Bulletin of Business and Economics, 12(4), 169-175

https://bbejournal.com
https://doi.org/10.61506/01.00101
Healthcare Professional’s Perception on Sehat Card Program in Khyber Pakhtunkhwa, Pakistan

Fawad Akhtar 1, Dr. Lal Muhammad2, Dr. Mian Muhammad Waseem Iqbal3
Abstract
Sehat Card Program (SCP) is popular initiative of Khyber Pakhtunkhwa province to improve the patient care and hospitals. In this
study, the author intends to explore the perceptions of healthcare professional toward the SCP. For this purpose, a well-organized
self-developed was prepare and tested within the field after validating it from the experts and data has been collected through it.
Reliability was tested through Cronbach’s Alpha and Exploratory Factor Analysis (EFA) were carried out to extract the important
latent constructs of health professionals’ reading different domains of SCP. Chi-square test were used to identify association between
healthcare professional’s demographic characteristics and their intentions toward different domains of SCP. Finally, the logistic
regression model was used and the author found that health professionals believe that different domains of SCP play a positive role
in improving quality of care, service delivery, health support, administration complexities, and resources utilization. The study found
that there is significant association present of quality of care, service delivery, support, administrative complexities and resource
utilization with the hospitals providing the facility of SCP. Overall, this study results suggest that SCP play a positive role in both
providing quality care to patients and in the improvement of hospital. This study provides important practical implications for the
government of Khyber Pakhtunkhwa on enhancing the facility to a large number of hospitals resulting in a positive change in both
patient care and hospitals.
Keywords: Sehat Card Program, Quality of Care, Service Delivery, Administrative Complexities, Hospital Improvements

1. Background
The United Nations adopted a set of 17 global goals in 2015 called the Sustainable Development Goals (SDGs) with the aim of
promoting sustainable development on a universal scale. One of these goals is to ensure that everyone can get the medical care they
need, which is closely related to the concept of universal health coverage (UN, 2015). The SDGs provide a roadmap for countries
to achieve Universal Health Coverage (UHC) by setting benchmarks for health outcomes and healthcare access. In addition to
campaigning for UHC, the SDGs also tackle social, economic, and environmental challenges that have an effect on people's health,
quality of life, and overall happiness. UHC ensures that fairness and efficacy of care at the population and individual levels are a
benchmark and expectation for the system as a whole, while still allowing private healthcare providers to play a key role (Zief et al.,
2020; Ali et al., 2021).
Both the SDGs and UHC aim to ensure that all people, regardless of income or location, have access to quality healthcare that
addresses the full range of factors that influence an individual's health. To prevent people from going into debt to pay for necessary
medical care, the SDGs related to health aim to make it universally accessible. The establishment of mandated health insurance for
people working in the private sector resulted in a rise in the consumption of healthcare services, notably outpatient visits. Access to
healthcare for all must be ensured through a methodical strategy, qualified medical personnel, and persuasive policy advocacy
(Hogan et al., 2018; Ashraf & Ali, 2018). The right to adequate medical care is a basic human right because medical care is a
necessity for all people everywhere (Lucas, 1988). A nation's progress and its people's happiness correlate with their ability to gain
entry to fundamental medical treatment (Aziz et al., 2021). Poverty and inequality continue to be major roadblocks to healthcare
access in developing countries, contributing to subpar health outcomes and scarce medical resources.
Rawls (2007) developed a "A Theory of Justice" grounded in principles of fairness and equality and argued that everyone deserves
equal rights and opportunities, including the right to excellent health. Rawls' ideas emphasize the importance of fairness and equality
in healthcare, while Conrad's (Conrad, 2007) work sheds light on how the medicalization of various aspects of life can shape
perceptions of health and influence resource allocation in healthcare. However, Systems theory, as proposed by (Bertalanffy, 1968)
views the healthcare system as a complex, interconnected whole. It emphasizes the interdependence of its components, like doctors,
hospitals, clinics, patients, and government regulations. This theory helps us understand how changes in one part of the system can
affect others and the system as a whole. The study conducted by Jutting (2002) examined the impact of health insurance on
individuals' access to medical services and financial security in isolated areas of Senegal. The investigation utilized binary probit
and logit/log linear models to analyze the data, revealing the difficulties faced by rural inhabitants as a result of financial limitations
and inadequate coverage. The research recommended expanding and connecting community financing schemes as a potential
solution. Gerdtham and Löthgren (2001) examined the cost efficiency of healthcare systems in OECD countries over 14 years,
finding a positive correlation between public healthcare expenditure as a percentage of GDP and cost effectiveness. Afriyie et al.,
(2022) reviewed health insurance plans in Low and Middle Income Countries (LMICs), discovering low enrollment rates among
vulnerable populations, suggesting the need for improved inclusivity to achieve UHC goals. Akazili et al. (2014) studied National
Health Insurance Scheme (NHIS) coverage among low-income mothers in rural Ghana, finding significant disparities in insurance
enrollment based on socioeconomic status, education, marital status, and religion. Only 33.9% of the poorest women had insurance,
compared to 58.3% of the wealthiest. Moreover, while 60% were registered, only 40% had valid insurance cards, leaving over 20%
without coverage. Income taxes and payments to the National Health Insurance Fund (NHIF) are progressive, whereas out-of-pocket
spending and contributions to the Community Health Fund (CHF) are regressive on healthcare finance and equity in Tanzania (Mtei
et al., 2012). The poorest did not get their fair share of healthcare benefits.

