LOWER DIR: Provision of surgical services under the Sehat Sahulat Programme (SSP) has been severely disrupted in Malakand division, especially in Lower Dir, following the imposition of taxes in the region, with doctors reportedly refusing to perform many procedures under the health insurance scheme.
According to available figures collected from private hospitals, around 200 surgeries were previously carried out daily in Lower Dir under the programme. However, since Sept 1, only about 20 surgeries a day are being performed through the SSP, while the remaining 180 are being conducted privately at significant cost to patients.
Five private hospitals affiliated with the SSP in Timergara, the headquarters of Lower Dir, had been providing a large number of surgical procedures under the programme. Hospital sources said orthopaedic and several other major surgeries had been affected due to the non-cooperation of doctors after the implementation of the new tax regime.
They added that gynaecological services and dialysis treatment continued to be provided under the SSP without interruption.
Orthopaedic surgeries among most affected
Under the taxes imposed in Malakand division, a 15 per cent withholding tax and a 14pc service tax are applicable, bringing the overall tax burden to 29pc.
According to the programme’s payment mechanism, 60pc of the package amount is paid to hospitals while 40pc goes to doctors. Medical practitioners argue that the new taxes have significantly reduced their earnings from procedures performed under the SSP.
Health officials told Dawn that compensation for surgeries under the programme was already inadequate and required revision. They say the existing package rates make it increasingly difficult to meet hospital expenses, procure medicines and surgical equipment and maintain the quality of healthcare services.
Private hospital managements, meanwhile, said they have continued providing treatment despite rising operational costs, heavy taxation and comparatively low SSP package rates. They contend, however, that the refusal of some doctors to perform surgeries under the scheme is directly affecting access to healthcare for low-income patients.
Residents have questioned why surgeries under the SSP continue in other districts of Khyber Pakhtunkhwa while similar services have been disrupted in Malakand division, particularly in Timergara.
They argue that financial and administrative disputes should not be allowed to affect poor patients who rely on the programme for free medical treatment.
With a population of around 1.6 million, Lower Dir has a large number of residents dependent on the health card scheme for surgical care. The current situation has forced many patients either to pay substantial amounts for treatment at private hospitals or seek care at government-run health facilities.
Hospital officials said the disruption had also increased pressure on the district headquarters hospital in Timergara, where patient inflows have risen in recent weeks.
Local residents have urged the provincial government, State Life Insurance Corporation and other stakeholders to resolve issues relating to taxation, hospital expenditures and doctors’ remuneration so that surgical services under the Sehat Sahulat Programme can be fully restored.
Published in Dawn, September 14th, 2026
