Improving Grievance Redressal System for Service Delivery: Lessons and Learnings from Sehat Sahulat Program (SSP)

Executive Summary Grievance Redressal (GR) improves trust and confidence in public health service deliveries and promotes equitable health services. The Sehat Sahulat Program (SSP) in Pakistan has been providing indoor health insurance throughout the country, and the program aims to expand its services to all citizens. The current study examined the existing GR/complaint system of SSP by conducting a SWOT analysis. The evaluation was carried out through qualitative and quantitative approaches, including in-depth interviews with supply-side stakeholders, and household and telephone surveys with beneficiaries. The analysis reveals that although the program offers multiple channels to register a complaint to its beneficiaries, including web portal, email, call center, and postal letter, the main source for complaint registration is the call center. A limited percentage of the beneficiaries and the general public know about call centers. The existing call center has various limitations, including limited deployed human resources, lack of call agent proficiency in the local language, absence of complaint taxonomy, etc. The call center also lacks full automation, i.e., IT-based integration with the stakeholders (including NADRA, SSP, and field offices), and it requires establishing the complete loop of each complaint along with stipulated timelines to resolve the complaints. The addition of dashboards would be helpful to acquire a progress summary of grievances. The program must also develop an integrated complaint management system where complaints received through various sources should be pooled, analyzed, and concluded effectively. Currently, the program needs a ground-level staff presence to interact with the public and guide them for complaint registration. Such a presence can improve the caseload of complaints and streamline the grievance system. Current grievances are highly linked with the policy decisions, starting from enrolment and the operational cycle. Effective service delivery is another challenge where a significant population has faced accessibility issues and denial of services besides the poor quality of services in remote areas. For example, increased empanelled hospitals would raise competition among hospitals and reduce the chances of service denial. As an institute, the SSP requires substantial effort to improve its M&E and management information system.