, along with this box nine is also a signatory of the MDS and as the US three of target eight since universal health coverage.
Dr Amir Rafiq Khattak: Our country vision is also to improve health in all Pakistanis, particularly women and children, providing universal access for to affordable, quality essential health services through responsive health system.
Dr Amir Rafiq Khattak: Along with this, our province have to va health policy outcome five five also says that enhance healthfulness health financings for effective service delivery and financial risk production for people of the heaven uber.
Dr Amir Rafiq Khattak: Our program brand name is Sim card Plus we have changed the name say solar program and switched over to send a card plus plus that we have added some additional benefits in the program and we have plus it added population in this program, so we are.
Dr Amir Rafiq Khattak: that's why we have rented the name say her card plus and our slogan is to have a cf which probably was means productions, he has helped which is happiness, if you provide protection in response of the health.
Dr Amir Rafiq Khattak: The people will be happy will be healthy, and they will be happy, our logo, you can see a healthy person with a wide open arms.
Dr Amir Rafiq Khattak: In a field so is quite happy, this is our logo and our program is implemented in all four promised in our province each and every one.
Dr Amir Rafiq Khattak: So this is a background or history of our program that we started in December 2015 with a kW financial assistance in Phase one in 2015 then rapidly we switched over to phase two in 2016 August in a six months eight months time spent and we.
Dr Amir Rafiq Khattak: Added more families in this and then into phase three in November 17, including the transgender in that also and I last year at August 2020 we covered all the population of the heavens too far in this program.
Dr Amir Rafiq Khattak: So in Phase one as soon as I said earlier, in her presentation that phase one was all for the poor wonderful people with a pmt score of 16.17 people who are.
Dr Amir Rafiq Khattak: Having a $1 per day for the family and we were at that time, targeting hundred thousand families in that period, there was only four districts, there was a pilot.
Dr Amir Rafiq Khattak: program started in four districts only covering 3% population of the heavens opened up that then we switched over to phase two with a pmt score.
Dr Amir Rafiq Khattak: 24 by five one and we covered 1.7 million households that covers 51% families of the heaven both of our province of all districts in.
Dr Amir Rafiq Khattak: And then switched over to phase three with a pmt score 32.5 which comes to $2 and 2.8 million household work over we see to 4% population of cable go to the park.
Dr Amir Rafiq Khattak: Then, as I said in August 2020 we covered the whole population hundred percent population will come under in this scheme with the coverage covering 7.5 million families in that.
Dr Amir Rafiq Khattak: Next year, and the January, we are going to merge the newly married districts, which were previously called fighter districts and we are going to go over that also in our family in our Program.
Dr Amir Rafiq Khattak: So the general feature of our program is, this is a health insurance program, and that is as the one year said that has been implemented by the shared life insurance corporation of Pakistan.
Dr Amir Rafiq Khattak: And we have started from first July 2020 contractor with them for five years and approximately we are saying we're going to cover some point 7 million families.
Dr Amir Rafiq Khattak: For free in patient health services as when you said that this program is also covering this time only in patient health services know OBD to reach at this moment but.
Dr Amir Rafiq Khattak: For the next year, we are also going to bind it the OBD in those four districts, which we initially started in the fall we're going to start the OBD services also in that.
Dr Amir Rafiq Khattak: Now, no cost of our program is around 33 million approximately and the services provision is through public and private hospital network.
Dr Amir Rafiq Khattak: At this moment, our package premium is 2849 rupees per family per year, that is around 16 point $5 around 16 point $5 per family per year, a premium is plus 40 rupees is also included in that that is reserved for if someone's package is.
Dr Amir Rafiq Khattak: Is is finished, so, then we give them some type of from that 40 rupees cool.
Dr Amir Rafiq Khattak: We also give some secondary care package and tertiary care package and so again we get package we have 40,000 for each member of the family.
Dr Amir Rafiq Khattak: If the family members family members are five so it around 200,000 per family or it is more than five so we also give additional 40,000 for each Member in this program.
Dr Amir Rafiq Khattak: And the tertiary care package we offered them for 100,000 per family, and if that finishes then we give them 400,000 additional top of for that.
Dr Amir Rafiq Khattak: And, including with that we also has agreement with the insurance company that the underutilized premium a day will return to us at 5% portion of the annuity lies premium, they will return to the government of heaven for.
Dr Amir Rafiq Khattak: These are the disease for secondary care services which are covered under our program all the secondary health services which our comes for as Inpatient normally comes is included in our program that is.
Dr Amir Rafiq Khattak: Including accident and emergency general medicine and surgery or to pad a tiny OPS pediatric ophthalmology nt etc.
Dr Amir Rafiq Khattak: But we are not limited to those only any as anything else covers comes under the secondary care services also included in our Program.
Dr Amir Rafiq Khattak: Along with this, we have some tertiary care services you're offering to the people of our book The power, which covers accident and emergency cardiovascular problems complication of diabetes.
Dr Amir Rafiq Khattak: We manage all type of cancer any type and all kind of cancer in this program along with this generally related disease, including dialysis and renal transplant in that, so far we have.
Dr Amir Rafiq Khattak: done around 55 renal transplant in our program management of neurosurgical diseases complication of secondary care diseases.
Dr Amir Rafiq Khattak: Of if any procedure needs tertiary care hospitalization that is also covered in this, along with this artificial limbs prosthetics and.
Dr Amir Rafiq Khattak: One important aspect is the breast cancer screening, we also cover the breast cancer screening in our Program.
Dr Amir Rafiq Khattak: So far, this is the second snapshot of our program so far we have done 752 480 admissions in our program and the total claim incurred in median is 18,121.32 million total.
Dr Amir Rafiq Khattak: Claims has been incurred so far.
Dr Amir Rafiq Khattak: As you know, that each and every program has some issues and challenges, so all wrong and also have a financial sustainability, one is shelly and another one is monopoly of one insurance company.
Dr Amir Rafiq Khattak: So for the financial sustainability, the government has what we have suggested to the government and what the government is going to do is our thinking over is that they will order to publication and.
Dr Amir Rafiq Khattak: Double dipping which we call it a derivative being that they also give money to the hospitals in the public sector and also the public sector hospital are earning money from the.
Dr Amir Rafiq Khattak: From all program so the government is going to reduce this money allegation wi fi allegation via stepwise.
Dr Amir Rafiq Khattak: To the public hospital and they will earn money from this program.
Dr Amir Rafiq Khattak: second thing is the government should also look for some additional sources of financing through taxation or reducing costs on other developmental programs to expand the.
Dr Amir Rafiq Khattak: physical space for sustaining free of cost insurance services, the main problem in here in Pakistan is there is a monopoly of one insurance company and our it's a very big company.
Dr Amir Rafiq Khattak: With around 1 trillion assets in Pakistan and around the world.
Dr Amir Rafiq Khattak: We have to encourage other companies for the come, but we have to modify our some rules and regulations for that to procure some other companies in this program.
Dr Amir Rafiq Khattak: There is some low utilization in the public sector hospital, as all of you are well aware that the public sector hospital, the government are paying them annually budget, so they are not much bother about this.
Dr Amir Rafiq Khattak: universal health coverage on this health insurance kind of thing, so the implementation in those public sector hospital is very difficult and we are trying our hard and hard.
