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Nazneen Shafiq



Seven and a half years old Nazneen Shafiq of Hussaini Nagar Baldiya town Karachi was only 3 when she developed a severe chest infection alongside high grade fever. Her family got her checked up from a local physician who put her on medication for a week, but her condition did not subside. The family went to a pediatric specialist who suspected some heart problem and referred the case to NICVD. Doctors at NICVD performed investigations and concluded that the 3-year-old was suffering from a congenital condition generally referred to as a “hole” in the heart.

In medical terms, she was diagnosed to be suffering from Atrial Septal Defect, a condition in which the upper two chamber of heart (The left and right atria) which are normally separated by a wall called ‘septum’ have an opening causing blood to flow back in the wrong direction.

Small Septal defects may remain unnoticed till middle ages or even later. However, with bigger defects, symptoms appear any time after birth through childhood as was the case with Nazneen Shafiq. The doctors initially put the patient on medication advising 3 monthly check ups expecting the septal defect will close in on itself as the patient grows in age and size.

Four years ever since passed, and the condition of the patient did not improve. Seeing no improvement in the patient and the fact that the defect has not closed in on itself, the doctors suggested closure by device procedure to the patient in February 2016. The cost of procedure once dawned upon the family left the family flabbergasted as they were soon to learn that the clinical procedure of Nazneen would mean eating up the family’s entire annual budget with little to spare. The high cost of this treatment put the whole low-income family in a double jeopardy. The family’s net monthly income stood at Rs. 312,000 per annum while the cost of procedure was Rs. 270,000. Given their net annual income, they could only choose between two options, both equally devastating or perhaps each more than the other. They could either Forego Nazneen’s care, watch her die a slow painful death and keep feeding the rest of the 14 family members or Proceed with Nazneen’s procedure and starve the rest of the 14 family members for one full year. Taking this option would require somebody paying a hefty PKR 270,000 to the hospital upfront for the procedure and then the family starving themselves for years to come to repay the debt. Although the latter option seems workable, families like Nazneen do not have a social circle to borrow such a large sum from nor have any access to public funding.

Luckily, the hospital they went into, National Institute of Cardio Vascular Diseases (NICVD) Karachi, happens to be a registered site for an access to healthcare initiative run by Heartfile. The Heartfile Health Financing program through its innovative features provides health care financing for patients just like Nazneen. The focal point doctor at NICVD sent a plain text SMS to HHF thereby initiating a formal financing request to HHF for Nazneen’s operation. Following its protocols, Heartfile Health financing mobilized an eligibility assessment resource within days to assess the eligibility of patient Nazneen for healthcare financing.

Heartfile’s validated and internationally accredited poverty scoring card declared the patient eligible for catastrophic healthcare financing. Approval of the financing request was immediately communicated to the patient, the doctor and the registered supplier via SMS as well as email. Once the funding for the procedure was secured and required health indicators of the patient were stabilized, patient Nazneen underwent the AD Closure by device procedure on 21 Mar 2016. Latest follow up upon the patient shows that she is well on the path of recovery and much better than before the procedure. The cost of the procedure was billed to Heartfile Health Financing who were able to underwrite the cost of procedure with donations from its donors.

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Heartfile Health Financing (HHF) is an access to treatment program for non-communicable diseases. It provides financial access for high-cost treatment for those who are unable to pay, are likely to spend catastrophically or forgo treatment. HHF's mobile phone-driven process is fully transparent and offers help to patients with dignity. HHF currently operates in selected hospitals in Pakistan and is being prepared for scale-up.  

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