1
PhD Scholar, Sarhad University of Science & IT, Peshawar, Pakistan, fawadakhtar85@gmail.com
2
Assistant Professor, Sarhad University of Science & IT, Peshawar, Pakistan, lal.ba@suit.edu.pk
3
Assistant Director Finance, PEDO Peshawar, Pakistan
169
The Sehat Card Program, officially known as the Sehat Sahulat Program, is a government-funded healthcare initiative in Khyber
Pakhtunkhwa (KP), Pakistan. The program aims to provide health insurance and financial protection to low-income families by
granting them access to free medical treatment at both public and private hospitals. The World Bank estimates that only 1% of
Pakistanis have medical coverage. Khyber Pakhtunkhwa's SCP is micro health insurance scheme is a step toward the province's goal
of UHC. By reducing the burden of healthcare costs on low-income families in KP, the SCP initiative hopes to enhance the health
of its participants and ultimately reduce poverty in the province. At most, each family can receive up to 1 million rupees annually in
free services, costing the government roughly 18 billion rupees annually. In order to provide free medical services to all residents of
KP, the government of KP spends 25 billion each year on the SCP. The primary objective of the SCP is to address the issue of
poverty in the region of KP by reducing the financial burden of healthcare bills and enhancing the overall health conditions of the
specific demographic through the provision of improved availability of exceptional healthcare services. Since the government is
investing so much money into the healthcare system, a study is warranted to determine whether or not the program is meeting its
primary aim.
1.1. Research Objectives
• Health professionals recognize the effects of the SCP domains quality of care, service delivery, support, administration
complexities, and resource utilization.
• Quality of care, service delivery, support, administration complexities, and resource utilization of the SCP depends on the
demographic characteristics of health professionals.
1.2. Hypotheses
• There are positive effects of the SCP domains such as quality of care, service delivery, support, administration
complexities, and resource utilization.
• There is a significant impact of demographic characteristics of health professionals on the SCP domains.