Dr Amir Rafiq Khattak: To to get some quality standards, improve the quality standard in those hospital also another is the healthcare Commission, which is the main player in this whole game that they will regulate.
Dr Amir Rafiq Khattak: and functional in those hospital and not only public but private hospital also.
Dr Amir Rafiq Khattak: Our siding and monitoring, we have to revise the existing setups and complaint management system, we are working on all of these things, and it on my body at district level to set up to ensure the proper or citing our monitoring right now, our program we are running it from the.
Dr Amir Rafiq Khattak: From the PM you that is centralized setup and we don't have any presentation at the district level, so we are going to.
Dr Amir Rafiq Khattak: increase or set up in that district level, so they will improve the or siding and monitoring in that and.
Dr Amir Rafiq Khattak: Wherever there is an insurance as Inshallah there is a treatment of us throughout the world, so we have to improve the role of healthcare Commission and Public Private Partnership have to come so to reduce this achievement abuse in the private sector also.
Dr Amir Rafiq Khattak: With this I thank you all for listening me and, yes, we are going to cover along with this, we are also going to cover some additional benefits like we are moving towards the liver transplant to include the liver transplant in this, and next step is to.
Dr Amir Rafiq Khattak: improve our setup at the provincial and district level and monitoring and evaluation also so with this hi Thank you all for listening me thank you.
Jahanzaib Sohail: Thank you, Dr Patrick, thank you for sharing the word all overview of sales soda proven and kp and now I would request Dr Simon not Bob inglis Sheena.
Jahanzaib Sohail: chopra to share the country experiences from Indonesia and India, respectively, Dr Solomon not fairly senior health specialist and cluster lead for the world bank's.
Jahanzaib Sohail: health and nutrition programs in Indonesia and Timo list and has been representing the World Bank team and the joint learning network for universal health coverage, since its inception.
Jahanzaib Sohail: With machine algebra is senior health specialist and working in hmp health, nutrition and population global practices in South Asia region over to you, Dr sawmill for your presentation.
Somil Nagpal | World Bank | Indonesia: Thank you, thank you dizzy and pleasure being here i'm just trying to share my screen.
Somil Nagpal | World Bank | Indonesia: Okay, so.
Somil Nagpal | World Bank | Indonesia: I hope.
Somil Nagpal | World Bank | Indonesia: The audio and video is all working well, please do let me know if it has any glitches.
Somil Nagpal | World Bank | Indonesia: Let me get started with the experience from Indonesia.
Somil Nagpal | World Bank | Indonesia: The program in Indonesia, the German cars, they hit them nasional or the National Health Insurance Program.
Somil Nagpal | World Bank | Indonesia: Is the flagship witnessing health coverage program of the country that I will be.
Somil Nagpal | World Bank | Indonesia: Talking about.
Somil Nagpal | World Bank | Indonesia: I will.
Somil Nagpal | World Bank | Indonesia: Request many, many colleagues here on this call, who are very well versed with a program tool, so please come in and and share their insights.
Somil Nagpal | World Bank | Indonesia: And, in particular, Michael can do it was asking you hit specialists in English offices also here and, as are many others like project and and Owen Smith, then anyhow Monday, so do please come in as as useful please so.
Somil Nagpal | World Bank | Indonesia: let's let's talk about the programming.
Somil Nagpal | World Bank | Indonesia: In three buckets off with a bang.
Somil Nagpal | World Bank | Indonesia: The Cayenne what has been able to do in the last seven years that remarkable achievement of the Program.
Somil Nagpal | World Bank | Indonesia: jack I in as at a crossroads, the second donation reforms that the program needs to do, and then a window of opportunity and what comes next, and that would be suspended, so you have to wait till the end.
Somil Nagpal | World Bank | Indonesia: Okay, so let's let's.
Somil Nagpal | World Bank | Indonesia: Look at the programs beginnings, and how it evolved.
Somil Nagpal | World Bank | Indonesia: indonesia's natural health insurance or gap in what we call here so jack I am I was a massive massive reform which very few might be player might be pair countries have been able to achieve.
Somil Nagpal | World Bank | Indonesia: And what is important is that Indonesia brought together all of its health insurance programs more than 300 risk pools into a single national scheme, which was managed by a semi autonomous public agency.
Somil Nagpal | World Bank | Indonesia: BP GS K.
Somil Nagpal | World Bank | Indonesia: which gives every Indonesian the same benefit package and with a uniform set of rules for all provides the program is not.
Somil Nagpal | World Bank | Indonesia: outsource to an insurance company, it is managed completely by bps K, which is an autonomous state body, and the risk is retained within the government all the processing is retained within the government.
Somil Nagpal | World Bank | Indonesia: And it's a combination of the Ministry of Health that sets the guidelines and rules and we pts K, which is the single payer working along with another institution, the national social security council, as the oversight agency as the structure of this program.
Somil Nagpal | World Bank | Indonesia: So the origins of.
Somil Nagpal | World Bank | Indonesia: Different financing programs in Indonesia, of course, is a long one in 1968 there was a program for civil services and retired armed forces personnel called assets.
Somil Nagpal | World Bank | Indonesia: There was, more recently, a program.
Somil Nagpal | World Bank | Indonesia: For subsidized health insurance for the poor or ask yourself in 2005 this was expanded to include the near floor and in 2008 this was called junk Christmas.
Somil Nagpal | World Bank | Indonesia: A complimentary scheme for pregnant women was introduced in 2010 and still continues called jumper cell, but then came the big reform in.
Somil Nagpal | World Bank | Indonesia: In between 2010 and 2014 the country by law, decided to merge all of its programs and come up with a single national health insurance scheme.
Somil Nagpal | World Bank | Indonesia: That consolidated the program for civil servants, the jumpstart program for the private sector, the gym Christmas program for the poor and near poor.
Somil Nagpal | World Bank | Indonesia: And the junkies does program which were the district level programs that we're not being for people who have not been released, much of Christmas all of these programs came together, one of the very few countries where.
Somil Nagpal | World Bank | Indonesia: Civil servants for private sector and the poor have access to the same program and the same benefit package next.
Somil Nagpal | World Bank | Indonesia: What has happened in the last seven years.
Somil Nagpal | World Bank | Indonesia: is very impressive coverage of a very comprehensive program that covers from outpatient services to Inpatient services full comprehensive package.
Somil Nagpal | World Bank | Indonesia: has been able to reach 243 million people or 83% of the population, I already mentioned that the single program very equitable doesn't have layers of programs based on continuity and non continuity schemes being different.
Somil Nagpal | World Bank | Indonesia: And it has been able to achieve significant financial protection, the country's out of pocket health expenditure.
Somil Nagpal | World Bank | Indonesia: declined from 47% of the total health expenditures to 32% in just five to six years and this declined by 15 percentage points in just about five years is possibly unprecedented again.
Somil Nagpal | World Bank | Indonesia: This is also associated with quite good financial protection against catastrophic expenses and impoverishment due to health care.
Somil Nagpal | World Bank | Indonesia: But now it's time for looking back at things that could not be done in the original reform that created July and in 2014 in trying to do that big Ben reform, some of the design elements that could not be addressed them are now.
