There is no magic potion to solve the healthcare problem across the world in less than seven years, ie by the maturity of the UN SDGs in 2030.

Some perspective: the OIC Strategic Health Program report covering a decade from 2013 to 2022 cites that the 57 Islamic countries are dispersed over a large geographical region spread out on four continents and constitute a substantial part of the world’s developing countries.

Having vast divergence in the levels of economic development, they do not make up as a homogenous economic group. However, despite this, the group has been able to achieve a 17.4-year increase in life expectancy from 1960 to 2010 on an overall basis which now stands at 64 years, but the average in the poorest sub-Saharan states is below 55. Woefully, 36% of children from OIC member countries were recorded as stunted and within that, 22% were severally underweight.

The report has identified that the Islamic countries are suffering from communicable and noncommunicable diseases at the same time and that 46% of deaths are from noncommunicable diseases, mainly cardiovascular disease, diabetes, cancer and chronic lung disease, whereas the rest of the deaths are caused by communicable diseases. The noncommunicable diseases were caused mainly by tobacco use besides an unhealthy diet and the lack of physical activity.

It is shocking to learn that on an overall basis, the OIC member countries allocate only 2.6% of their GDP for health compared with the world average of 10.4% whereas healthcare accounts for only 9% of their total government expenditures.
Only 28 or 50% of member countries meet the critical threshold of 23 health personnel (doctors, nurses and midwives) per a 10,000 population, generally considered necessary by the World Health Organization (WHO) to deliver the essential health services. The average per capita health expenditure in OIC member countries, as a group, is only US$147 or 15% of the world average of US$947.

The OIC health report is comprised of six sections. The first three sections consist of data-based analytical research on the current health conditions and recent developments in Islamic countries whereas the last three segments propose the areas of cooperation, recommend actionable items under each thematic area and propose a mechanism for the implementation and monitoring of the proposed programs.

Having briefly explained the aforementioned data, I will now jump to the last three sections to analyze the solutions but before that, it is important to keep in mind the contributory factors for a well-organized healthcare system which can deliver the goods. These are leadership and governance, service delivery channels, trained health workforce, health information and data collection system, provision of essential medicines and most importantly, adequate funding to support all of these.

The comprehensive OIC report has suggested scores of measures to be considered at the national level, OIC level and international cooperation level to improve the health condition of the masses in its member countries. The report has identified the health system strengthening area; disease prevention and control area; maternal, new-born and child health and nutrition area; medicines, vaccines and medical technologies area; emergency health response and interventions area; and finally the information, research, education and advocacy area.

The proposed financial resources to support the improvement in the areas include the allocation of financial resources from the Islamic Solidarity Fund for Development and the Special Program for the Development of Africa, calling upon OIC member counties to pledge financial resources, workout modalities to encourage the involvement of private sector, international development and philanthropic organizations and garner funds from various multilateral financial institutions and commercial banks.

Having reviewed the recommendations, and without doubting the sincerity of the hardwork invested in the report, in my opinion, many items demand an ideal situation and therefore seem theoretical given the current weak infrastructure, poor management and the lack of the skill set needed to accomplish them in the majority of Islamic countries. For example, have a look at the following recommendations and judge for yourself as to their workability given the ground realities in OIC member countries:

National level: “Establish a high-level multisectoral health committee as well as local level intersectoral cooperation with representation from other public sector ministries, nongovernmental organizations, the private health sector and other stakeholders to prepare a roadmap for achieving universal health coverage.”

OIC and international cooperation level: Facilitate knowledge exchange and the co-production of new knowledge among member countries through the joint capacity-building programs, which bring together implementers and policymakers to jointly develop innovative approaches to accelerate progress towards implementing universal healthcare coverage.

I believe that the problem is too large to be tackled by trying to achieve perfection on the first go; rather, a step-by-step approach, considering the local realities and by utilizing the local resources first, shall be more pragmatic. As such, I would like to suggest the following action plan which is reflective of my deep study of the ‘Sehat’ (health) card scheme launched by the government of Pakistan in 2019 for the underprivileged.

I consider it to be a brilliant and a landmark scheme tried for the first time by any underdeveloped OIC member state which opened the doors of elite private hospitals to the poorest of the poor of the country for getting in-patient treatment for major illnesses including cancer, heart surgery, accident-related injuries, burns and any other medical condition needing hospitalization and constant care. Almost half of the country’s underprivileged population was covered by the scheme in less than three years. The Takaful cover was provided by a state-owned life insurance company based on the government guarantee.