2. Research Methodology
Primary data has been collected from the health professionals working in hospitals in Khyber Pakhtunkhwa through self-designed
questionnaire. The validity has been checked through expert opinion before data collection. Data was collected from the health
professionals of both types of hospitals which providing or not providing the facility of SCP. The health professionals include
physicians, surgeon nurses, administrators, and others from both government and private sector hospitals. The data were collected
with a sample of size 412 which provides a margin of error of ±5% with 95% power and a small effect size of 0.20 by G*power
Cohen, J. (1988). The collected data which comprises different aspects of quality of care, service delivery, support, administration
complexities, and resources utilization of the SCP in views of health professionals were analyzed through SPSS software.
In this article, both types of statistical approaches parametric and non-parametric were used to analyze the collected data. To achieve
the objectives of the study at the very first we accompanied a reliability analysis of overall health professional’s data and section-
wise through Cronbach’s Alpha (Cronbach, 1951). After assessing the reliability, we used exploratory factor analysis (EFA) on data
to form the most potential latent constructs. Therefore, after extracting the most important factors, items observed from 1 to 5 Likert
scale were converted to continuous variables. As rich literature is available on it that items observed from 1 to 5 Likert scale can be
transformed into continuous variables by many transformation approaches (Awang et al. 2016) and (Maydeu-Olivares, 2005).
Furthermore, the nonparametric Chi-Square test (McHugh, 2013), was used to determine the demographic variables of health
professionals related to the different aspects of quality of care, service delivery, support, administration complexities, and resources
utilization of the SCP. Finally, a logistic regression model (Jutting, 2002) was used to investigate the impact of quality of care,
service delivery, support, administration complexities, and resource utilization of the SCP.

3. Health Professionals’ views about the Effects of SCP

3.1. Reliability analysis
Table 1 presents the results of Cronbach’s Alpha along with average square loadings for the health professional’s data regarding the
Effects of SCP domains. The overall reliability for the data set is noted as 0.875 and section-wise it is noted for quality of care 0.920,
service delivery 0.973, support 0.994, administration complexities 0.956, and resources utilization 0.939. The average square
loadings (ASL) for all five domains of the SCP noted more than 0.500 for quality of care 0.597, service delivery 0.633, health
support 0.784, administration complexities 0.814, and resources utilization 0.654.

Table 1: Reliability analysis results for the health professional’s data regarding SCP
Data Cronbach’s Alpha No. of items Average Square Loadings
Overall 0.875 45 -
Quality of care (QC) 0.920 7 0.597
Service delivery (SD) 0.973 8 0.633
Health Support (HS) 0.994 8 0.784
Administration Complexities (AC) 0.956 9 0.814
Resources Utilization (AU) 0.939 7 0.654

Table 2 provides the items loaded in five factors, which explains 80.7% cumulative variance. The exploratory factor analysis shows
the excellent performance of the model with five factors quality of care explained 20.7%, service delivery 19.9%, health support
17.8%, administration complexities 13.0%, and resources utilization 9.3% variance. Further quality of care and resources utilization
170
in each domain loaded with 7 items and ASL 0.597 and 0.654 respectively, service delivery and support with 8 items and ASL 0.633
and 0.784, and administration complexities with 9 items and ASL 0.814.

