Rationale of the pilot project: in a poverty perpetuating and precipitating context, economic shocks involving catastrophic spending are the most common risks facing households in Pakistan. “Spending catastrophically” means spending of critical savings, selling assets, relinquishing basic needs and/or borrowing in order to finance healthcare through out-of-pocket payments. Two thirds of the households recently surveyed in Pakistan reported that they had been affected by one or more health shocks and had spent catastrophically during the last 3 years. Since the breadwinners of most of these poor households are in the non-formally employed sector, there are difficulties in using insurance as a means of protecting them against the risks of economic health shocks. The other feasible option to protect against catastrophic spending is to enable cash transfers from a “social protection” or “health equity fund”. Pakistan’s existing social protection mechanisms for health have a very small envelope and suffer from a number of deficiencies, including abuse and patronage in targeting, unpredictability of coverage and lack of transparency in the use of resources.
The approach adopted: this project involves an IT-supported, automated demand side health financing instrument (this website) that can be accessed by local health care workers to seek urgent support for those running the risk of spending, catastrophically. This website is integrated with a custom-made technology platform that enables processing of requests, received through registered service requesters. Heartfile (the clearing house) will then ascertain eligibility, verify requests and subsequently authorize cash transfers to underwrite the cost of healthcare.
The pilot is envisaged to enable efficient, timely and well targeted cash transfers to protect the poor against catastrophic spending on health and has the potential to limit abuse. In addition, a seed “Health Equity Fund” has also been established as a means of resourcing cash transfers.
What is innovative about this project?
This system has been designed to eliminate duplication and abuse; additionally, it reduces opportunities for patronage because of the reliance on multiple checks to ascertain eligibility as opposed to reliance on one criterion, as is currently being done in the country’s social protection system. In comparison with other social protection systems established by the private sector in the country, this system will provide better visibility to donors. It has been configured to ensure that donors have the ability to view the use of their funds on a transaction basis and have the ability to instruct demand-specific use of their funds. The system also enables donors to have full view of the administrative costs incurred and above a certain category, enables them to request for audit of any transaction or demand processing. As such therefore, this platform is unique even by international standards and offers unprecedented advantages.
How will we assess impact?
The technology platform and option for funding is currently being made available to selected sites in a pilot setting and is being evaluated in a randomized controlled design. A number of outcomes of interest have already been defined.