Somil Nagpal | World Bank | Indonesia: In need for a second generation of reforms, and particularly in terms of access and quality, the program has been in deficit.
Somil Nagpal | World Bank | Indonesia: There was a cumulative deficit of $2.2 billion in May 2020.
Somil Nagpal | World Bank | Indonesia: After all, these efforts.
Somil Nagpal | World Bank | Indonesia: About 70 million people still remain and ensure.
Somil Nagpal | World Bank | Indonesia: The quality of primary care services readiness a primary care still remains, not that great and the country with its 15,000 islands and very diverse.
Somil Nagpal | World Bank | Indonesia: settings continues to face an unfinished mtg agenda where it is still facing high maternal mortality high under vaccinations high numbers of stunted children and.
Somil Nagpal | World Bank | Indonesia: has been the.
Somil Nagpal | World Bank | Indonesia: third largest contributor to global TV burden, even as it starts facing a big agenda in terms of non communicable disease.
Somil Nagpal | World Bank | Indonesia: So in this setting.
Somil Nagpal | World Bank | Indonesia: Also, just to mention that the program has been under resourced and not have still does not have enough money which full fledged universal health coverage package may require Indonesia.
Somil Nagpal | World Bank | Indonesia: The public health expenditure is 1.4 percentage of GDP, which is about $55 per capita, it is significantly less than what decent comprehensive package may cost, and so this is still a consideration and the.
Somil Nagpal | World Bank | Indonesia: pandemic has further hit a blow on the physical space so that's another another challenge in terms of the UFC service coverage index.
Somil Nagpal | World Bank | Indonesia: The score for Indonesia is is 57 out of 100 which makes it ranked at 126 so there's a lot to be done in terms of improving the usgs service coverage index, which basically is a looking at racer indicators.
Somil Nagpal | World Bank | Indonesia: Of have some of the Communists services of communicable and non communicable diseases.
Somil Nagpal | World Bank | Indonesia: of this is the very.
Somil Nagpal | World Bank | Indonesia: Complex.
Somil Nagpal | World Bank | Indonesia: Health financing structure in the country.
Somil Nagpal | World Bank | Indonesia: there's a.
Somil Nagpal | World Bank | Indonesia: multiple levels of flow multiple sources of financing for the district, and for the.
Somil Nagpal | World Bank | Indonesia: hospital and for the primary care centers but, in this context, the health insurance program is now one of the largest players.
Somil Nagpal | World Bank | Indonesia: And it has the potential to be tied to performance tied to outcomes and it is only modality that can also influence a private providers so there's a lot of sway in the system that Jay can can potentially.
Somil Nagpal | World Bank | Indonesia: Create and create systemic.
Somil Nagpal | World Bank | Indonesia: Improvements in this otherwise very difficult decentralized context and that's a that's a potential that is waiting to be tapped.
Somil Nagpal | World Bank | Indonesia: So.
Somil Nagpal | World Bank | Indonesia: The next generation of reforms that are needed at this point.
Somil Nagpal | World Bank | Indonesia: On the revenue side and on the expenditure side on the revenue side, the low entry barriers and the V contribution compliance is creating a scenario for adverse selection so just to remind.
Somil Nagpal | World Bank | Indonesia: A large part of the population which is poor and near poor is covered with full coverage by the government.
Somil Nagpal | World Bank | Indonesia: and other large part of the population, which is the formal sector civil servant, and the private formal sector pays for itself and is again.
Somil Nagpal | World Bank | Indonesia: All covered, but the informal the missing middle which is not the formal private but not formal sector, not the poorest groups are where.
Somil Nagpal | World Bank | Indonesia: People are expected to contribute, and this is where the country has chosen to keep low entry barriers so people can.
Somil Nagpal | World Bank | Indonesia: access services by joining the program anytime the waiting period is very short just two weeks for outpatient services and just 45 days for Inpatient services.
Somil Nagpal | World Bank | Indonesia: Which means that I can just choose to join the program when I am about to need a service if i'm not part of the poor and from the formal sector, where the mandate is very clearly established, but then this means that there will be a lot of people who.
Somil Nagpal | World Bank | Indonesia: joined the program avail of episode, for example, a maternity or a plan surgery or any other kind of large cost, and then they stop paying.
Somil Nagpal | World Bank | Indonesia: So about 45% of the voluntary contributors are dormant in the sense that they have not been able to leaping their premiums and likewise a large part of the informal sector has already were enrolled yet, because it is, it is understood that, if there is a need.
Somil Nagpal | World Bank | Indonesia: At least in a non emergency setting it is an easy entry system, so this way the program ends up literally covering anybody who needs it, but only gets the premium from them during a shorter period and not regularly which creates a deficit situation for this voluntary group.
Somil Nagpal | World Bank | Indonesia: And this part is where there's an adverse selection and needs to be managed in the future.
Somil Nagpal | World Bank | Indonesia: Regardless to say that most countries will have tried to work with the informal sector face a very similar situation.
Somil Nagpal | World Bank | Indonesia: and Indonesia is no exception, and so most countries that did manage to cover the informal sector and had to use text based financing to cover the informal sector as well.
Somil Nagpal | World Bank | Indonesia: Thailand, for example, being a notable example.
Somil Nagpal | World Bank | Indonesia: So this.
Somil Nagpal | World Bank | Indonesia: This adverse selection is the main cause for the programs deficit, if you can look at the second graph on the panel, most of the groups.
Somil Nagpal | World Bank | Indonesia: Except for the local governments of city beneficiaries.
Somil Nagpal | World Bank | Indonesia: Most of the other group that seven sevens a private formal and even the poor and near poor are viable visa V, the premium collected and the claims paid, but the biggest.
Somil Nagpal | World Bank | Indonesia: problem with liability comes from this informal voluntary group, where the contributions are much smaller than the clean payments tactically because of this serving as a safety net function with easy.
Somil Nagpal | World Bank | Indonesia: By choice easy entry barrier created so this deficit ends up being bombed by the government and that's a $2 billion that we mentioned where where the.
Somil Nagpal | World Bank | Indonesia: challenge comes from this informal group of informal workers and non workers.
Somil Nagpal | World Bank | Indonesia: So one challenges on this, how do we, how do we cover the informal sector there's a de facto coverage of everybody in the informal sector because they can just come and pay a small amount and and start with a small waiting period.
Somil Nagpal | World Bank | Indonesia: And so the government is essentially doing de facto coverage, but but not regular premiums don't come for the rest of the informal sector.
Somil Nagpal | World Bank | Indonesia: The other problem is with the expenditure side, where the increasing share of hospital payments is is also a challenge and needs to be addressed in 2018.
Somil Nagpal | World Bank | Indonesia: Though only a third of all property or iPod encounters took place in hospitals, the hospital expenditure had gone up from about 76% or three fourths of the of the total expenditure when when jake and started to about 564 84% of the expenditures, so this is already.
Somil Nagpal | World Bank | Indonesia: compressing the space for primary care where the need for more investments.
Somil Nagpal | World Bank | Indonesia: So that also institutional coordination challenges to sort out, given the regulatory role of mo edge and the single payer.
Somil Nagpal | World Bank | Indonesia: How do they share their roles in determining the premium the benefit package settling provide a payment rates negotiating contracts and monitoring the quality of care.