Table 2: Exploratory factor analysis results for health professional’s data about SCP domains
Item (Measurement: Likert 1–5) SD HS AC AU QC
Sehat Card program (SCP) encourages healthcare providers to focus on 0.525
preventive measures and early intervention, which can lead to better health
outcomes.
SCP ensures that all citizens have equal access to high-quality healthcare 0.532
services.
Access to preventive care is more readily available under a SCP system, 0.536
leading to better health outcomes.
Has the implementation of SCP in your region led to increased patient 0.602
satisfaction with the quality of healthcare services
In your view, does SCP promote a culture of continuous improvement in 0.590
healthcare services and outcomes
SCP may lead to greater accountability and transparency in healthcare 0.628
delivery, contributing to better care quality.
Do you believe that SCP has encouraged healthcare providers to adopt best 0.638
practices and standards, leading to improved care quality?
Over the past years hospital service improved for assessing current patient 0.634
needs and expectations.
Over the past years, the hospital has shown steady, measurable 0.651
improvements in the quality of services provided by clinical support
departments such as laboratory, pharmacy, and radiology.
Over the past years, the hospital has shown steady, measurable 0.578
improvements in gaining trust of patients.
Over the past years hospital does a good job of assessing future patient needs 0.609
and expectations.
Over the past years hospital provide equal treatment to both SCP and non- 0.651
SCP patient
Over the past years healthcare providers adopted efficient processes and 0.635
practices, which can improve service delivery.
Over the past years does SCP promote a culture of continuous improvement 0.653
in healthcare service delivery
Has the implementation of SCP in the province led to increased patient 0.653
satisfaction with the delivery of healthcare services?
The hospital has effective policies to support improving the quality of care 0.795
and services.
The hospital regularly checks equipment and supplies to make sure they 0.795
meet quality requirements.
The services that the hospital provides are thoroughly tested for quality 0.739
before they are implemented.
The hospital views quality assurance as a continuing search for ways to 0.794
improve.
SCP ensures that individuals receive the necessary support for their 0.785
healthcare needs.
SCP can alleviate financial burdens on individuals and families, providing 0.794
essential financial support during medical emergencies.
SCP promotes a patient-centered approach, which includes emotional and 0.785
psychological support in addition to medical care.
SCP can help reduce the financial stress associated with healthcare 0.785
expenses, thereby enhancing overall support for individuals and families.
In the past years enough, arrangements are made to overcome administration 0.800
complexities of SCP.
The hospital does a good job of assessing current patient needs and 0.829
expectations.
In the hospital administration sufficient people are available with the right 0.715
skills.

171
 The hospital administration promptly resolve doctors as well as patient 0.877
complaints regarding SCP.
The hospital does a good job of assessing future patient needs and 0.800
expectations.
SCP can streamline financial management and reduce billing complexities 0.829
for healthcare providers.
SCP promotes standardized administrative procedures, which can reduce 0.715
errors and inefficiencies.
SCP can help reduce administrative costs, ensuring that resources are used 0.877
more effectively.
SCP encourages healthcare providers to adopt standardized practices, 0.877
simplifying the administrative processes.
Patients’ complaints are studied to identify patterns and learn to prevent the 0.619
same problems from recurring.
SCP helps allocate healthcare resources more efficiently, ensuring that they 0.713
are used where they are needed most.
In your opinion, has SCP led to a reduction in wastage of healthcare 0.566
resources in the hospital?
SCP can lead to better staff utilization and optimized workforce 0.713
management.
SCP ensures that healthcare resources are distributed fairly among different 0.713
regions and populations.
Has SCP resulted in the development of new healthcare facilities or the 0.542
upgrading of existing ones, leading to better resource utilization?
SCP can facilitate better resource forecasting. In your view, has this led to 0.713
more efficient use of resources?
Quality of care (QC), service delivery (SD), health support (S), administration complexities (AC), and resources utilization (AU)

The data collected from 412 health professionals regarding their perception of the Sehat card program in KP consists of 43% male
and 57% female from different age groups and occupational categories. 10.2% of health professionals are from the age group 18-30
years, 53.4% from 31-45, 29.1% from 46-56, and 7.3% are above 57 years old. 20.4% of the health professionals are physicians,
23.3% are surgeons, 30.6% are from administration, 15.3% are nurses, and 10.4% from other allied staff. The health professionals
have different years of experience with 16.3% having less than 5 years of experience, 58% having 5-10 years and 25.7% having
more than 10 years of experience. Further 60.7% of health professionals are working at government hospitals and 39.3% are working
at private hospitals. While 66.5% of health professionals are working in hospitals where the Sehat card program facility is available
and 33.5% of the health professionals are working in hospitals where the facility is not available.

