Muhammad Hanif (36 years of age) owns a mobile phone repairing shop in Bara bazar, district Khyber. Every two weeks he would have to close his shop for a whole day to take his wife to the hospital for a medical checkup. His wife was pregnant, but the situation was different, a bit more challenging to her health this time. The gynecologist had told him that his wife will need to undergo a Cesarean surgery to give birth to their third child.

Hanif recalls, “We were worried. It was an expense of around a hundred thousand rupees. Earnings from the shop weren’t enough to bear this additional burden. Things have changed a lot recently, traditional mobile phones are being replaced with smartphones and that has made repair very complicated, as it requires skills and training in dealing with the software issues. I couldn’t adapt to these changes which has already reduced my daily earnings, and general circumstances in the region over the past few years have affected my financial condition even further.”

Like all the people from the area, his family had to face temporarily displacement, they were moved to Peshawar. Hanif reminisces, “Those were hard times, shutting my shop meant I was deprived of my regular income. We had to rely on some savings, and we were under the burden of debts, as living in Peshawar was far more expensive compared to living in our own village. It took us almost one and a half year to get back to our home and reopen the shop.”

He came to know through one of his relatives in Peshawar that as a resident of district Khyber he was eligible for the Sehat Insaf card. Everyone with a permanent address from any of the seven merged districts on his national identity card is eligible for the treatment of his own or any of his family members under the program.

Soon, he was heading towards a private medical facility while holding his Sehat Insaf Card. All the expenses during the treatment were covered. Hanif adds, “We were blessed with a son. On getting discharged from the hospital, they reimbursed the charges of initial tests and gave us one thousand rupees for transportation back to our village.”

Free medical treatment to the residents of Merged Areas is covered under the Sehat Sahulat Program (previously known as Prime Minister’s National Health Program). It was initiated by the Ministry of National Health Services, Regulations and Coordination (NHSRC) in collaboration with Provincial governments.

Khyber Pakhtunkhwa had already introduced the Sehat Sahulat Program since December 2015 when the previous Pakistan Tehreek-e-Insaf (PTI) government initiated the Social Health Protection or Sehat Sahulat Program with the financial support from German Government through Kreditanstalt für Wiederaufbau (KFW) Development Bank.

In the beginning, it covered four districts, Mardan, Malakand, Kohat and Chitral which is 21 percent of the province population. Owing to its success, it was extended to other districts, covering 64 percent of the population and targets targeting 3.2 million families.

When PTI rose to power in the center, it took it to rest of the country. This year, in February, Prime Minister Imran Khan extended it to Merged Areas with the announcement of a special package for the region. It is being implemented through KP government.

The package includes in Patient Services (All Medical and Surgical Procedures) of total of Rs. 720,000 provided per family per year, with breakdown of Rs. 600,000 for primary and 120,000 for secondary level treatment. It is double the amount allocated in the rest of Khyber Pakhtunkhwa where Rs. 250,000 are allocated for primary and Rs. 50,000 for secondary healthcare. Also, under the special package, residents of these districts can get treatment in more

than one hundred hospitals empaneled in Khyber Pakhtunkhwa as well as all the hospitals across Pakistan that are listed under the program at federal level. 

The facilities are provided through State Life Insurance Corporation of State Life carried out an assessment of the available public and private health care facilities according to standards defined by the Health Department.

Sitting in Haji Sher Rehman hujra at Lohar Garhai in Alam Gudar village, Bara, district Khyber, elderly villager Shamsul Haq narrates his story, “I had my Angioplasty at Peshawar Institute of Medical Sciences under Sehat Sahulat Program. It was a few months back, when I had a chest pain, checkups with the doctors revealed that I had a heart attack due to clogged arteries. They recommended Angioplasty.”

“It is an expensive procedure, that is not affordable for us, but Sehat Insaf Card made it easier for me to get through the treatment and have two stents were placed in my arteries.” In the past few months, the provincial government has taken on the issue of slow distribution of Sehat Insaf cards in all the Merged Areas. Political representatives and district administrations have started organizing events and collection points have also been increased, so people can get their cards from the nearest place. In December two separate events were held in in North Waziristan and Bajaur districts. At the event in Bajaur, it was said that 24,000 new Sehat Insaf Cards have arrived Bajaur districts and could be collected from specified locations for all the tehsils.

To build the capacity of the medical facilities in the Merged Areas, district headquarters hospitals are outsourced based on public private partnership, so the process could be accelerated and unnecessary delays in recruitment of staff and procurement of equipment could be avoided. 

Yaar Zaman, an octogenarian from Mirdad Khail tribe in Landi Kotal, district Khyber recall his childhood memories when they would have minor injuries and a local medical practitioner Aziz would offer treatment in exchange of agricultural commodities or domestic items like eggs when they had to travel on mules to get to the bazar for treatment. “Now, medical illnesses are way more complicated. Recently, I came to know that one of my sons, who is a heart patient, needs two to three hundred thousand rupees for an operation. This was both shocking and depressing.”

“How someone can manage to pay such a huge sum of money for a one-time treatment?”

Luckily, someone told them that they had to check their names in the Sehat Sahulat Program. “Fortunately, our names were listed. And he got all the treatment free of cost.” “When you can manage expenses, worries that come with the illness are reduced. This is such a huge relief for people like us” said Yaar Zaman.