Somil Nagpal | World Bank | Indonesia: is a function which requires much closer coordination and clarity on roles that would be another important area for the second division of reforms.
Somil Nagpal | World Bank | Indonesia: Let me skip this and just quickly say that.
Somil Nagpal | World Bank | Indonesia: A lot of work has been done an extensive body of analytical and advisory work has been undertaken.
Somil Nagpal | World Bank | Indonesia: by the Bank, and this has.
Somil Nagpal | World Bank | Indonesia: helped inform check ins and also more recently the design of our bank finance operation that has currently being submitted to our board.
Somil Nagpal | World Bank | Indonesia: there's a series of policy briefs on financial sustainability for jake and that also needs to help with some of these second division reform challenges and so there's a window of opportunity now this we are, we are partnering with the government to help prioritize the.
Somil Nagpal | World Bank | Indonesia: The key reforms that needed to be undertaken, particularly on the expenditure side and $400 million.
Somil Nagpal | World Bank | Indonesia: program for results program has recently been designed and submitted to our board.
Somil Nagpal | World Bank | Indonesia: This.
Somil Nagpal | World Bank | Indonesia: is combined with several other investment across the bank portfolio, including previous primary care program and an upcoming program on innovations for health service delivery, as well as a development policy operation related to human capital.
Somil Nagpal | World Bank | Indonesia: This is a very fortunate moment in innovations health sector were very reform centric teams are there across different stakeholders and also.
Somil Nagpal | World Bank | Indonesia: The challenges that the country has faced with the pandemic has also brought the health sector at the Center stage of policy attention, and so, in this context, the program is trying to focus on.
Somil Nagpal | World Bank | Indonesia: very clear quality of care and different pathways that are reinforced through the claims payment system.
Somil Nagpal | World Bank | Indonesia: ways to improve efficiency, putting claims management, improving policy formulation and implementation, improving provide a payments and oversight of the Program.
Somil Nagpal | World Bank | Indonesia: So i'll stop there will be very happy to discuss the questions as we move forward, but on this note I give it back to Jersey and to to sheila Thank you.
Jahanzaib Sohail: Thank you so so first thing we already have.
Jahanzaib Sohail: Over time, so we need to make some compromises so she moved over to you for giving us overview from the Indian Thank you.
Sheena Chhabra: Thank you very much.
Sheena Chhabra: I will try and keep to the time that I was allocated so i'm really delighted that, along with me, I have my colleague Dr Owen Smith and Dr idea tandon who are also participating in the webinar and.
Sheena Chhabra: You know so man has been a very integral part of the team and has seen the genesis of the health insurance schemes in India and i'm also delighted that he is there, so.
Sheena Chhabra: I would that I would like to quickly talk about the are huge one product that had monthly genaro be a huge now, which is a court in short called tmj, which is one of the major health sector reforms that India has seen in the last three years.
Sheena Chhabra: And I just.
Sheena Chhabra: You know, like to share what that reform is about and discuss that in detail, so this would be the largest and government finance.
Sheena Chhabra: health insurance scheme, you know, an interest of time I won't take too much time in terms of India, I think a lot of you on the line already know about that we are the most populous country second most populous country in India and in terms of.
Sheena Chhabra: You know, it has a structure of a federal and state structure with.
Sheena Chhabra: With about you know 28.
Sheena Chhabra: States and and fixed Union territory in terms of you know, if you look at the performance of the health systems, I think it does.
Sheena Chhabra: You know perform, of course, on many key indicators like.
Sheena Chhabra: Lower middle income countries.
Sheena Chhabra: But you know, there are in the indicators, you know which which we look at in terms of.
Sheena Chhabra: You know, on nutrition and financial protection in fact it lags its peers, so that, broadly in terms of.
Sheena Chhabra: You know the context, the government spending has remained pretty static, though, the overall spending has grown, but in terms of which has remained pretty static to about 1.1% of the GDP, which really could move to the next slide.
Sheena Chhabra: So you know, in terms of there is a very high out of pocket payments about 50% of the people rely on for payments.
Sheena Chhabra: In terms of the government programs, a lot of it is supply side, financing, whether we look at state programs, or we look at.
Sheena Chhabra: federal programs, and there is very, very high reliance on the private sector.
Sheena Chhabra: With over nearly two thirds of the health service provisioning happening in the private sector, where we look at providers, I think, if you look at public sector providers is high absenteeism for quality.
Sheena Chhabra: and, similarly, even in terms of private providers, I think it is very variable quality of services and, within that context i'd like to now share, about tmj and next slide please.
Sheena Chhabra: So, in the context of bmj you know where we look at health insurance team, there was southern states like can Africa and andhra Pradesh which had some early schemes that they had which will hundred percent financed.
Sheena Chhabra: by the state, and there were some early experiments with a private provision of health insurance and about 13 years back, the first federal scheme on health insurance was.
Sheena Chhabra: initiated, which is called our spy or the roster spots, to be my coach now.
Sheena Chhabra: This is something which you know, in terms of the currency mj I think there are many differences with that team, though, you know this was a federal schema with different states could participate, the focus of this team was.
Sheena Chhabra: To provide on the secondary care services and then as India moved along I think between 2008 and 2018 that decade, so are you know, in addition to the federal rfp wise team that focus on.
Sheena Chhabra: The secondary care it's also saw a lot of flowers bloom where different tastes broken and they brought in their own skates estates team.
Sheena Chhabra: which were you know working so separately from our spy, but a lot of their schemes we look at you know one.
Sheena Chhabra: unique feature has been that these have largely been you know fully tax finance risk protection schemes, which has had no contribution of the beneficiaries.
Sheena Chhabra: These have been focused on covering on hospitalization care these hadn't looked at participation of both public sector and private sector.
Sheena Chhabra: hospitals and had been targeted to the poor and the vulnerable populations, and then there are many states that are now expanding these two other population groups.
Sheena Chhabra: Against this backdrop of you know 20 States implementing the scheme.
Sheena Chhabra: You know, if we look at reforms it started with State then we had the federal scheme, then we last saw the expansion of the health insurance scheme with State, so what is seen as there's been back and forth with be between the.
Sheena Chhabra: Federal Government and Center where the reform momentum is concerned, but I think the bmj clearly I see what is coming out is the.
Sheena Chhabra: essence of india's federal system where the leadership and the anchoring of the team is now becoming more and more with bmj which expands the rsv by team, and also in terms of aims to improve you know, look at convergence with different States came next slide please.
Sheena Chhabra: next crisis.
Sheena Chhabra: You know, we a PNG recently celebrated its third birthday in September and what it does, is it covers the bottom 40% of the population which has.
Sheena Chhabra: Basically, identified, based on a socio economic class a cost sensors that was done in 2011.
Sheena Chhabra: Based on which you know there's deprivation criteria, there are about 500 million people who have been identified, who are entitled to.
Sheena Chhabra: tmj in addition to that several States had expanded the p amp G coverage and overall a PC there are about 700 million people who are covered under the tmj or tmj type of.
Sheena Chhabra: skin, since I mentioned that this is a federal scheme, the participation of states is voluntary.
Sheena Chhabra: Of the 28 States all but three states had joined the team all Union territories are part of the scheme, like the scheme in Pakistan, this is also portable across states.