Table 3: Differences in the Latent constrains for the domains of SCP based on health professional’s demographic
characteristics
Latent constrains Gender Hospital Type SCP Facility Occupational Experience
Category
QC χ2 = 32.763 χ2 = 13.774 χ2 = 56.800 χ2 = 76.877 χ2 = 54.466
P=0.109 P=0.952 P=0.000 P=0.924 P=0.242
SD χ2 = 30.311 χ2 = 16.983 χ2 = 109.531 χ2 = 94.414 χ2 = 46.906
P=0.256 P=0.910 P=0.000 P=0.739 P=0.674
HS χ2 = 18.138 χ2 = 13.751 χ2 = 62.321 χ2 = 69.127 χ2 = 51.437
P=0.513 P=0.798 P=0.000 P=0.699 P=0.072
AC χ2 = 13.281 χ2 = 11.234 χ2 = 58.560 χ2 = 78.398 χ2 = 32.128
P=0.824 P=0.916 P=0.000 P=0.403 P=0.737
AU χ2 = 25.621 χ2 = 26.520 χ2 = 40.537 χ2 = 71.609 χ2 = 50.723
P=0.219 P=0.277 P=0.013 P=0.943 P=0.293

Particularly the vital role played by the demographic characteristics of health professionals in the SCP. The differences in the five
domains of SCP were measured through demographic characteristics of health professionals using the Chi-square test. Table 3 shows
no significant difference in the Latent constraints for the domains of SCP based on health professionals' gender, hospital type,
occupational category, and experience. A statistically highly significant difference was noted in the Latent constraints for the
domains of SCP based on the SCP facility. This shows that in a hospital where the SCP facility is available significant differences
are present in quality of care, service delivery, support, administration complexities, and resource utilization compared to hospitals
where the SCP facility is not available.
Next table 4, and 5 shows the impact of quality of care, service delivery, support, administration complexities, and resource
utilization of the SCP. Table 5 presents the estimated logistic model summary and the correctness of the model prediction. It has
172
been found that the overall model is correctly 89.1% while those hospitals having the facility of SCP are correctly predicted by
93.4% and those hospitals that don't have the facility of SCP are correctly predicted by 80.4%. Based on the explained variation it
has been recorded 44.5% and 61.7% variations have been explained by the selected latent constraints of the five domains of SCP.
Based on the Omnibus test the estimated model coefficients and add ratios the overall model was noted as statistically significant
with Chi-square value = 242.486 and P = 0.000.

Table 4: Model Summary and correctness

-2 Log likelihood Cox & Snell R Square Nagelkerke R Square
282.921a .445 .617
Observed Predicted
SC Program Percentage Correct
No Yes
No 111 27 80.4
SC Program
Yes 18 256 93.4
Overall Percentage 89.1
*Omnibus test = Step, Block and Model Chi-square = 242.486, P = 0.00

Table 5 presents the statistical significance for each of the independent variables of the estimated model using the Wald test and P-
values. From the results significant impact of all independent variables was found. From the odd ratio, it was found that in the
hospitals where SCP facility is available quality of care is 1.159 times higher compared to those hospitals with no facility of SCP.
Similarly, service delivery, support, and administrative complexity are found 1.221, 1.174, 1.210, and 1.144 higher compared to
those hospitals with no facility of SCP. Additionally, all the estimated coefficients were found positive showing a positive role of
SCP facilities.

Table 5: Impact of five domains of the Sehat Card Program

B S.E. Wald df Sig. Exp(B) 95% C.I. for EXP(B)
Lower Upper
QC .147 .033 20.312 1 .000 1.159 1.087 1.236
SD .200 .026 57.036 1 .000 1.221 1.159 1.286
HS .160 .022 53.289 1 .000 1.174 1.124 1.225
AC .191 .027 49.344 1 .000 1.210 1.148 1.277
RU .134 .031 18.977 1 .000 1.144 1.077 1.215
Constant -24.148 2.549 89.735 1 .000 .000

