Bano Bibi is 73 years old and she is raising her two young granddaughters alone. When her son died in 2005 the girls were left with her — the younger granddaughter was only one year old. Every day is a struggle to make ends meet, and she resorts to begging along the roadsides of Islamabad to bring food or money home for the girls. As Bibi made her way along the side of the road one day, a car struck her and sped off. She was brought to the hospital with a leg fractured at the hip, and she lay there in agony for 15 days because she couldn’t afford surgery. Her situation seemed hopeless, until doctors alerted her to Heartfile. Now she credits the organization with her ability to walk, and even for saving her life.
In 1998, the Pakistani health policy think tank Heartfile was established by the country’s first female cardiologist, Dr Sania Nishtar. Driven by her commitment to help Pakistan’s underprivileged, the organization originally raised public awareness about heart disease. Only four years later it led to the creation of Pakistan’s National Action Plan for the prevention and control of non-communicable diseases, a partnership with the World Health Organization and the Ministry of Health in Pakistan. Now Heartfile has also developed a model to finance critical healthcare for impoverished populations.
In the past decade, Pakistan has been pummeled with natural disasters and societal turmoil. This and the further decline of the already frail economy have made inequalities more pronounced, and the already inadequate system of healthcare for the poor is being hit particularly hard. According to a 2013 study published by The Lancet, 78% of Pakistan’s population (approximately 140 million people) pay out-of-pocket for healthcare. For many this entails “catastrophic spending”: using critical savings, selling assets, or relinquishing basic needs in order to pay for healthcare. “Heartfile health financing is an access to care initiative aimed at helping very marginalized communities overcome financial barriers when accessing healthcare, particularly when catastrophic expenditures are involved,” explains Ihtiram Khattak, Heartfile’s senior manager of operations.
Heartfile has developed an innovative model of health financing that enrolls primarily public sector health facilities. They work with these facilities to provide coverage for catastrophic health events to the poorest using a website and database that assesses a patient’s poverty status and eligibility, verifies requests through a national database, and purchases required surgical items/consumables directly from the private sector or authorizes cash transfers to get patients the life-changing and life-saving medical care they need — all in under 24 hours.
“Heartfile health financing is trying to establish an equity fund-based health system model that can help in achieving universal health coverage for those in the informal sector who cannot be covered by insurance,” Khattak says. “Many countries have yet to accept healthcare as a fundamental human right. In Pakistan we are a long way from this. Since our model is replicable in many different national settings, we think of ourselves as the torch-bearers of universal healthcare and harbingers of healthcare as a fundamental human right.”
Eleven hospitals are enrolled in the Heartfile program in three of Pakistan’s four provinces, and operations encompass eight clinical specialties. With this vision, Heartfile has been able to reach more than 2,500 patients — approximately half of them women — since 2010. IDRC support is helping to build Heartfile’s capacity and assess the feasibility of scaling the model to develop beyond the tertiary care level (which focuses on specialized consultative healthcare) to include primary care, which typically benefits the greatest number of users.
Heartfile’s founder, Dr Sania Nishtar, has been named co-chair of the World Health Organization’s newly established High-level Global Commission on Non-communicable Diseases, which aims to extend life expectancy for millions of people and identify innovative ways to curb the world’s greatest causes of death.
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