Sheena Chhabra: So if I was there's a saying in today's but wanted to take a benefit of the same in Maharashtra it was possible for me to do so and, as I mentioned earlier there's only covered hospitalization care.
Sheena Chhabra: And there are about the 115 hundred secondary and tertiary benefit care packages, you know which are really look at bundled payment.
Sheena Chhabra: And our case it's bundled payment through which.
Sheena Chhabra: The services are provided and the p amp J, as of now, the outpatient services care is not included in tmj.
Sheena Chhabra: It is completely cashless it rides on a very strong it backbone right from pre authorization to you know, in terms of.
Sheena Chhabra: When the person is in the hospital to entire claim settlement all of that happens on the IT platform, it is completely cashless and covers about.
Sheena Chhabra: Over 20,000 hospitals, half of which are private hospitals which are entitled under the scheme and about half of them are public sector hospital.
Sheena Chhabra: The annual limit is based per household for hospitalization and is about $7,000 per per per household which, which is really you know, a dramatic increase.
Sheena Chhabra: Over you know 1714 increase overall spy that we have the scheme is managed by a special agency that was setup which is called the national health authority and at the State level, because you know, since.
Sheena Chhabra: Health is a state subjects in India, the implementation happens at the State level, this is matt you implemented at the state level by state health agencies and i'll talk a little bit more about that as we go along in terms of financing.
Sheena Chhabra: At all centrally sponsored scheme, the ratio of what the central Federal Government spends with the be what the state government spends for most states, the ratio is 60% at the Center and 40%.
Sheena Chhabra: Is a State share, however, you know, depending on some of these smaller states and Hillary states and Union territories, it could be even you know the Center may even be covering up to 90 200% of the.
Sheena Chhabra: Of the budget, there are no contributions or co payments, which are there by the beneficiary in terms of implementation, it is.
Sheena Chhabra: very interesting three years back, when there was a lot of discussion and you know the states are provided with the flexibility of what kind of mechanism do they want to use do they want to go with an insurance company or the fha themselves for my trust and they managed to scale.
Sheena Chhabra: A lot of the company states initially thought about going with an insurance company, but I think over time, the.
Sheena Chhabra: vast majority of the state has opted for managing this team by the trust mode, there are some states which actually use a combination of.
Sheena Chhabra: Both a trust and an insurance company model because you may experience has shown that a vast majority of the plane and really you know if there is a five lakh rupee coverage in under total.
Sheena Chhabra: Cover during the year, one finds that it's really up to one lakh that most of the.
Sheena Chhabra: Claims or to the year will fall under that so they have that covered by the insurance company, but it's about this threshold, you know.
Sheena Chhabra: household goes above that threshold, then this is something which, be a trust or the esoteric manages those.
Sheena Chhabra: Given that the capacity and I think that's another common theme that we thought.
Sheena Chhabra: capacity of the state is very variable they were some States which did have state level teams which was similar to this are in a much better capacity to manage this, but a lot of the States do have a third party administrator or tps which is used as a.
Sheena Chhabra: In terms of performance management next slide please.
Sheena Chhabra: So just you know, in terms of the architecture this summarizes what i've just said it's really the Government of India, or you have been at the State level, you have a trust or a society.
Sheena Chhabra: that's there that either manages it themselves or has an insurance company to manage this, there is a third party administrator which the insurance company or the trucks May.
Sheena Chhabra: contract and this reimburses the impaneled hospitals both government hospitals and private hospitals, there is no differentiation in the package rates which are offered to both of these hospitals and this does appear, you know work as a cash is king next slide please.
Sheena Chhabra: In terms of the building blocks a PC you know, this is the demand side financing scheme depending on where the patient utilizes scheme, you know the money is where.
Sheena Chhabra: It follows the patient, you know, in terms of there is also the purchaser and providers split because you know it's the trust and insurance company.
Sheena Chhabra: That really is the one that was making payments to the hospitals, were the beneficiaries are going to avail of these.
Sheena Chhabra: teams in terms of government hospitals and I think that this was a point to this in a previous in the previous presentation, where we talked about double dipping you know.
Sheena Chhabra: i'm just smiling to myself, because these are things that we have.
Sheena Chhabra: also seen in India, and there are a lot of discussions on inviting government hospital be paid the same amount of money, but what we have found, and we have done very detailed case studies on that and we'll be happy to share and it could be a.
Sheena Chhabra: subject matter of a separate webinar what we find that most of the money that goes to government hospitals, is all line item based there's very little flexible money that the government hospitals have.
Sheena Chhabra: And there are states that has successfully using the revenues that are generated from PM J and the previous.
Sheena Chhabra: team, which has helped to look at gaps in infrastructure, it has helped to look at gaps in HR, it is also been very useful to look at the wider base incentives for.
Sheena Chhabra: Participation in this team that that have been very useful in terms of actually looking at expansion of the benefits of the scheme and reaching back to the intended target audience.
Sheena Chhabra: As I mentioned earlier, there is explicit benefits package of over 1500 procedures and the entire claim management from pre authorization to.
Sheena Chhabra: Settlement all of that is done on an IT system which has you know it's a transaction management system that say several of the States which already we're implementing similar teams through api's they use the system, and whereas there are other states where we there's primary data.
Sheena Chhabra: That that is key, then within the system, and that is what is being used there's also a hospital in Panama and modules to which the hospital's get impaneled.
Sheena Chhabra: And and that's something which are you know is linked with the transaction management system also and there is the database that's there and I just show you in you know, in terms of how the beneficiaries get.
Sheena Chhabra: registered under the scheme of when they go and as we move on to the next slide next slide please.
Sheena Chhabra: So essentially what happens is you know you have a.
Sheena Chhabra: either to the bmj website, or there are Apps that are available or at the hospital level, you can access information to see whether you are into entitled beneficiary identified under the team or not after checking the.
Sheena Chhabra: Eligibility one can you know go to the hospital at the hospital level or two, there are other centers that are also available or through the website, one can verify whether one is a pma beneficiary or not, and can access the.
Sheena Chhabra: treatment in terms of hospitals all public sector hospitals, I mean you know as part of impaneled under PNG but the private hospitals have a hospital based module under which they get impaneled there are there are you know criteria.
Sheena Chhabra: which are very clearly laid out in terms of their participation in the.
Sheena Chhabra: program and in terms of hospitals, because you know in terms the access of hospitals and really with a you know, in terms of we do find that in tier two and tier three cities.
Sheena Chhabra: Access is limited and then our special incentives that are provided for hospitals, they have paid extra if they are part of.
Sheena Chhabra: You know that they get 10% extra, to the benefit package, if they are located in what we call an aspirational district, or which are the really the poor and the backward districts.
Sheena Chhabra: So there is extra payment to them, hospitals, also have incentive if they meet quality standards, so there are some basic minimum standards that need to be met, but over and above you know, there is.
Sheena Chhabra: There are standards which are laid if they are nadh activated hospitals, they get 10% extra and there's also within that there are two tiers that are there to 10 to 15% depending on which to.
Sheena Chhabra: Have hospitals day you could get extra money on that also since the medical college hospitals have better infrastructure and.
Sheena Chhabra: You know they have provided also an incentive for you know where they are provided with extra 10% over and above the best benefit package rates.
