The federal government of Pakistan has decided not to provide funding for provincial health coverage, including insurance schemes, in accordance with the 18th Constitutional Amendment.
Provinces have been advised to explore full-fledged contributory health insurance models to support healthcare services for their populations.
The decision follows the continuation of the Sehat Sahulat Programme only for selected federal territories, with no extension planned for provincial populations.
The programme, with a revised cost of Rs. 40.2 billion, has been extended until June 30, 2027, but is now limited to the Islamabad Capital Territory, Azad Jammu and Kashmir (AJK), and Gilgit Baltistan (GB).
Provincial Inclusion Not Supported
Internal proposals to include Sindh’s Tharparkar district under the programme were rejected by the Central Development Working Party and the Executive Committee of the National Economic Council (ECNEC).
Officials argued that including even a single provincial district could set a precedent for other provinces, noting that health is a devolved subject after the 18th Amendment.
Programme Lifecycle and Recommendations
The Sehat Sahulat Programme, launched in 2015, had completed its lifecycle on June 30, 2025, following multiple extensions. A special committee formed by ECNEC recommended shifting the programme to the recurrent budget rather than continuing it as a development project.
The committee directed the Ministry of National Health Services to submit a project completion report and propose a limited structure to sustain indoor healthcare services for vulnerable populations, consistent with the programme’s original intent.
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It also recommended that provinces, along with AJK and GB, should continue or develop their own social health protection schemes through their respective budgets.
Extending the federal programme to provincial districts was opposed due to the already overstretched Public Sector Development Programme.
Future Plans for Contributory Health Insurance
The committee suggested that after moving the completed project to the recurrent budget, the health ministry, in coordination with provinces, could design pilot schemes based on claim co-payments, similar to Punjab’s model. This could serve as a foundation for a full-scale contributory social health insurance system.
Background of Sehat Sahulat Programme
The programme was originally approved on February 7, 2018, under the Prime Minister’s National Health Programme Phase Two, at a cost of Rs. 34 billion, targeting families living below the poverty line using data from the Benazir Income Support Programme (BISP).
Over time, the scheme expanded through multiple revisions.
In August 2019, the federal government stopped provincial contributions for priority care treatment, citing the spirit of the 18th Amendment. The programme formally ended on June 30, 2025.
