AsianScientist (Oct. 17, 2011) – In a country like Pakistan where over 70 percent of the 180 million population pay for their healthcare directly from their pockets, falling ill can spell a financial catastrophe. Government interventions have been woefully insufficient thus far, leaving charitable organizations to fund healthcare for the poor.
Charities that provide health financing to the poor are often plagued by abuse. After all, how does one verify requests for health financing? Enter Heartfile Health Financing (HHF), the finance arm of Heartfile.
Featuring an innovative use of existing mobile technology, Heartfile boasts a customized IT platform linked to the government’s National Database Registration Authority through which doctors can verify a patient’s poverty status and receive the necessary funding, all within a span of 72 hours.
Apart from reducing abuse through its multiple checks, this system also provides greater transparency to donors who can log on to the Heartfile website and view the use of their funds on a transaction basis and instruct demand-specific use of their funds. Donors are given full view of administrative costs and have the opportunity to request an audit of any transaction.
Heartfile’s innovative system was the brainchild of Dr. Sania Nishtar, better known as Pakistan’s first female cardiologist, who founded Heartfile in 1998. Back then, as she was performing coronary angiographies, Dr. Nishtar wondered why well-heeled patients had the procedure done with new catheters, while poorer patients were operated on with catheters that were used and washed. This observation sparked an interest in health policy and charity, and has changed the course of Dr. Nishtar’s career since.
The name Heartfile belies the remit of its operations. While the organization started off trying to raise awareness of heart disease, its focus has shifted in the last decade. Since Dr. Nishtar authored Pakistan’s first health reform plan and compendium of health statistics, she has become a key voice catalyzing change within Pakistan’s health system.
Asian Scientist Magazine speaks to Dr. Nishtar, whom we have come to regard as a distinguished doctor, prolific author, decorated golfer, and current champion of Pakistan’s health reform.
Congratulations on the launch of the Sania Nishtar Health Fund. Are there specific ways in which this fund will support the work of Heartfile Health Financing (HHF)?
Heartfile Health Financing, as you are aware, is a demand side health financing system, which was created to fill a strategic gap in the country’s health financing landscape. More than 73 percent of Pakistan’s population pays out-of-pocket to access healthcare; it has been estimated that more than 40 million individuals run the risk of spending catastrophically on healthcare.
As a result, catastrophic expenditures on health, medical indebtedness and medical impoverishment are a common occurrence. There are many who forego care – for example, women with broken hips are taken away from hospitals, bedridden for life, because families cannot afford to pay for hip operations.
As opposed to this need, existing government mechanisms in the country that could respond to the urgent health financing needs of this segment of the population have narrow coverage and are plagued by a number of challenges. Pakistan’s deteriorating fiscal situation and erosion of systems of governance and welfare are not making things easier for the poor. There was therefore the need to develop a demand side health financing system, which could ensure social protection for health for the poor.
The fund has been created within this context. However, it is important to appreciate that the fund doesn’t operate in isolation. It is part of the Heartfile Health Financing system, which comprises three parts – the fund, an mHealth integrated web-based technology platform, which handles requests transparently and expeditiously, and a system of validating poverty, which is integrated with the country’s database registration authority. This system enables us to respond to requests from poor patients urgently after verifying that they indeed deserve assistance.
When I launched the system a year and a half ago, I set up a small fund with seed funding committing the royalty of my book, Choked Pipes. Two other donations followed immediately – one from the Rockefeller Foundation and the other from Sulemanyiah Trust.
Now I have structured the fund more formally with an establishing gift committing the monetary award, which accompanied the Global Innovation Award I received this July. This is how the Sania Nishtar fund came into being. It is a step towards making Heartfile Health Financing financially sustainable.
Heartfile Health Financing is a unique and innovative concept. Apart from Pakistan, do you think this model can be adopted elsewhere? If so, are there any foreseeable obstacles in doing so?
