Health Insurance for Pakistan's Agricultural Workers

Agriculture is the backbone of Pakistan’s economy, contributing 22.7% to GDP and employing 37.4% of the labor force (Pakistan Economic Survey, 2023). Despite their crucial role, agricultural workers operate under harsh and often unsafe conditions. They face a high risk of occupational hazards such as pesticide poisoning, machinery-related injuries, musculoskeletal disorders, and chronic respiratory illnesses due to prolonged exposure to dust and chemicals. Yet, healthcare access remains minimal. Less than 5% of rural agricultural workers are covered by any form of health insurance, leaving millions financially exposed to health-related emergencies (State Bank of Pakistan, 2023).

Health insurance is a critical tool for safeguarding the economic well-being of this vulnerable group. In the absence of coverage, out-of-pocket medical expenditures often force workers to sell assets, take high-interest loans, or forgo treatment altogether. According to the World Bank (2023), healthcare-related expenses push approximately 7.6 million Pakistanis into poverty each year, with rural populations disproportionately affected.

The economic impact extends beyond individual households. When workers are forced to interrupt or abandon agricultural activities due to health issues, productivity suffers, leading to lower yields, reduced income, and broader food security concerns. Health insurance can buffer these shocks, enabling timely medical care and quicker recovery, which translates into improved labor efficiency and higher overall output.

This study explores the economic implications of expanding health insurance among agricultural workers. It examines various models, such as public-private partnerships, community-based schemes, and integration with social safety nets like the Benazir Income Support Program (BISP). Evidence suggests that even partial coverage improves health outcomes, reduces absenteeism, and enhances household resilience to economic shocks. By ensuring equitable access to healthcare, health insurance can be a powerful driver of rural development, social protection, and inclusive economic growth in Pakistan’s agricultural sector.

Ensuring Health Security for Agricultural Workers in Pakistan

Agricultural workers form the backbone of Pakistan’s rural economy, yet they remain one of the most neglected segments of the labor force. The majority, around 89%, are informal or daily wage earners, lacking formal contracts, job security, or access to occupational benefits (Labor Force Survey, 2023). Their work involves direct exposure to hazardous conditions, yet only 2% of these workers are covered under any government-sponsored health scheme, such as the Benazir Income Support Program (BISP, 2023). As a result, they are highly vulnerable to both health-related and financial shocks.

Health risks for agricultural workers are numerous and often severe. Chemical exposure, particularly from pesticides and fertilizers, accounts for an estimated 20,000 poisoning cases annually in Punjab alone (Punjab Health Department, 2023). Prolonged contact with these chemicals can cause long-term respiratory illnesses, neurological damage, and even cancer. Physical injuries from machinery such as tractors and threshers are also prevalent, with over 12,000 injuries reported every year (Pakistan Bureau of Statistics, 2023). Moreover, poor sanitation, lack of clean drinking water, and proximity to livestock contribute to the spread of infectious diseases like malaria, dengue, and tuberculosis (WHO, 2023).

These health challenges are compounded by the lack of access to affordable healthcare. Without insurance, many workers delay seeking treatment, leading to chronic conditions that diminish their productivity. A study in rural Sindh revealed that 60% of farm workers had to sell livestock or borrow money to pay for medical expenses (Aga Khan University, 2022). This not only undermines their economic stability but also perpetuates cycles of poverty and reduced labor output.

Health insurance can offer a viable solution. It not only covers hospitalization and treatment costs but also encourages preventive care, reducing long-term health complications. Economically, insured workers report 30% fewer sick days (ILO, 2023), leading to higher productivity. Health insurance reduces medical impoverishment by 40% and supports improved savings and investment habits (World Bank, 2023). Healthier, financially secure workers also contribute to better agricultural yields estimated to improve by 15–20% with a healthier workforce (FAO, 2023).

International models like India’s Pradhan Mantri Fasal Bima Yojana (PMFBY) show the potential of integrated insurance schemes that combine crop and health coverage. This has led to a 25% increase in healthcare access among Indian farmers and a significant reduction in asset distress sales (NITI Aayog, 2023). For Pakistan, scaling up affordable, inclusive health insurance for agricultural workers can be transformative that can boost rural health, resilience, and long-term economic growth.

Overcoming Barriers to Health Insurance for Agricultural Workers in Pakistan

Despite the urgent need for health coverage among Pakistan’s agricultural workforce, health insurance uptake remains critically low. Several barriers prevent widespread adoption of health insurance in rural areas. A major challenge is low awareness, approximately 80%, of rural workers are unfamiliar with the concept of health insurance or the benefits it can offer (Gallup Pakistan, 2023). This knowledge gap leaves them unprepared for medical emergencies and reliant on out-of-pocket expenditures.

Affordability is another key barrier. Daily wage earners often earn between PKR 500-800 per day and cannot afford even subsidized insurance premiums. Additionally, current public programs like the Sehat Sahulat Program have limited reach in rural areas and often do not include agricultural laborers as a target group, leading to weak implementation and low enrollment.

To address these challenges, a multipronged policy strategy is essential. Firstly, the Sehat Sahulat Program should be expanded to include all registered and informal agricultural workers, with support from agribusinesses through co-funded premiums under corporate social responsibility (CSR) initiatives. Secondly, village-level awareness campaigns should be conducted using local languages and trusted community figures. Outreach through mobile phones, radio, and mosque announcements can further amplify reach.

Enforcing occupational safety regulations such as providing free protective gear and medical checkups in high-risk farming areas can improve health outcomes and reduce insurance claims over time. Lastly, public-private partnerships (PPPs) should be promoted by collaborating with microfinance institutions and private insurers to design low-cost, flexible insurance packages tailored to seasonal income patterns of farm workers.

Through inclusive design, awareness, and shared financial responsibility, Pakistan can significantly improve rural health security and unlock broader socio-economic benefits for its agricultural sector.

Conclusion

Health insurance represents a critical yet underutilized pillar in securing the well-being and productivity of Pakistan’s agricultural workers. Despite contributing significantly to the economy, these workers remain highly vulnerable to occupational hazards and financial instability due to limited healthcare access. With the vast majority lacking insurance, even minor health issues can result in catastrophic economic consequences, such as debt, asset sales, and long-term productivity losses.

Expanding health insurance coverage in the agricultural sector offers transformative potential not only for individual workers but for Pakistan’s broader goals of poverty reduction, rural development, and food security. Evidence shows that insured agricultural workers experience fewer sick days, higher output, and improved financial resilience. International models like India’s PMFBY further affirm that integrated crop and health insurance can dramatically improve healthcare access and reduce economic distress.

However, meaningful progress requires a multi-pronged policy response: subsidizing insurance premiums, strengthening rural outreach and awareness, leveraging public-private partnerships, and integrating occupational safety into national health frameworks. Targeted, inclusive health coverage tailored to the needs of agricultural workers can break the cycle of medical impoverishment and empower Pakistan’s rural economy. By recognizing health insurance as both a social safeguard and an economic enabler, Pakistan can build a more resilient, equitable, and productive agricultural sector.

References: Pakistan Economic Survey; World Bank; ILO; FAO; State Bank of Pakistan; Labor Force Survey; BISP; Punjab Health Department; Pakistan Bureau of Statistics; Aga Khan University; NITI Aayog; Gallup Pakistan

Please note that the views expressed in this article are of the author and do not necessarily reflect the views or policies of any organization.

The writer is affiliated with the Department of Epidemiology and Public Health, Faculty of Health and Pharmaceutical Sciences, University of Agriculture, Faisalabad, Pakistan.

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