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The case for health insurance


December 22, 2019

At the government and the individual level, Pakistan is warming up to the idea of health insurance with the government creating systems for underprivileged beneficiaries and citizens realising the importance of having a plan B in case of an illness

Inflation does not only affect the cost of using tomatoes in the curry or air conditioning in summers. It also affects our choices when it comes to health. Can I procrastinate on this blood test? Must I go to a specialist? Why can’t I just look up my symptoms on Google and buy off-the-counter antibiotics? If the gall bladder pain is not killing me, let us delay that surgery. These questions are ones most citizens ponder over.

Pakistan has begun realising – both at the governmental and individual levels – that it is time to move towards the idea of health insurance. Not only is the government moving towards creating health insurance systems for underprivileged beneficiaries, but citizens too who have realised its worth and have begun looking at health insurance as saving that gives them a plan B in case of an illness. In addition, organisations especially in the corporate sector are now, more than ever, giving their employees the health insurance. Universal Health Coverage day fell on December12, an apt occasion to take a look at this emerging trend in Pakistan.

Health Insurance in the Public Sector

Sehat Sahulat is a flagship programme of the Ministry of National Health Services Regulations and Coordination, and participating provinces. It is a social health protection initiative, working to provide financial health protection to poor families in order to prevent them from falling into extreme poverty because of extra-ordinary health care expenditure. For doing so, each enrolled family is provided with free of cost health insurance to access indoor health care services from empanelled hospitals.

The Sehat Sahulat Programme started in January 2016. To date almost 5.9 million families have been enrolled; the programme has been implemented in more than 75 districts across Pakistan, Sehat Sahulat is a public sector project, funded by the Government of Pakistan (GoP) resources. The federal government is paying of the premium for ICT, GB, AJK, newly-merged districts of Khyber Pakhtunkhwa, district Tharparkar, and persons with disabilities, overseas Pakistani labourers, and members of the transgender community.

“Health is a human right; Universal Health Coverage (UHC) day which falls on December 12 is a very important day as it enables us to draw attention to the importance of health coverage. UHC is the most powerful policy lever through which we can achieve this,” says Dr Sania Nishtar, the special assistant to the prime minister on social protection and poverty alleviation. She explains that when one talks about health coverage, one has to be mindful that it refers to three things — geographic coverage, financial access to health care, and healthcare quality.

“It is important to realise that that health care costs are most impoverishing for people, and therefore it is critical to ensure financial access to healthcare so that people are not pushed into poverty as a result of healthcare expenditures and do not forego healthcare because they cannot pay,” she says, adding that social protection is a very important policy tool to enable financial access to healthcare.

“Within the Ehsaas umbrella, there are a number of interventions. One of those is Tahafuz which is the social protection arm of Ehsaas to ensure financial access to healthcare. We hope to begin operations in early 2020 and plan to scale it up nationally,” says Dr Nishtar.

“Health is a human right; Universal Health Coverage (UHC) day which falls on December 12 is a very important day as it enables us to draw attention to the importance of health coverage, says Dr Sania Nishtar

A representative of the Punjab Health Initiative Management Company (PHIMC) explained how the government-supported health insurance programme is working in the Punjab. While it is very much a health insurance setup, the beneficiaries do not have to pay anything; instead, the government pays the premium on their behalf. The coverage has recently been expanded from 13 to all, 36 districts of the Punjab.

There are some crucial exclusions when it comes to health coverage. Mental health treatment and dental treatment coverage for example are limited. However, expensive and long-term treatments like treatment for cancer, dialysis, and surgical procedures like bypass for cardiac disease are covered.

“Up till now government-supported health insurance programmes in Pakistan have only targeted underprivileged, citizens but over time we will have to include people from the middle-tier economic strata as well who can partially pay the insurance premiums,” said the PHIMC representative.

Health Insurance in the Private Sector

Dr Harris Shahzad, an eye surgeon and one of the directors at Shahzad Eye Hospital in Karachi, says that his hospital does get a lot of insurance-covered patients.