Yes indeed. Our model is relevant for many other developing countries with poor populations in the informal sector where medical impoverishment and medical indebtedness is a challenge.
If you look at WHO data, there are many countries which fall within this category and therefore interest is being generated in our model with respect to it being one of the vehicles which can assist in achieving universal coverage for health in these settings.
The system also appeals to countries and agencies that are genuinely interested in improving social protection targeting, as it supplants human discretion with automated algorithms, and subjective decision-making with preconfigured rules through the technology enabled platform. The system is appealing to the donor as it has many donor empowerment features, is fully transparent, and enables tracking of donations.
The fact that the system has been designed with potential to scale-up as a major consideration, adds to the appeal. We therefore see the beginnings of interest from many countries to replicate this and expand this internationally.
Of course, there will be many challenges in taking this course. We will have to hone our model in the first place and assist with adaptations relevant to the local settings.
Apart from its sophisticated IT platform, we can see that this financing system is different from other charities and that you are planning to make it self-sufficient. What was your motivation to start this? What actually kicked it off?
My last book, Choked Pipes, was on health systems reform. When I was sending off the final proofs to the Oxford University Press and proof reading the manuscript over and over again, I just couldn’t get one thing out of my mind. I wasn’t sure if I was going to see the plan I was proposing cascaded into implementation in my lifetime. I was compelled to think of practical action, which could enable me to initialize the process of reform while still being outside the government.
In addition, the image of poor patients being pushed into misery as a result of health burden and expenditures were overwhelming – this is a remnant of my past experiences as a clinician.
As I was seeing the final version of the manuscript I promised myself I will launch something practical that actually alleviates suffering rather than being an advocate of health reform for the rest of my life.
So in launching Heartfile Health Financing, I was trying to achieve two objectives. On one hand I was looking for an entry point into health reform. However, on the other hand, I wanted to meet an urgent humanitarian need. There were just far too many people foregoing healthcare and being pushed into medical impoverishment because of lack of financial access to healthcare.
Since its creation in 1998, Heartfile has certainly expanded its remit. Where do you think the organization is headed from here?
Well, in relation to the health financing steam of work, my aspiration is to ensure financial access to healthcare in my country for all – and we are a population of over 170 million. It is just unacceptable that the poor have to forego care just because they cannot pay. Denying the right to health is unacceptable.
One of my personal objectives is to configure one arm of Heartfile, the Health Financing system, such that it has sustainable capacity to ensure financial access of each and every deserving individual to healthcare in my country. This has major implications for scale up. I also want the organization to have the capacity to replicate this in other countries.
The other side of Heartfile operates as a think tank, where currently there is a heavy reliance on me. I want structure that steam of work on sustainable lines also and I have a number of goals and objectives set out there for the organization as well. I want to see the health system in my country reformed, responsive and equitable and I believe that that is achievable with the right inputs.
This question is for our female readers. How do you juggle being CEO of an NGO, a cardiologist, a mother, and a prolific writer?
You just have to be very organized and very cognizant of what time can achieve when matched with a focused effort. I spend every morning looking at my overall strategic plan for the organization and myself, and make a note of long and short term objectives. Then I plan the day and analyze how the day and my engagements and time are in alignment with those objectives – and there are times when you have to mark priorities and make choices. You constantly have to remind yourself to stay focused.
It appears, from reading previous interviews, that the career you have now was not something you envisaged while in medical school. If you could begin your career all over again, is there anything you would do differently?
It is easy to answer this question in retrospect, but isn’t appropriate to do so. I started my journey on one ship and I am now on a different one. But what is important is that I am continuing and that my goal is to make a difference.
Finally, do you have anything else you would like to share with our magazine’s audience?
To learn more about Dr. Nishtar: Dr. Sania Nishtar’s website
Copyright: Asian Scientist Magazine.
Disclaimer: This article does not necessarily reflect the views of AsianScientist or its staff.