Sheena Chhabra: In terms of the claims the way what happens is the pre authorization.
Sheena Chhabra: The responsibility of that is that of the fha and the fha may have either the insurance company and the TPA take part, you know.
Sheena Chhabra: Look at the approvals, or it could also be implementing Support Agency, which is hired by the fha which means we'll come back and the entire process of looking at medical or days, looking at.
Sheena Chhabra: aspects related to fraud management, etc, all of that falls within.
Sheena Chhabra: The fha and.
Sheena Chhabra: There is also a strong grievance management.
Sheena Chhabra: setup i'll talk a little bit more about that as we go along, you haven't discussed this and the entire monitoring and all happen at the associate level for the state and overall.
Sheena Chhabra: Monitoring in terms of how the states are performing that happened at the national level mixtapes be.
Sheena Chhabra: A next letter P this lazy to our you know.
Sheena Chhabra: I won't delve too much into detail, but just wanted to say that one of the issues around sustainability of the team, you know, has been.
Sheena Chhabra: Right from the beginning to look at a strong Anti Fraud framework within bmj which looks at right from how do you prevent fraud and.
Sheena Chhabra: and part of the pre authorization strong IP system, having a very clear cut policy looking at institutional structures to looking at detection, where there is a global.
Sheena Chhabra: solution provider which P amp J has on boarded in SAS it has various tools for monitoring fraud right from facts and radar which is you know these are.
Sheena Chhabra: Comprehensive fraud analytics and control and tracking system tools.
Sheena Chhabra: There is a radar which really looks at the risk assessments and detection as a beneficiary level at the level of hospitals at the level of different kinds of procedures, etc, so there is a whole lot of analyses data analyses that happened to look at.
Sheena Chhabra: Those elements and, of course, the other part, is that.
Sheena Chhabra: With with the detection, what do you do you do also have to look at strong.
Sheena Chhabra: veterans measures in place which.
Sheena Chhabra: You know, in terms of.
Sheena Chhabra: P amp a shrine in terms of looking at.
Sheena Chhabra: You know how.
Sheena Chhabra: If you find hospitals, that are not complying how there is naming and shaming of hospitals are they being management and also suspension of hospitals, that may happen, and in some cases, which is very few they may be, also criminal action against that next slide this.
Sheena Chhabra: Is this is just to sort of demonstrate how there are different kind of dashboards which are there to look at the performance of insurance and TPA next slide.
Sheena Chhabra: The grievance aggressiveness mechanism, you know, there are multiple channels through which we went this can be registered, which are tracked both at the State level, as well as at the national level to look at.
Sheena Chhabra: You know how the complaints get registered and the complainant can actually view the status of the agreements in terms of what's happening.
Sheena Chhabra: happened to those and if any of the stakeholders be beneficiary hospital ice or ensure you know can can a large grievances make slightly.
Sheena Chhabra: Now, with all of this, I think the question, maybe, what does it cost if you look at the overall budget allocation it costs.
Sheena Chhabra: Less than one us billion dollars, which is you know, in terms of only about one sixth of what the national health mission.
Sheena Chhabra: Privacy mission in India costs and what we find that with you know, in terms of the code, I think the utilization has been much lower and.
Sheena Chhabra: Actually 50% of the budget is really unspent, and as we were talking about some of the challenges.
Sheena Chhabra: I think there are challenges around beneficiary awareness, because it's an entitlement based team, the SEC is not very widely understood and instead of that it's really something like.
Sheena Chhabra: A national food security or a ration card that is much better understood by a beneficiary, but for that one would have to expand the benefits to.
Sheena Chhabra: A much larger population since you're 40% you would have to go up to 65% of the population and you also, so there are issues around that there are also always issues around.
Sheena Chhabra: i've already talked about supply side issues, but also in terms of package way.
Sheena Chhabra: And are they you know adequate or not so, so there are some of those issues makes it.
Sheena Chhabra: So, and this is really.
Sheena Chhabra: Like that yes.
Sheena Chhabra: Yes, i'm just doing.
Sheena Chhabra: yeah yeah yeah so i'm defining up.
Sheena Chhabra: So, in terms of primary care, this is something which.
Sheena Chhabra: Are you know currently there is a complimentary program which is really supply side program with health and wellness Center.
Sheena Chhabra: which looks at the primary care aspects of this, in addition to that currently there's another program which looks at expansion of our health infrastructure for primary care that has been launched by the government.
Sheena Chhabra: Along with a special grants to local bodies for provision of our primary care and other 15 finance Commission that is being provided, so the primary care is being taken care by that.
Sheena Chhabra: You know, currently, given the complexity of purely looking at implementing of private.
Sheena Chhabra: Private primary care providers, we have not, this is there are some pilots that are happening, and there may be some packages, like the diagnostic packages, etc.
Sheena Chhabra: That have been covered.
Sheena Chhabra: But other This is something which is really a long term agenda well in terms of payment reform that we looked at.
Sheena Chhabra: So with that last life me.
Sheena Chhabra: I think.
Sheena Chhabra: In the end I just like to say that tmj is looking at our meeting public financing for hospitalization care to the pool through public and private in patient care.
Sheena Chhabra: and provides a lot of flexibility to the State to look at expansion in terms of the services that it provides, over and above the services provided under the bmj packages, the population that is covered and also, if you want to provide a higher.
Sheena Chhabra: cover and we'll cover than what the tmj provides there's also work that is happening currently in terms of consolidation of various fragmented.
Sheena Chhabra: With schools through several of the government sponsored schemes and that's something which is a work in progress, but you know we can discuss of any going back to me thank you very much.
Jahanzaib Sohail: Thank you very much Tina and so much for giving us wonderful presentation and definitely show everybody enjoying it so with this actually, I would like to mention that the first we have joined by Mr or shut.
Jahanzaib Sohail: up, who is director, as well as CEO of barrel sense on the program somehow we couldn't join us earlier because he was at the.
Jahanzaib Sohail: Prime Minister office and, secondly, we can start quickly the discussion we have already hooked up the time when we went over the time and may Lucas you for 10 more additional money as far.
Jahanzaib Sohail: Chris discussion, I would like to hand over for us valid and we can take lead and moderate the discussion part with the respect of visitors over to reference.
Faraz Khalid WHO EMRO: Thank you very much, as a real, I think.
Faraz Khalid WHO EMRO: Because of the shortness of time i'm thinking aloud that we can prioritize and seeing the messages in the chat box one main point i'm seeing any event before coming to that point, I think.
Faraz Khalid WHO EMRO: The definition of universal health coverage and the journeys which countries are taking, so these schemes these bottom of approaches, I think they're quite.
Faraz Khalid WHO EMRO: The same quite promising steps in the right direction.
Faraz Khalid WHO EMRO: But i'm sure that a country level, maybe program managers or higher level policymakers.
Faraz Khalid WHO EMRO: We don't cinema eyes these programs these schemes with UFC so they are means to it.
Faraz Khalid WHO EMRO: And then, as we define the program or planets scale a plan, I think the bigger UFC picture should be mind rather than tweaking.
Faraz Khalid WHO EMRO: The UFC definition or UFC concept as per se, as per the definitely the va the va program is designed, so I think that could be one common point of learning and but taking it further, I will see two points here one with regards to benefit package, the other is.