“The insurance usually does not cover OPD charges or investigations. They do cover surgical procedures, but give preference to ‘admission/inpatient’ rather than day care, which most eye care centres are. We usually do between 15 and 30 cases a month that have insurance-coverage for eye surgery,” says Shahzad. He says that insurance-covered patients have discounted rates at hospitals, and also cover major surgeries like treatment for a retinal detachment. “There’s always a cap on how much funds they can use depending on what company they are using or how much they have used on other specialties as well.

The emergence of a financial product supermarket like Smart Choice that enables people to compare between various insurance choices available and make informed decisions, shows that Pakistan is moving towards insurances. Health insurance is one of the key areas in this regard. Working with key players in the field of insurance, it is a one-stop shop for insurances. “For the longest time, Pakistanis were not aware of the difference between life insurance and health insurance. Awareness has increased. Comparative online platform have a lot to do with this,” says Majid Shah Bukhari, head of sales and operations at Smart Choice.

He says now people are also buying health insurance privately “for their peace of mind. It is easier to pay Rs 1,500 per month, for example, and know that you have treatment coverage up to Rs 500,000 for an unforeseen illness. In this era of inflation, illness of one family member can throw off your budgeting for years and leave you in debt. Health insurance saves you from that”.

Bukhari says that a lot of expats buy health insurance for their aging parents, and newlywed couples buy it to cover maternity expenses. There are also insurance plans available for illnesses like cancer.

The umbrella of choices for health insurance policies has become wider. “Shariah-compliant insurance policies (Takaful) are also available now, alongside conventional insurance,” says Bukhari.

“Health insurance provides a backup for unforeseen circumstances; it is like a compulsory saving,” says Dr Rukhsana Shahid, a general physician, who has been evaluating patients for fitness for life insurance policies since 1985 at Shahrukh Clinic which she founded.

“The cost of living has increased so we see fewer individuals buying insurance as they don’t want to spend that extra bit for insurance every month. The same applies to health insurance. However given the cost of medical care, it is inevitable that Pakistanis will have to move towards health insurance.”

The writer is a freelance journalist with a focus on human rights, gender and peace-building. She works in the field of Corporate Communications

Different strokes for different rozaydaars

Times have changed and so have the food choices of those observing the fast

Different strokes for different rozaydaars

The idea, back then, was that you need to stuff yourself with such food at sehri that will help you not feel hungry, nor thirsty till Iftar. While that never actually happened, nutritious and filling foods like khajlapheni, and qeema  or aloo parathas kept one full enough at least till mid-day. And then we topped it off with jugs of water, and lay there on a couch later, panting with over-eating, filling up our bellies in the hope that the holy month would suddenly give us the capacity of a camel to store food and fluids.

That was the era where we didn’t care about good cholesterol or bad cholesterol, and it didn’t really matter if, instead of losing weight, Ramzan meant gaining a few pounds. Ramzan is about self-control, starting with food. It actually has been interpreted by a foodie nation as being just the opposite — about indulgence in food. But with awareness about healthier food choices, all of this may have begun to change, at least in urban Pakistan.

One thing is for sure: the health-conscious fasting person now focuses more on sehri than on iftar, particularly, if the said person also wants to pray peacefully at night, at home or at the masjid. For such people, they have a completely altered routine in Ramzan. Heavy, oily food, and an overload of beans and chickpeas can cause bloating and digestive issues, even though the latter two are very good sources of nutrition and should be taken in moderation.

The one change that we see is that unlike earlier when people used to first have iftar, then dinner a few hours later, and then sehri, the more conscientious eater is eating just two meals a day, with in-between healthy snacking if needed.

For many of us, the parathas and khajlas made of white flour and laden with fats have been replaced by porridge, oatmeal, brown bread, chapatis made of whole-wheat flour, and even brown rice. However, some things still remain indispensable for sehri, like eggs. Eggs have earned that spot as a favourite for good reason. Eggs provide 13 essential vitamins and minerals (vitamin D, riboflavin, selenium), antioxidants Lutein and zeaxanthin, and high-quality protein, all needed for one who is fasting.

The new entrants are the health-benefit items that once were seen as medicinal, but are now seen as “snacks”.

