Audit flags irregularities in Sehat Sahulat Programme at Khyber Teaching Hospital

PESHAWAR: An internal audit at Khyber Teaching Hospital has identified financial irregularities linked to Khyber Pakhtunkhwa’s Sehat Sahulat Programme, raising concerns about oversight of the health insurance initiative.

According to the audit report and hospital sources, doctors, nurses and other staff at Khyber Teaching Hospital allegedly received payments for surgeries and medical procedures under the programme even though the operations were carried out during official morning duty hours in government operating theatres. Such procedures do not qualify for additional payments under the scheme.

Hospital sources said the procedures were allegedly billed through the Institute-Based Practice system, which is meant to allow consultants to see private patients within hospital facilities after official working hours. A hospital source familiar with the audit findings said, “They performed surgeries during the morning shift in government theatres but later claimed payments under the IBP arrangement,” and added, “This practice not only violated financial rules but also deprived the hospital of its rightful revenue.”

Questions over billing and supplies

The audit also pointed to concerns regarding medicines and surgical supplies. According to hospital sources, drugs and equipment prescribed for patients being treated under the health card scheme were at times allegedly reused for other patients, while their cost continued to be charged as operational expenditure under Sehat Sahulat Programme claims.

Sources within the hospital further alleged that the suspected wrongdoing involved a wider group of employees, including technicians, nurses and doctors, describing it as a “systematic exploitation” of the programme.

Official documents cited in the report show that Khyber Teaching Hospital received about Rs2.15 billion through health card treatments from 2020 to 2025. Of 108 consultants working under the IBP system, between 24 and 30 surgical and allied consultants were allegedly linked to the questionable practices.

The audit said 3,921 surgeries were carried out under the scheme during the review period. In 178 of those cases, patients reportedly paid cash despite being entitled to free treatment under the health card facility.

Revenue-sharing formula under scrutiny

The report also highlighted concerns about the revenue-sharing arrangement introduced in 2020. Under that formula, doctors receive 45% of the income generated from health card treatments, anaesthesia services get 15%, hospitals receive 32%, technicians 5%, and administrative staff 3%.

Hospital administrators argue that the formula leaves the institution without enough resources to meet overhead expenses, including pharmacy services, utilities, maintenance and infrastructure costs. According to the audit, this has resulted in annual losses of more than Rs50 million and over Rs500 million during the life of the programme.

The Sehat Sahulat Programme was launched by the provincial government in December 2015 as a pilot in four districts for around 100,000 families. It was later expanded, and by November 2020 it covered the entire provincial population, with around 5.4 million families registered. Under the expanded scheme, each registered family became eligible for treatment worth up to Rs1 million per year. The provincial government allocated nearly Rs18 billion for the initiative, making it one of the country’s largest publicly funded health insurance programmes.

The internal audit of the IBP system at Khyber Teaching Hospital said the findings exposed broader weaknesses in financial oversight, governance and operational controls.

“Project Director of the Sehat Sahulat Programme Dr Riaz Tanoli acknowledged that complaints about irregularities had been received.

However, he stated, “Corruption cannot be eliminated entirely,” and said “institutions including the National Accountability Bureau and anti-corruption authorities oversee the programme and can act if misconduct is established”.

At a press conference, Chief Minister Sohail Afridi said, “There will be zero tolerance for corruption.” He added, “Our priority is to ensure transparent health services for the people. Anyone involved in wrongdoing will face the law.”

Muzzamil Aslam, adviser to the chief minister on finance, also responded and said, “In such mega projects, 100% transparency is impossible.”