Faraz Khalid WHO EMRO: Strategic purchasing or provider payment methods and third could be possibly anywhere.
Faraz Khalid WHO EMRO: How do we wear that contract out the purchasing function to an insurance company one chance company multiple insurance companies.
Faraz Khalid WHO EMRO: Are that is a kind of responsibility, which should be with the public agency versus an autonomous industry versus private agency.
Faraz Khalid WHO EMRO: I don't think we would have time to get into the details of it, perhaps I can pick up one main point of quick discussion, which is about.
Faraz Khalid WHO EMRO: benefit package and I think I would pick up from attendance point very highlighted that Ben Ben our colleagues from said solar program federal and.
Faraz Khalid WHO EMRO: Our presenting that isn't impatient package and illnesses there's they are being provided by public providers in, so I think in the interest of time, the little I know about Pakistan, being a Pakistan, I will reflect on it that anything I think.
Faraz Khalid WHO EMRO: On paper, that is the case, but frequent stock outs lead to, and I will give example let's say if a patient needs a basic orthopedic fixated or if I take it, higher.
Faraz Khalid WHO EMRO: A stent in a hub, so in that case above the provider will not charge for doctors see bed fee or nursing care they're very minimal user charge at the time of admission.
Faraz Khalid WHO EMRO: But the patient would be required to pay out of pocket and usually purchase from the market may be a hard stand or a basic orthopedic fixture.
Faraz Khalid WHO EMRO: So I think that is the starting point, but then the question comes, which I think Michael and justin we're raising.
Faraz Khalid WHO EMRO: That unity, we know that from other countries analytical work that for even Buddhists have separate into society so is.
Faraz Khalid WHO EMRO: Our illnesses requiring hospitalization do they need to vote catastrophic expenditures versus outpatient care and long term care, especially requires medicines.
Faraz Khalid WHO EMRO: So so so my question in this case, would be to set solar program managers and not be the same question not only that what was the starting point, I understand there were some based on studies conducted.
Faraz Khalid WHO EMRO: In Pakistan, specifically around below poverty houses and what were the results were they different from other low building country literature and, if not so or what were the key points under consideration for policymakers when they were picking ill patients.
Faraz Khalid WHO EMRO: illnesses requiring hospitalization and then further going on.
Faraz Khalid WHO EMRO: Is PFC supplies David system to public sector is it too strong, to take care of.
Faraz Khalid WHO EMRO: The OBD illnesses was that the case or in my last point here is that is there an institutional mechanism in place to decide on.
Faraz Khalid WHO EMRO: To what next would be added, is the benefit package, and what are the criteria how's the decision making done, because I know that in kp says so that, to start with transplants we're not there.
Faraz Khalid WHO EMRO: rena crossbones or others so so, what was the decision criteria House were deciding, and what is the mechanism around it, so perhaps.
Faraz Khalid WHO EMRO: In the interest of time estimate, probably for our discussion around benefit package so.
Faraz Khalid WHO EMRO: Let me first reflect our sense of the program cody's either federal or TV to reflect on it, and then I will request colleagues from both India and Indonesia to reflect on their experience and what could be the learning points, so let me see.
Faraz Khalid WHO EMRO: lauren and others do we have colleagues from sets of the program I know I should has joined or others.
Faraz Khalid WHO EMRO: who want to reflect on it.
Faraz Khalid WHO EMRO: Please God.
Dr Riaz Sonia - SSP Pakistan: Obama double to.
Dr Riaz Sonia - SSP Pakistan: almighty accepted or not.
Dr Riaz Sonia - SSP Pakistan: First of all, apologies, I was stuck in the same House for some.
Dr Riaz Sonia - SSP Pakistan: As you, you will important.
Dr Riaz Sonia - SSP Pakistan: governmental meeting with regard to the same program actually we were in the face of finalizing the procurement for the universal health insurance phase three starting from January March.
Dr Riaz Sonia - SSP Pakistan: So i'm thankful to all the participants here and my cody that does is already given you a presentation on the progress or overview of the program a couple of questions I saw in the chat box I think Ross and rest of the team members.
Dr Riaz Sonia - SSP Pakistan: throw some light on this, but I just would like to add a couple of things.
Dr Riaz Sonia - SSP Pakistan: A we understand at this scale is a unique program, especially in our part of the world, and if you see globally, we are the first generation first nation of this size 44 million plus was going for the government funded universal health insurance coverage.
Dr Riaz Sonia - SSP Pakistan: People often ask me within Pakistan at the policy level policy circles at the donor side international stage is your how.
Dr Riaz Sonia - SSP Pakistan: You see, the sustainability of the program, both in terms of the financial sustainability service and service delivery and, last but not least is from the legal perspective.
Dr Riaz Sonia - SSP Pakistan: how you see it financially viable, let me give me just one glimpse I saw one of the questions in the chat box currently.
Dr Riaz Sonia - SSP Pakistan: Pakistani Government when I say governments miss any government to digital government and for provincial gardeners are seven governments, we are spending it for the 2021 budget estimates, around 650 billion rupees on the healthcare.
Dr Riaz Sonia - SSP Pakistan: And for our upcoming phase three universal health insurance program the budget estimate, we see is around in the vicinity of around 180 to 200 billion rupees which counts almost 30% of the budget in within the 30% of budget if we can provide a free.
Dr Riaz Sonia - SSP Pakistan: and affordable health insurance coverage, while the citizens of Pakistan, I think there's a very much sustainable with the restaurant downtown nashville the.
Dr Riaz Sonia - SSP Pakistan: policy makers can allocate the funds to work with regard to the Community health services primary healthcare chronic medication and other avenues be.
Dr Riaz Sonia - SSP Pakistan: Of the tribal areas of Pakistan, two years ago, when we universalised it and, by the way, is new.
Dr Riaz Sonia - SSP Pakistan: Ignoring that is one of the most backward area on the Afghanistan border.
Dr Riaz Sonia - SSP Pakistan: And last two years, two years more than.
Dr Riaz Sonia - SSP Pakistan: 30% of new healthcare facilities in my area by Bible.
Dr Riaz Sonia - SSP Pakistan: verse to.
Dr Riaz Sonia - SSP Pakistan: expand the solar program, including on the.
Dr Riaz Sonia - SSP Pakistan: premise.
Dr Riaz Sonia - SSP Pakistan: is going to join us in their future next year, they have all the bumps down will be covered under the same car.
Faraz Khalid WHO EMRO: vc.
Faraz Khalid WHO EMRO: Alright, no worries, so I think anyone from keep he said, so the program want to come in and comment specifically around the benefit package.
Faraz Khalid WHO EMRO: I should, is back I should do you want to comment coming briefly sorry we can't hear you.
Faraz Khalid WHO EMRO: you're muted.
Dr Riaz Sonia - SSP Pakistan: Let me unmute yourself I hope.
Faraz Khalid WHO EMRO: Yes, please yes.
Dr Riaz Sonia - SSP Pakistan: With the package.
Dr Riaz Sonia - SSP Pakistan: Within the Inpatient services spectrum, we are covering our most everything except the implants in the trust transplants and transplants, we have already started in kp and now we are reading for the phase three of the federal areas in Punjab areas is.