Dates, traditionally seen as the thing to open one’s fast with, have now made their way to the sehri meal as well. They are not just high in antioxidants, fiber, and potassium, but also provide essential nutrients, such as vitamin B-6 and iron. Bananas, an essential component of the fruit chaat, is now being eaten by the health-conscious rozaydaar as part of the morning pre-fast meal as well, as they provide fiber, potassium, vitamin B6, vitamin C, and various antioxidants and phytonutrients.

One of the things a person fasting in summers goes through is possible dehydration, or an electrolyte imbalance. Bananas, known as the leader among fruits and vegetables containing potassium, help control muscles and blood pressure. Thus bananas replenish electrolytes.

While restaurants offer attractive deals, the regular and more cautious people who observe fasting are being seen avoiding the eating out experience. “Unless it is unavoidable, me and my family have stopped eating out to eat at iftar,” says a regular fast-keeper. “The food in restaurants, no matter how tasty, will be always more oily, more rich in spices, and probably less hygienically prepared compared to home-cooked food.”

“When the fast is broken after almost 15 hours, it takes the body time to adjust to eating and drinking. It’s not a good idea to suddenly overload your system after a break from eating for a long time. The food’s not going anywhere! Why not have it in breaks, going gentle on your system?”

Also read: Oh, this makes sense

The new entrants are the health-benefit items that once were seen as medicinal items, but are now seen as “snacks”. You might see a particularly health-aware friend munching on iceberg lettuce with pine nuts topped with chia seeds as a post-iftar snack. Another relative might be having a combo of flaxseed, pumpkin seeds, and prunes with yogurt at sehri. And yet another one might be seen sprinkling moringa leaves powder on top of a sugar-free fruit chaat.

Different strokes for different rozaydaars.

Yes, times have changed and so have the food choices of those observing fast. Many of these changes are positive. Perhaps people have begun to realise that Ramzan and fasting do not remind us of stuffing our mouths with food on tables laden with 20 items, but in fact this month is a reminder of the joys of simple, wholesome, healthy food that is a blessing from the Creator. Abundance is, then, perhaps, in our attitude towards food, not in the quantity. It is the month of gratitude. Good health calls for gratitude, and practical gratitude demands taking care of your health.

Happy fasting and healthy feasting.

15 types of food and drinks that will help Pakistanis get through this hot Ramazan

Published: June 19, 2015


KARACHI: Brace yourselves, Pakistanis. If Nasa reports are to be believed, this will be one of the hottest, driest Ramazan the country has ever seen. This means you need to be well hydrated, and eat a balanced nutritious Sehri and Iftar so that your energy levels do not sink and make you dysfunctional during your fast. A well rounded diet is needed. Instead of a table laden with less nutritious food choices, let us try and opt for quality rather than quantity…lesser but tastier and more nutritious dishes.

So even if you continue with a bit of the samosa pakora binges, here are 15 suggestions from The Express Tribune that will give you considerable energy boosts. Happy Fasting!

1. Lassi or Chaach

Yogurt will be your saviour so add it to your diet in every possible form. Lassi is the thicker, often sweet version of our yogurt based favourite drink. Sweet Lassi can have different flavours with adding in fruits, specially delicious mangoes. But Chaach, thinner in consistency and seasoned with a little salt, is actually a great choice at Iftar, as it replenishes the body’s lost salts.

2. Haleem, Hareesa or Shola

These all-in-ones have ingredients from all food groups. Haleem is most popular, with protein of meat and pulses. But Hareesa is also an amazing option. It basically omits the pulses and uses boiled, cracked or ground wheat and meat as the main ingredients. Shola is a similar mix of mince meat, spinach, lentils and rice. At Iftar, these are excellent options.

3. Mewa (Dried fruit and nuts)

We normally associate dried fruit and nuts with winter, but while fasting we need the rich nutrition they provide. Other than the usual almonds, peanuts and walnuts, also go for dried apricots, plums, prunes, kishmish (raisins) and figs for much needed fibre. You need the Vitamin E, Calcium, minerals, Omega-3 and protein they provide.

