The federal government has decided not to provide funding for provincial health coverage and insurance schemes, citing the 18th Constitutional Amendment, and has advised provinces to develop fully contributory health insurance models through their own resources.
The decision followed approval of the continuation of the Sehat Sahulat Programme for selected federally administered regions only, with no plan to extend coverage to provincial populations. According to a report, the programme has been approved with a revised cost of Rs 40.2 billion.
Under the new arrangement, the Sehat Sahulat Programme has been extended until June 30, 2027, but its scope has been restricted to the Islamabad Capital Territory, Azad Jammu and Kashmir, and Gilgit Baltistan. The programme will not be available for provinces beyond these regions.
The decision was taken after a high-level meeting chaired by the prime minister on January 2. Following the meeting, the Prime Minister’s Office issued a directive on January 9 confirming that the programme would continue beyond June 30, 2025 only for the three federally administered areas.
In this context, internal proposals to include Sindh’s Tharparkar district under the Sehat Sahulat Programme were rejected during meetings of the Central Development Working Party and the Executive Committee of the National Economic Council. Officials argued that approving coverage for even one provincial district would trigger similar demands from other provinces.
Documents reviewed during the meetings emphasized that health is a devolved subject after the 18th Amendment. Allowing federal funding for provincial health schemes was described as inconsistent with constitutional responsibilities and fiscal discipline.
Earlier, on August 7, 2025, Ecnec approved the formation of a special committee to review the programme’s future. The committee concluded that the Sehat Sahulat Programme had completed its lifecycle on June 30, 2025 after multiple extensions and should be shifted from the development budget to the current budget.
The committee directed the Ministry of National Health Services to submit a project completion report and propose a limited structure to sustain indoor healthcare for vulnerable groups. It also recommended that provinces, along with AJK and GB, should design and finance their own social health protection schemes.
While opposing any federal extension to provincial districts, the committee suggested that a pilot contributory insurance model based on claim co-payments could be explored in coordination with provinces, similar to Punjab’s existing system.
The Sehat Sahulat Programme was originally approved on February 7, 2018, at a cost of Rs 34 billion to provide health coverage to low-income families identified through the Benazir Income Support Programme.