Dr Riaz Sonia - SSP Pakistan: So, starting with a kidney then we'll be following to the liver and other task plans as well, in due course.
Dr Riaz Sonia - SSP Pakistan: What I foresee.
Dr Riaz Sonia - SSP Pakistan: Being a health insurance expert or the House manager that in days to come, more and more, the services currently outside the heritage was tremendous appetite is maybe tuberculosis.
Dr Riaz Sonia - SSP Pakistan: Or maybe diabetes, which are the chronic medication or specialized particular programs are functioning in due course, they will be part of this benefit package so through.
Dr Riaz Sonia - SSP Pakistan: One vehicle, we can deliver our ordinary citizen other services Just to give you one example, an interesting example, with regard to the upcoming benefit package.
Dr Riaz Sonia - SSP Pakistan: kp government has already adopted that model we have already created in addition of the basic health coverage and excess of last health coverage, we have introduced a reserve fund provision is.
Dr Riaz Sonia - SSP Pakistan: So government as an when needed can add up any disease or any coverage in the benefit package Just to give you, in the current drop of the Corbett.
Dr Riaz Sonia - SSP Pakistan: If we had already this provision government has to announce only wanting more to give one instruction to the program or to the other service providers in the health card.
Dr Riaz Sonia - SSP Pakistan: Is quickly discovered and you don't need to create any specialized hospitals for death metal and you can provide pandemic services across Pakistan in more than 550 plus hospitals.
Dr Riaz Sonia - SSP Pakistan: within days to come, when we are launching this project from January 145 December of this year, any future such tuition will also be managed, who are more flexible benefit package design coming in the days to come.
Dr Riaz Sonia - SSP Pakistan: And the pastry.
Faraz Khalid WHO EMRO: Thank you, I think that is.
Faraz Khalid WHO EMRO: Very good.
Faraz Khalid WHO EMRO: I think that this this is such a rich in interesting discussion and I was seeing comments on the same point by Owen Smith reflecting on.
This point of.
Faraz Khalid WHO EMRO: How we can, if you're targeting expenditures what could be a more efficient way to do it, so I think this each side of this this whole.
Faraz Khalid WHO EMRO: Discussion requires that probably a separate seminar, and I think our country colleagues will be in touch with the.
Faraz Khalid WHO EMRO: More with sense of the program that on which specific areas do they think there could be some such peer to peer learning.
Faraz Khalid WHO EMRO: So I think this was first of the webinar sees which was trying to shed light on the bigger picture, but we can put have succeeded have some focus.
Faraz Khalid WHO EMRO: sessions of different aspects of the program so with this, I think I will hand over back to jeezy because I understand you're already done with 10 minutes leave a record from the participants and we already have a jira for quick closing remarks vacuity.
Jahanzaib Sohail: Thank you, thank you for us yeah considering the time limitation.
Jahanzaib Sohail: And also interest from the audience, so we can have a follow up session, where we can have a detailed discussion and, from my point of view i'm very much interested to know how we can.
Jahanzaib Sohail: come up with the sustainability of this program considering the physical space for help, but now handing over to a Jay who is our lead economist health, nutrition and population South Asia region for is going to order.
Ajay Tandon, World Bank: Thanks thanks very much Jay Z and I won't take up too much time, I think.
Ajay Tandon, World Bank: Several of the points that I was going to make have already been made very eloquently by by far as just a just, I think you also.
Ajay Tandon, World Bank: advertise the joint learning network right that the real surface of the joint link building network is to facilitate these kind of peer to peer learning discussions, and you can see that many countries in Asia are making steps towards universal health coverage.
Ajay Tandon, World Bank: A lot of similarities and how they're doing so, but also some important differences in in how they're implementing and and and the key is to really learn from each other and to avoid mistakes that other countries may have made.
Ajay Tandon, World Bank: And I think one of the points that I wanted to to underscore is that many of these reforms, like in Pakistan and India, they are not just reformed about.
Ajay Tandon, World Bank: Financial protection there also reforms in how providers have paid, so you know it's moving away from traditional supply side, financing to now being provided from the demand side and also enabling.
Ajay Tandon, World Bank: The architecture that brings in private provision with public financing, we have a lot of capacity in all three countries in the private sector and, as such, architectural reforms can enable.
Ajay Tandon, World Bank: You know leveraging that capacity for for for for enhancing public goals like universal universal health coverage and and there is evidence in Indonesia and in to some extent that you know that it also these these programs help.
Ajay Tandon, World Bank: Reduce for gone care for one hospitalizations when people knew that they had coverage, we saw an uptake in in hospitalization coverage.
Ajay Tandon, World Bank: But I want to, I want to underscore the point that you know that it's not just enough to do hospital coverage and as companies move forward.
Ajay Tandon, World Bank: should also consider either strengthening primary healthcare, together with these financial protection team, though, I think.
Ajay Tandon, World Bank: Michael borowitz made a very interesting point that you know let's not forget that you know if you want to have renal.
Ajay Tandon, World Bank: transplant and dialysis you should at the same time, make sure, either as part of this, the scheme.
Ajay Tandon, World Bank: or preferably as part of the scheme, but other other schemes that you're you have good diabetes coverage good coverage for hypertension and the primary care level.
Ajay Tandon, World Bank: And they are that you're also tracking To what extent are you paying for hospitalizations that are caused by what what I call ambulatory care sensitive conditions right conditions for which, if you had good primary care, you would not.
Ajay Tandon, World Bank: You would minimize the need to be to be hospitalized and and and to the extent possible, where public financing is limited to really use that to target the poor of several of the countries are doing.
Ajay Tandon, World Bank: but also to pay attention to, not just in terms of how providers are paid or what's the benefit package is.
Ajay Tandon, World Bank: but also on how much you know how much outlays are there, because then in many countries, we have seen that the promises are they're not adequately finance and that creates a whole new set of additional problems.
Ajay Tandon, World Bank: That should be avoided, so to also pay attention to to the unit cost thing to do what what is being reimbursed that we don't want to have a program for the poor, that is poorly finance.
Ajay Tandon, World Bank: Is is is one thing I would like to leave you with an even more important to have such programs, given the impact of coben, not just on health, but also on the economy's rising poverty rates in our region and and also.
Ajay Tandon, World Bank: increasing vulnerability so clearly steps in the right direction, you know, we have the.
Ajay Tandon, World Bank: The ignoble title of being the region with the highest out of pocket spending so hopefully we now are moving towards the trajectory where we are no longer with number one.
Ajay Tandon, World Bank: In out of pocket commencing but are moving toward having having much more service coverage, as well as financial protection so back to you and hope we can continue this dialogue JC and others, thank you very much.
Jahanzaib Sohail: Thank you, is it absolutely, we would like to continue this so.
Jahanzaib Sohail: We are really over 18 minutes and now.
Jahanzaib Sohail: On the behalf of SF he Pakistan and jalen we are again thankful to government of Pakistan, particularly the set similar program all the presenters and organizers and participants.
Jahanzaib Sohail: Who been so much active and come up with so many questions we try to come up with another webinar to have a detailed discussion some so thank you very much once again and let's end the session, thank you.
Sheena Chhabra: Thank you.