4. Yogurt smoothies and home-made fruit yogurt

Yes, yoghurt makes a re-entry on the list. This season has the biggest variety of fruits. So go for yogurt-based smoothies with peaches, mangoes, cherries and apricots. Chop the same fruits for a healthier variety and whip them into some sweetened yogurt.

TIP: Add a dash of jelly powder and jelly cubes and see the result.

5. Filled parathas

This is the complete meal, delicious with chutney, achar and kachoomar (finely chopped onions and tomatoes with lemon juice). Fillings can be any and many. Qeema, mashed potatoes, cooked gobhi (cauliflower), or even channa daal. For a healthier variety, make them with whole whaet four and  replace regular oil or ghee with olive oil.

6. Kabab Shabab

Different kinds are life saviours for people on the go. So stock up! Shaami kababs, chapli kababs, potato cutlets, finger kababs or those made with dum ka qeema….any and every variety is great for both Sehri and Iftar. They provide the much needed meat quotient to your diet in Ramazan and blend well with anything.

7. Laal sharbat concoctions

A Pakistanis Ramazan without Rooh Afza and all its sister brands is incomplete. Refreshing and light, it is known to have herbal ingredients that fight the effects of hot winds that can cause a heat stroke. Have it as is or add it to your Limo Paani (lemonade). A great idea is to have it with milk and slivered nuts for Sehri.

8. Chaat variations

This is a no-brainer and a given, and perhaps THE healthiest and most sensible choice when it comes to our traditional Pakistani Iftar. One can go all creative with it. Separate the fruit chaat, dahi baray and Cholay (chick peas) or mix them all up for a more Anaarkali variety, its yummy and filling, and gives you a balanced meal.

9. Raita Salaad

Even regular salad eaters somehow take a hiatus from salads in Ramazan, and that is a big mistake. Keep crunchy cucumbers and chopped veggies on the side. To make it yummier, have mint raita. For a more filling variety, cucumber or baingan (eggplant) raita can be mixed to anything, like daal and salad. Remember, your body needs the greens.

10. The vital Anday

You cannot take away the eggs from a Pakistanis Sehri. So go ahead. Enjoy the khaaqina, the Pakistani omelette, the more international cheese and mushroom omelette, or boiled eggs if your health conscious. Even eggnog is a good idea for a boost. If the smell of raw egg offends you, add a few drops of Rooh Afza.

PS: Dont forget the meetha toast (French toast).

11. Sandwiches and wraps from around the world


Think outside the box. Why just go for fried stuff, that too in this heat? Go for sandwiches and wraps. Healthier ones can be in multi-grain breads and whole wheat pita. It can be wholesome if you add in greens and veggies, and you can experiment with different kinds of meats. Add feta cheese instead of cheddar if you want it to be even yummier and healthier.

12. Soups and yakhnis

You are not going to drink these outdoors under the glaring sun. So to ease your parched throat, get the much needed liquid intake, and fill yourself up, continue with soups and yakhnis if you are a soup person. They are filling and give us the salts and proteins. If vegetables and lentils are added to them, even better.

13. Kheer with sheermaal OR Jalebi, Phainee with milk

You don’t want to go so low on sugar that you are fainting away. So specially for Sehri or that midnight snack after you come home from taraweeh, these two options are hot favourites.

14. Shorbay aur salan

Again, do something off beat. You don’t have to stick to just dry qeema and bhunna gosht. Do keep at the aloo gosht and qorma. Have them with boiled rice or pulao, or even chapaati, for a complete Iftar come dinner or Sehri.

15. Bun kabab

Last but not the last, this is good at any time for any reason. Fill it with kabab, anda, chutney, cutlet or even daal. This is the ideal food that will ward away those hunger pangs.

PS: Remember, a burger can never be a bun kabab!

Miracle milk – The Camel Milk Diaries
Pakistan experiences a boost in sale of camel milk, hailed as an elixir of health. PHOTOS : FARAHNAZ ZAHIDI

Pakistan experiences a boost in sale of camel milk, hailed as an elixir of health. PHOTOS : FARAHNAZ ZAHIDI

A few yards short of the very busy Korangi crossing in Karachi, a series of makeshift settlements set up by nomadic clans is attracting a lot of attention. The family profile of these matriarchal clans is almost identical. Headed by a woman, they comprise of one or two men, children and a few camels with their calves. Their main source of income is the sale of camel milk. People stop their cars, motorbikes and bicycles and form queues to buy this nutritious milk, which has recently gained popularity in Pakistan.

