Strengthening Primary Health Care and Social Protection: Universal Coverage in Pakistan through Heartfile Health Financing

One of the poorest countries in the world, Pakistan has been afflicted by both societal turmoil and natural disasters during the past decade. The resulting decline of an already-frail economy has made inequalities even more prominent. This development has acutely affected the health sector, which bears the burden of care for the poorest and is suffering from an increasingly dire loss of public funding. In order to address the country's woefully inadequate system of health care for the poor, the Pakistani health policy think tank Heartfile has developed an innovative model of health financing. It consists in enrolling health facilities (mainly in the public sector) to join together in order to provide catastrophic health coverage to the poorest. The Heartfile Health Financing (HHF) model has a technology interface that assesses a patient's poverty status and verifies it through linkage with a national database. HHF has been working at the tertiary care level so far, but is intended to cover primary care as well. This grant will enable an assessment of how the present model can be scaled up the primary care level. Using interviews and group discussions from the beneficiaries and non-beneficiaries of HHF, this assessment will help improve the model and adapt it to the primary care level. Ultimately the project aims at having HHF contribute to the goal of universal health coverage in Pakistan. The process of assessment in this project will include a significant component of capacity building for the organization's staff, particularly in the area of research. The provision of training in research methods and support for more formal training (such as doctoral training of staff) will help ensure that research systems are in-built and ongoing as HHF scales up to the primary care level.