INSPIRE Pakistan

Informing the Social Health Protection Initiative through Rigorous Evidence


Dissemination of the needs assessment for the OPD insurance scheme

During their recent stay in Pakistan, the research consortium invited all key stakeholders of the SHPI Phase 2 project to a dissemination workshop that was held in Peshawar on June 1st. This was a great opportunity for the research team members to present the first major deliverable of their research: the needs assessment for the OPD insurance scheme.

To involve the key stakeholders and the members of the research consortium who could not travel to Pakistan, the meeting took place simultaneously in person and online. The event started with opening remarks by Dr. Khalid Rehman (KMU) and the KfW representative Dr. Masuma Zaidi, followed by a presentation by Dr. Poul and Dr. Irum Sheikh on the progress of m4h OPD scheme design. Prof. Dr. Andreas Landmann (FAU) provided relevant background information about the research project , which, as presented here, aims to provide scientific evidence in support of the implementation of the SHPI phase 2. Following his introduction, Maira Shaukat (HIGH), Alina Imping (FAU), and Dr. Lisa Rogge (FAU) presented the main results of the needs assessment, the first major research activity and focal point of the meeting.

As presented by Alina Imping, the objective of the needs assessment was to better understand future beneficiaries’ health needs and their preferences regarding the OPD insurance scheme design. The data collection took place in four pilot districts in Khyber Pakhtunkhwa province between December 2021 and April 2022. The first wave of the population panel consisted of a household survey and provided data on the current status of health care utilization. These were combined with additional information from qualitative focus group discussions with future beneficiaries on the care-seeking process and on access barriers to OPD utilization. The qualitative group also included supply-side perspectives by conducting in depth-interviews with physicians. Finally, the population panel group assessed insurance preferences via a discrete choice experiment.

Alina Imping and Maira Shaukat continued the presentation providing an overview of the needs assessment main findings. The research team found that OPD care utilization is high among potential beneficiaries, but many visits only pertain to receiving medication, without diagnostics and consultation fees. Thus, complete care is often not received. Importantly, frequent OPD expenditures pose substantial financial burden, as suggested by the fact that costs are the major reason for forgone care. Also, the results highlight that widespread misinformation on health issues exists and that despite OPD facilities being within reach, substantial costs have to be borne, often leading to non-adherence. Further, respondents report long waiting hours in public secondary facilities. Dr. Lisa Rogge proceeded presenting the results regarding the insurance package preferences. These suggest that provider types play the most relevant role for potential beneficiaries, followed by health conditions and services covered. Respondents strongly prefer having also higher-level care providers and telemedicine covered. Finally, transportation as well as addressing chronic diseases seem central matters to respondents.

Overall, the findings indicate an urgent need for an OPD scheme based on the unmet needs for health care and the high costs associated with OPD care-seeking in the target population. In addition to relieving financial hardship, there is the potential for the scheme to eventually increase trust in the system to cater to population needs as well as to facilitate adherence.

The presentation was followed by an active discussion, which the key stakeholders used to pose questions and exchange ideas, allowing the research team to gain useful feedback for the upcoming research steps. Dr. Poul Thim (m4h) thanked the research team for the effort and underlined the relevance of the findings related to health care utilization barriers and beneficiaries’ preferences. Dr. Zohaib Khan (KMU) emphasized that that the research consortium is highly committed to cooperate with m4h and the program, responding to their needs and communicating the research approaches and possibilities. Dr. Masuma Zaidi (KfW) also appreciated the work of the research group and encouraged for further collaboration. Overall, the meeting represented an important occasion for the research team to share their first findings and obtain useful insights, and the whole team is now looking forward to the next steps of their research.

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