The most sought-after property in camel’s milk is freshness. Cynical buyers, therefore, insist that the camel be milked in front of them. The technique is simple. Calves are brought close to the mother’s udders and when they begin to nudge her to be fed, milk starts flowing into the udders. At that moment, calves are harshly pulled away and their share of milk is taken out by skilled hands into stainless steel buckets or in a thermos or utensil provided by the more hygiene-conscious buyers.

But hygiene, in most cases, is less than satisfactory. These families, living in the open, lack proper facilities of sanitation. While the milk has no impurities, their hands and utensils are often not clean. And with the common belief that one must never boil camel’s milk, the bacteria transferred from unwashed utensils remain alive. “We don’t boil camel’s milk. It should never be boiled. I buy it every week for my wife who complains of lethargy, weakness, aches and pains,” says a regular buyer, who almost walked away empty-handed when he saw a girl adulterate the milk with water.

A matter of preference

Within the last few years, camel milk patrons are increasing in number. Despite having a thin consistency, salty taste and slight odour, the milk has created a market for itself in the country due to its potential medicinal benefits. The imported version, bottled with preservatives, is commonly available in high-end grocery store chillers.

But street vendors continue to present an appealing option to consumers who want the satisfaction of purchasing organic milk. Nusrat Ahmed, who works at Adeela Camel Milk, however, does not approve of the practice. “These camel herders are unfair to the calves. They pull the calf away from the mother and they do not get enough milk. Also, how do their camels produce so much milk on a daily basis? It is possible that they inject hormones into the animal,” he says. Camel milk is not a food product, it is a medicine, vouches Ahmed, and warns that the milk should not be boiled. “If you boil it, camel milk will still be nutritious, but will no longer be a medicine. It has certain natural ingredients that fight disease and they perish once you boil it.”

Many rural families have moved to cities to sell camel milk. PHOTOS : FARAHNAZ ZAHIDI

From virility in males to obesity control, the benefits of camel milk as a form of treatment are many. Wali Muhammad Akhtar, one of the most senior staff members at Dawakhana Hakeem Ajmal Khan in Saddar, Karachi, confirms that camel milk is beneficial for health. “It is Sunnah of the Prophet (pbuh). How can it not be beneficial?” he says. “It has less fat content so we use it in medicines to cure obesity. It is also the main ingredient of a popular herbal product called Labub Kabir Ajmali (an aphrodisiac for men),” says Akhtar, adding that the medicine’s recommended dose is half a teaspoon before breakfast. While assessing the product in light of the Avicennian alternative branch of medicine, commonly known as hikmat, Hakeem Ajmal, named after his great grandfather, confirms that camel’s milk is used in some of the Dawakhana’s 350 plus products. According to him, the ingredient is used in its original form instead of an extract or essence. “Camel milk is hot and dry in temperament,” explains Ajmal, referring to Avicenna’s theory of humours.

There is mass consensus among health practitioners regarding the potential health benefits of camel milk. Nutritionist Tayyaba Khan says that the milk is nutritionally very rich. “It has Vitamin C which helps boost immunity. It is also rich in iron and Vitamin B. It helps with diabetes management and is fortified with minerals.” Diabetics are therefore leaning towards camel milk as a possible course of treatment with no side effects. According to reports, camel milk has about a quart of insulin in each litre, making it a potential treatment option for diabetics. India’s Bikaner Diabetes Care Research Center conducted a study on the effects of camel milk on type 1 diabetes, determining that consuming camel milk significantly reduces insulin doses required to maintain long-term glycemic or blood sugar levels. Zahida, a 50-year-old diabetic, has just begun using camel milk as a form of alternative therapy. When asked who prescribed it to her, she says, “Suna hai logon se (I have heard about it from people),” and feels that since it has no harm if no benefits, then why not give it a try. But according to Akhtar, to reap those benefits, one should first boil camel milk.

