Pakistan - Innovative Financing For the Poorest of the Poor

With the support of the donor community, and the strong culture of philanthropy available in Pakistan, there is now a real opportunity to help the poorest of the poor with their healthcare needs - and demonstrate to the world Pakistan's leadership in this field.

The current floods in Pakistan once again have put enormous pressure on Pakistan's creaking health system - compacting on last year's floods, which were themselves described as unprecedented at the time. These have been major blows for our people - and our country, which seems to suffer more than most from environmental disasters and human security issues.

A country of nearly 190 million people, of whom at least 25%t live below the poverty line, 19% of the population is malnourished, including 30% of children under the age of five. The renewed floods are bound to add to these disturbing figures, with increased risk of water-borne disease, such as diarrhoea, which can have devastating consequences for young children.

The main burden, of course, falls on the poorest of the poor. Less than 26% of the population is covered for health care costs. Even in government-financed public facilities, a patient is expected to cover expenses such as user's charges, medication and consumables. And these charges are way out of the range of the very poor. They spend catastrophically, become indebted and are pushed into the medical-poverty trap. Many also forego treatment. Statistics show that healthcare costs are the most common cause of economic shocks faced by households. Most mixed health systems in developing countries face problems similar to Pakistan. More than a 100 million people become impoverished and a further 150 million face severe financial hardship as a result of health cares payments, globally.

Health equity funds can protect the poor against medical impoverishment, especially so when the insurance option is unavailable, unviable or does not fully cover healthcare costs. This approach is being used by us in our program, Heartfile Health Financing (, a system which is expanding the use of mobile telephony for health. In many developing countries, the mobile phone is becoming the information portal for healthcare workers. In Pakistan, I believe we lead the world in taking the use of mobile telephony to a new level - in developing a system to help fund the healthcare expenses of the poorest of the poor.

This is being accomplished through a recently established web-accessible technology platform and health equity fund, allied to a proper system of validating poverty and prioritising patients--the three components of Heartfile Health Financing. Requests for assistance by health workers, on behalf of a patient, can be made through an SMS template - but also by fax, telephone and letter. The technology platform has many unique features in relation to processing requests, targeting assistance, eliminating abuse, institutionalising accountability and empowering donors.

Once requests for assistance are received, the validation system swings into action. Phone calls can be made to friends, neighbours and family members - with the final step being the patient's unique identification number on the national database where all citizens are registered. The essential criteria is that only the poor and deserving must benefit - and payments are made at a level where health costs exceed 40 % of a household's capacity to pay in any one year. The system has also been configured to ensure that donors can view the use of their funds on a transaction basis- not least the administrative costs incurred. In fact, donors can track every penny they give.

The new system, is working in three hospitals, in Islamabad and Rawalpindi, Pakistan's twin cities. The number of patients seeking support is growing apace. Instead of waiting for months for a heart operation - which in itself can be fatal - a patient can be funded for surgery within days of the original application. Poor women who previously ran the risk of being taken away from the hospital bedridden for life because families could not pay for hip operations are being helped. And there are many many more.

These are initial steps on a long road - but there is no limit to the potential of this system. The technology infrastructure has been created with scale-up as a main consideration. Indeed, Pakistan's telecommunications infrastructure allows it to be used in even in the remotest areas of our country - and without the need for extensive and expensive field operations. This means that we can eventually take this system to all corners of our country.

Pakistan's impressive mobile teledensity makes mobile telephones a ubiquitous communications device, which can be leveraged for further health financing.

With the support of the donor community, and the strong culture of philanthropy available in Pakistan, there is now a real opportunity to help the poorest of the poor with their healthcare needs - and demonstrate to the world Pakistan's leadership in this field.

Dr Sania Nishtar is the President and Founder of Heartfile Health Financing, and the recently launched Sania Nishtar Health Fund which supports it.

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