The scheme had revolutionized the state of healthcare for the poor to the extent that the complex heart bypass operations were conducted in the most expensive hospitals the poor could never have imagined to even enter, let alone getting treated. Going forward, it was planned to also cover outpatient treatment for cardholders.

The scheme could be emulated by the other underdeveloped OIC member countries if the people running the governments would sincerely wish to make life easier for the poor. Governments can easily cut down on many non-developmental expenses, especially the VIP culture enjoyed by officials, to divert allocation to the scheme from a pathetic 2.6% of the budget to at least a decent 10%. I describe below the main features of the scheme:

1. Without relying on any external financial assistance, each underdeveloped OIC member country should try to introduce mandatory health cover for the poorest of the poor on a top priority basis. This may be achieved through the national Takaful scheme to be undertaken by the national level insurer.
2. If no national insurer entity exists in a member country, the scheme could be established at the government level and its management assigned to a key insurer in the country from the private sector.
3. Taking advantage of the technology and relying on the citizenship database every country holds, each family unit from the poorer segment of society should be issued one family health card covering all members with a certain stored value to be used at any public and private sector clinics and hospitals.
4. It must be made mandatory for all private sector clinics and hospitals to accept the government issued health card and provide all possible inpatient and outpatient assistance to eligible patients.
5. The clinics and hospitals are allowed to claim reimbursement under the scheme at the full rate they would normally charge in the ordinary course while dealing with the cash or insured patients, unless they offer voluntary discounts to the government as their corporate social responsibility.
6. Since this would be a non-cash card, the stored value in the card shall elapse upon completion of the calendar year, ie on the 31st December and reinstated for the full value on every 1st January. The limit can be enhanced in genuine cases where the card value is fully consumed but the treatment remains incomplete.
7. The health insurance amount covered by the card should be directly underwritten by the government since normal reinsurance entities shall not be willing to underwrite the social welfare scheme with no premium contribution from the beneficiaries.

Now look at the bigger picture. The sudden upsurge in the patient load and the increased revenue and profitability streams shall encourage the private sector to build new clinics and hospitals to enlarge the sphere of healthcare in both urban and rural areas, thereby taking the burden away from the government to do so and providing healthcare to all citizens at their doorsteps.

Such a growth trajectory shall also attract building new medical colleges and nursing institutions to cope with the vastly increased patient load. The spillover effects shall be far-reaching to include drug manufacturing and trading besides the supply of medical equipment and consumables. In summary, while the government shall spend on the scheme from one hand, it will reap the payback benefits from the other through the greatly expanded healthcare sector and ancillary trading activities which shall bring in substantial new tax revenue and make the scheme indirectly self-reliant, or even profitable for the government. However, the condition is that the government must take the first initiative.

The involvement of the OIC may be needed should the government of a country find it difficult to bear full sponsorship of the scheme owing to a large population, or generally poorer health conditions with a large patient base despite a relatively low population. The OIC could provide a grant, or the IsDB may finance the establishment of new government hospitals, or the bank’s investment arm may fund the private sector in doing so.

The aforementioned shall transform the scene of healthcare on a pan-OIC basis. While the affluent Islamic countries are already taking extremely good care of their citizens’ health, the scheme shall bring at par the population of the underdeveloped Islamic countries by delivering a well-organized healthcare system discussed above. The overall improvement in the health conditions of the masses shall certainly lead to enhanced well-being in society, thus fulfilling the objectives of SDG 3.

The subject of good health and well-being comes to an end with this seventh article in which I have discussed the great work contributed by the Muslim stalwart Ibn Sina which provided the foundation for healthcare and his work has remained an enlightening force for centuries. Also, I have introduced you to the new doctrine ‘Fiqh of health’ coined by Dr Mohammed Haytham Al Khayyat. Also, in this article I have put my heart out as to how the innovative scheme introduced by Pakistan can address the health woes in the Islamic world or in any country for that matter. I hope the WHO and OIC are listening.

The purpose of this educative series and the article is not to hurt any religious or commercial sentiments either consciously or even unwittingly.

Sohail Zubairi is an Islamic finance specialist, AAOIFI-certified Shariah advisor and auditor as well as CIAE-certified Islamic arbitrator and expert. He can be contacted at [email protected].

Next week: Discussion on a new SDG shall commence. So do not go anywhere.