Future demand

With proven benefits, it is hard to determine why camel milk is still not a common or popular choice and has a growing, but niche market. One of the reasons could be an inherent social prejudice against the animal which is associated with low economic value and underdevelopment, herded by the Bedouins and nomads. There seems to be a social hierarchy in animals as well: The camel is a symbol of the working class while a horse represents grandeur and status. Mules and donkeys rank even lower on the social ladder, although donkey’s milk has been used since centuries as a beauty product, especially an anti-aging agent, with tales of Cleopatra bathing in it. “We buy camel milk for Rs40 per kg. We don’t drink camel milk commonly despite its easy availability in Rohi (Cholistan Desert). We just use it to make kheer,” says Nazeeran Bibi, who lives in a village near Bahawalpur.

Ali Raza takes great care of his camel named baby as the animal is his family’s main source of income.  PHOTOS : FARAHNAZ ZAHIDI

Despite the milk’s low price, as confirmed by Dr Ghulam Ahmed, a field operations manager for Engro Foods Limited, Bahawalpur, it is not popular. Ghulam is actively involved with the company’s milk collection and animal farming projects, which contributes to the supply of camel milk throughout Pakistan. “After May, supply becomes limited, so, the price is raised slightly, starting at Rs45,” says Ghulam, adding that it will still always be cheaper than cow’s milk. “Camel milk will be more readily available in the calving and the rainy season when more fodder is available for the animal.”

In urban centres, however, prices are expectedly higher, and online sellers have cropped up to meet the increasing demand. “We have camel milk which is very suitable for hepatitis, cancer, sugar and liver disease,” claims a Karachi-based website for camel milk that offers door-to-door delivery service.

With the emergence of a new market for camel milk, further urbanisation of families like that of Goshi, in her late 40s, who has moved to Karachi from Jhang, Punjab, is expected. Unlike others who claim that they have borrowed their camels for a period of four months from camel farmers, Goshi says that she owns the animals. Her nine-year-old son, Ali Raza, plays with a calf and kisses it affectionately. “His name is Baby. He is one month old.” Ali does not go to school and spends his time herding camels, relying on the sale of the animal’s milk for a livelihood till the season comes to a close.

Farahnaz Zahidi works as a senior subeditor at The Express Tribune.

She tweets @FarahnazZahidi

Published in The Express Tribune, Sunday Magazine, May 31st, 2015.

Pakistani media: Public health a blip on the media radar

ByFarahnaz Zahidi

Published: November 28, 2012

In the relentless war of ratings, media ignores health care in the country.

KARACHI: A staggering 54% of the most serious crises and shocks Pakistan has suffered in the last three years have been health-related, while only 3% have been law and order related.

This came up in a meeting on Tuesday organised by John Snow, Inc. (JSI), a public health research and consulting firm that has worked in Pakistan for over two decades to improve the quality of and access to health care systems. More than 20 hosts of morning shows and current affairs programmes sat alongside journalists on Tuesday to discuss the relationship between public health and the media.

The focus of the meet was to discuss why public health is not on the Pakistani media’s radar despite its importance. Annually, around 22,000 women die because of entirely preventable causes linked with maternal mortality and 423,000 children under the age of five die, with 100,000 deaths attributed to pneumonia alone. The dialogue led by Dr Ali and Dr Moeed Pirzada focused on ways  the media can foster debate and raise awareness about issues of public health. An anchor-person of a regional language television channel admitted that in his four years on the job, he has only hosted two programmes related to health.

“Pakistan has 60,000 villages, roughly, and only 6,000 skilled birth attendants. Do the maternal mortality rates surprise us, then?” asked Dr Nabeela Ali, chief of Party of JSI’s Technical Assistance Unit for Health (TAUH).

The participants discussed that in the relentless war of ratings, television channels and newspapers are unwilling to devote adequate space to public health. When juxtaposed with stories of celebrities going across the border or political heirs caught in scandals, the story of a woman dying in childbirth is simply not snazzy enough.

Published in The Express Tribune, November 28th, 2012.