4. Discussion
In this study, the authors found that, overall, SCP resulted in positive effects increased quality of care, service delivery and support.
In addition to this, the SCP also increased the administrative complexities and resource utilization within the hospitals. QC has
positive relationship with SCP and study is consistent with (Ali & Sentruk, 2019; Yanful, 2023) with respect to UHC that can lead
to improvements in the quality of care provided by hospitals, as more people gain access to essential health services. UHC has been
shown to have a positive impact on HS outcomes, including life expectancy (Brown, 2020). Reason being, under UHC, people have
no concerns about how they'll pay for medical care, which means they can get better treatment sooner and deal with chronic ailments
better. The results shows that AC influence the SCP and consistent with Mtei et al. (2012) Chemouni (2018) because UHC lead to
AC. RU has significant effort on SCP because UHC can increase demand for health services, including hospital services, as more
people gain access to care without financial hardship. This increased demand can put pressure on hospital staffing and resources,
particularly in areas where there are already shortages of health workers and infrastructure. Our results show significant association
of quality of care, service delivery, support, administrative complexities and resource utilization with the hospitals providing the
facility of SCP. Furthermore, no significant association found of the five domains of SCP with gender of health professionals,
hospital type, occupational category and with health professionals experience.
4.1. Limitation
This research study is not without limitations there are some limitations. First, the sample collected from health professionals was
small in size, and less number of hospitals included was due to a limited number of hospitals currently offering the services of the
SCP in remote districts of KP. In addition to this a convincing sampling approach is used, health professionals who notice the
positive aspects of the SCP are more likely to participate. Another significant limitation is the only five domains of the questionnaire
mostly the positive sides of the SCP in our perception the results are biased in the way that. Developing a questionnaire rich with
domains and with both positive and negative sides of the SCP can limit bias and provide equal weight to both positive and negative
sides. Future research is required that may address different aspects and further investigation of influential determinants for the
improvement of SCP.

5. Conclusion
According to our study's conclusion, the health care providers in Khyber Pakhtunkhwa province agree that the SCP has a beneficial
impact on care quality, service delivery, support, administrative complexity, and resource utilization. The results also found there is
173
no difference in the quality of care, service delivery, support, administration complexities, and resource utilization based on the
gender of health professionals, hospital type, and occupational category and with health professional's experience. In addition to
this, study shows that a significant association present of the SCP with quality of care, service delivery, health support, administration
complexities, and resource utilization.

