The notion of access to health care in a large-scale social health protection initiative: a case study of ‘Sehat Sahulat Programme’ at Khyber Pakhtunkhwa, Pakistan

Background Sehat Sahulat Programme (SSP), a health insurance initiative, was launched by the Government of Khyber Pakhtunkhwa (GoKP) in Pakistan to improve access quality services. In this paper, we describe notion under SSP, present stakeholders’ views on access-related challenges, and suggest ways forward realise SSP’s objective broader context its contribution towards Pakistan’s drive achieve Universal Health Coverage (UHC). Methods We employed case study design approach using three data sources. used official GoKP programme documents capture chronology events (policy interventions), in-depth interviews explore drivers behind non-participant observations understand decision-making implementation processes. maximum variation sampling. Access observation sites gained through SSP director. recruited interviewees direct indirect approaches conducted thematic analysis. Findings engaged State Life Insurance Corporation (SLIC) as purchaser. SLIC purchased services from public private hospitals for patients, up 600,000 Pakistani Rupees (PKR) per family year. Considering coverage, officials claimed made care accessible, which development partners contested. Instead narrow finance-centric definition GoKP, highlighted dimensions access, including services’ acceptability availability. Tensions existed between interpretation stakeholders different access. For instance, that improved availability, but noted an under-supply providers remote districts province. Bridging such undersupply, inter-district referrals, patient advocates led travel costs geographical barriers. Similarly, had good acceptability. The damaged limited choice, low package rates, delayed claims payments. Conclusions This analysis suggests challenges with needed address. A key transferrable lesson is demand-side intervention (insurance) might not weak supply side. Therefore, countries contemplating improving enroute achieving UHC need address both considerations.