Social Health Protection Initiative in Pakistan

We are analysing and informing the implementation of one of the largest health insurance schemes for the poor in Pakistan.

Since 2015, the Government of Pakistan has been receiving health-financing grants from the German Development Bank (KfW) to finance health insurance to the poor people under the Social Health Protection Initiative (SHPI) in two provinces, Khyber Pakhtunkhwa (KP), and Gilgit Baltistan (GB). Being implemented by the two provincial Directorates of Health the programme’s concept is based on our feasibility study. The study looked at both coverage and design of insurance scheme, as well as at the inclusion of hospitals, and the implementation modalities.


Health risks adversely impact lives and livelihoods of the poor and a health shock further burdens the poor with unaffordable health expenditures. The challenge in this project is to provide access to high-quality health services to the beneficiaries, while making it worthwhile to the included hospitals to compete for the beneficiaries. The insurance scheme also needs to be closely monitored and managed within the two provinces, as initially, the Directorates of Health lacked required management and technical capacity.

Our approach

According to our feasibility study, the most effective use of KfW funds is through tendering out the implementation to insurance providers and organisations with experience in implementing insurance schemes at a district- or sub-district-level population. These recommendations have informed the programming of SHPI Phase I under which we are providing technical assistance on the implementation of the insurance scheme as well as on the tendering processes for insurance providers.

In a technical supervisory role, we are looking at financial planning, quantitative and qualitative examination of outputs, as well as supporting and coordinating stakeholders’ involvement in the project. We also reviewed the existing accreditation systems for public and private health providers in the target areas and their suitability for the project and assisted the Directorates of Health in KP and GB to develop and issue necessary regulations and mechanisms that ensure that the funds out of claims reach and remain in the health facilities where services have been provided.


The initiative involves scaled pilots in five KP districts, as well as in Gilgit in GB and has been adopted subsequently for the whole of Pakistan. It is thus one of the largest health insurance schemes for the poor and poorest in the world. Following elections, the political environment in KP and GB remain favourable to the development of strategies for universal health coverage including instruments for social health protection.

Watch our video below for more information (opens as a new window):
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Watch the full version on the KfW website here.

Area of expertise