References
Afriyie, D., Krasniq, B., Hooley, B., Tediosi, F., & Fink, G. (2022). Equity in health insurance schemes enrollment in low and
middle-income countries: A systematic review and meta-analysis. International Journal for Equity in Health, 21(21),1-12.
Akazili, J., Welaga, P., Bawah, A., Achana, F. S., Oduro, A., Awoonor-Williams, J. K., Williams, J. E., Aikins, M., & Phillips, J. F.
(2014). Is Ghana’s pro-poor health insurance scheme really for the poor? evidence from Northern Ghana. BMC Health
Services Research, 14(1), 1-9.
Ali, A., & Şenturk, I. (2019). Justifying the Impact of Economic Deprivation, Maternal Status and Health infrastructure on Under-
Five Child Mortality in Pakistan: An Empirical Analysis. Bulletin of Business and Economics, 8(3), 140-154.
Ali, A., Audi, M., Bibi, C., & Roussel, Y. (2021). The Impact of Gender Inequality and Environmental Degradation on Human Well-
being in the Case of Pakistan: A Time Series Analysis. International Journal of Economics and Financial Issues, 11(2), 92-
99.
Ashraf, I., & Ali, A. (2018). Socio-Economic Well-Being and Women Status in Pakistan: An Empirical Analysis. Bulletin of
Business and Economics (BBE), 7(2), 46-58.
Awang, Z., Afthanorhan, A., & Mamat, M. (2016). The Likert scale analysis using parametric based structural equation modeling
(SEM). Computer Methods Social Sciences, 36(4), 13-21.
Aziz, N., Liu, T., Yang, S., & Zukiewicz-Sobczak, W. (2021). Causal relationship between health insurance and overall health status
of children: Insights from Pakistan. Frontiers in Public Health, 10, 934007. doi: 10.3389/fpubh.2022.934007. PMID:
36568764; PMCID: PMC9768499.
Bertalanffy, L. Von. (1968). General System Theory: Foundations, Development, Applications. New York: George Braziller.
Brown, A. (2020). Better health outcomes: the impact of universal health coverage (UHC). Journal of Health Policy, 45(2), 123-
136.
Chemouni, B. (2018). The political path to universal health coverage: Power, ideas and community-based health insurance in
Rwanda. World Development, 106, 87-98. ISSN 0305-750X.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Erlbaum.
Conrad, P. (2007). The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders. Baltimore,
MD: Johns Hopkins University Press.
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334.
Gerdtham, U. G., & Löthgren, M. (2001). Health system effects on cost efficiency in the OECD countries. Applied Economics,
33(5), 643-647.
Hogan, D. R., Stevens, G. A., Hosseinpoor, A. R., & Boerma, T. (2018). Monitoring universal health coverage within the Sustainable
Development Goals: Development and baseline data for an index of essential health services. The Lancet Global Health,
6(2), 152-168.
Jutting, J. P. (2002). The impact of health insurance on the access to health care and financial protection in rural areas of developing
countries: Case study Senegal. In 2002 Annual meeting, July 28-31, Long Beach, CA 19641. American Agricultural
Economics Association (New Name 2008: Agricultural and Applied Economics Association).
Lucas, R. E. (1988). On the mechanics of economic development. Journal of Monetary Economics, 22 (1), 3-42.
Maydeu-Olivares, A. (2005). Further empirical results on parametric versus non-parametric irt modeling of likert-type personality
data. Multivariate Behavioral Research, 40, 261-279.
McHugh, M. L. (2013). The chi-square test of independence. Biochemia medica, 23(2), 143-149.
Mtei, G., Makawia, S., Ally, M., Kuwawenaruwa, A., Meheus, F., & Borghi, J. (2012). Who pays and who benefits from health
care? An assessment of equity in health care financing and benefit distribution in Tanzania. Health Policy and Planning,
27(Suppl 1), i23-i34. doi:10.1093/heapol/czs018. PMID: 22388497.
Rawls, J. (1971). A Theory of Justice. Cambridge, MA: Harvard University Press.
United Nations Development Programme. (2015). Sustainable development goals. Retrieved from
https://www.undp.org/content/undp/en/home/sustainable-development-goals.html
Yanful, B., Kirubarajan, A., Bhatia, D. (2023). Quality of care in the context of universal health coverage: a scoping review. Health
Research Policy and Systems, 21, 1-29.
Zieff, G., Kerr, Z. Y., Moore, J. B., & Stoner, L. (2020). Universal Healthcare in the United States of America: A Healthy Debate.
Medicina (Kaunas), 56(11), 580.

174
 Appendix A: Demographics of Participants
Gender Count Percent
Male 177 43.0
Female 235 57.0
Total 412 100.0
Age group Count Percent
18- 30 42 10.2
31-45 220 53.4
46-56 120 29.1
57 and above 30 7.3
Total 412 100.0
Working at Count Percent
Govt. Hospital 250 60.7
Private Hospital 162 39.3
Total 412 100.0
SC Program Count Percent
Yes 274 66.5
No 138 33.5
Total 412 100.0
Occupational Category Count Percent
Physician 84 20.4
Surgeon 96 23.3
Admin 126 30.6
Nurses 63 15.3
Others 43 10.4
Total 412 100.0
Years of Experience Count Percent
Less than 5 67 16.3
5-10 years 239 58.0
More than 10 years 106 25.7
Total 412 100.0

175