improving health infrastructure and healthcare services while maintaining the role of the federal government in coordinating key programs such as communicable disease control. initiated in 1992 by the pakistan peoples party (ppp), the social action programme aims to make advances in four social sectors: primary education, primary health, water supply and sanitation, and family planning. the goals of the program are to reform institutions and increase financing for social services within these sectors. sap is largely financed by external organizations such as the world bank, asian development bank, government of netherlands, and overseas development agency of uk. in 1994, the government of pakistan launched the national programme for family planning and primary healthcare. the main goal of the program is to provide primary health care to underserved populations, particularly women and children, through family planning services. since its inception, the program has become one of the largest community health based programs in the world, providing primary healthcare services to 80 million people mostly in rural areas. one of the program's main initiatives, the lady health worker programme, trains women to serve as community health providers in areas across the country and has turned out to be a promising community-based health worker program. lady health workers are local, literate women who undergo approximately 15 months of training after recruitment. once training is complete, the lady health workers serve 100 to 150 homes by visiting 5-7 homes daily. the main responsibilities of lady health workers are to conduct screenings of pregnant women and refer them to clinical services if needed, distribute condoms and contraceptive pills, provide interventions for malnutrition such as nutritional counseling, and treat common diseases with special drug kits. there are currently approximately 96,000 women serving as lady health workers. compared to communities not served by lady health workers, communities with access to this initiative are 11% more likely to use modern family methods, 13% more likely to have a tetanus toxoid vaccination, 15% more likely to receive a medical check-up within 24 hours of birth, and 15% more likely to have immunized children below the age of three years. despite the lady health worker programme's strengths, a study conducted in 2002 in karachi has shown that many lady health workers feel that their salary is too low and their payment is too irregular. lady health workers are not classified as permanent government employees and, therefore, do not have government benefits. the contractual nature of their job is a constant threat and source of anxiety. other possible improvements include skill and career development opportunities for lady health workers and a stronger patient referral system within the program. prime minister national health program prime minister's national health program was launched on december 31, 2015. it was a state-run health insurance program. the main aim of the program is to benefit the pakistani citizens living under the line of poverty. federal health minister was appointed to monitor the process. initially, the program covered 15 districts of the punjab, balochistan and the federally administered tribal areas and islamabad as well. sindh and khyber pakhtunkhwa governments declined to become part of this scheme. the free-of-cost treatment was offered for cardiovascular diseases, diabetes, burma and rta (life and limb saving treatment, implants, prosthesis). it also includes treatment of end-stage renal diseases and dialysis, chronic infections (hepatitis), organ failure (hepatic, renal, cardiopulmonary) and cancer treatment (chemotherapy, radiotherapy and surgery). until now 3227113 have been enrolled in this program. furthermore, on january 3, 2018, the program was extended to 38 districts including the gilgit-baltistan, azad jammu and kashmir along with others. emergence of digital healthcare in the last decade, pakistan has undergone massive digitization in various sectors of economy. introduction of 3g/4g technologies, growing internet penetration, and an emerging startup ecosystem have fueled a new wave of innovation. technology has led to a number of positive changes in healthcare delivery. today, pakistan has over 12 startups that work on various service areas, from service delivery to finding the right doctor. these healthcare companies have not only attracted local audience but also attracted foreign investment. 60 million pakistanis have a smartphone, and they can avail healthcare information, book appointment with the doctors, order medicines, and request lab tests from their smartphones. this emergence of digital healthcare platforms is making it easy for the people to access the right doctor and enabling them to avail the best healthcare services at their doorsteps. in recent times, the startup culture in pakistan has boomed with many players trying to change the healthcare segment as well. these startups are helping patients to buy medicines online, order lab tests and get home sample collection done and maintain medical records so that all patient data & history is stored in one place. beside all these facilities, these startups are also providing the online audio and video consultation services.