Daily Times

The pandemic of the novel coronavirus (COVID-19) has created havoc globally. While the effects of the pandemic are being observed across the wide range of sectors, the disease in particular is testing the nerves of healthcare systems across the globe. COVID-19 has posed huge challenges to fragile states with an inadequate healthcare infrastructure and has also affected the health systems of well-developed nations. This is primarily due to the lack of preparedness to deal with such pandemic. With the confirmed cases in the country getting close to 14,000, with 281 lives lost (as of 27th April, 2020), healthcare system in Pakistan is stretched to its limits like other countries. It is quite obvious that Pakistan is faced with a mammoth task to respond to the disaster with a weak health infrastructure and funding constraints. To contain virus transmission, although some preventive measures (such as wearing of masks, physical distancing and hygiene practices et.) are being observed among the general public; however, more serious actions are needed across the nation. It is appreciative to see that National Disaster Management Authority and the key players at the federal and provincial Government are executing public health measures to prevent virus transmission. Health and Finance Ministry are in complete sync these days instead of being at loggerheads with each other over funding issues. This article is therefore, an attempt to capture some of these dynamics, alongside suggestions for better repositioning of health systems in the country.

Historically, Pakistan’s healthcare system has been operating with very meager funding allocation (2% versus 10% globally), with a major share of funding going into staff’s salaries. Approved positions of healthcare providers are often not filled due to budgetary constraints. As a result, most of the Taluka Head Quarter Hospitals in the country are usually unable to offer their services round the clock. The cracks in the weak health system became public when the country received the shock of COVID-19 cases with severe respiratory problems requiring ventilators and isolation facilities; which were simply non-existent particularly at most of the district level hospitals. This calls more funding resources in our health system to effectively manage with the routine care, and also to be more prepared to deal with outbreaks and such pandemics. In addition, non-health sector industries also became the victim of years of underinvestment in health system as the lockdown measures rippled through various sectors and reduced their capability to respond. It is therefore high time for these sectors to also invest more in health of their employees and keep preventive measures at the core of their businesses.

COVID-19 has huge implications for national economy and its goal for poverty alleviation. It is commendable the way in which the country (despite of its meager allocation) rose to the occasion and introduced the ‘Ehsas Program’ to provide emergency relief to cover 12 million families who have lost their income due to the lockdown. Under the rubric of Ehsaas Program, the eligible households are entitled received Rs. 12,000 per family and the total estimated budget is PKR. 144 billion. It is indeed commendable that both the federal and provincial Governments have approached the problem through multi-sectoral strategy. It is also remarkable to witness the rapidness with which the Government managed to allocate PKR 1.25 trillion which will be spent through a multi-sectoral relief package with an aim to address the challenges arisen due to the outbreak COVID-19 (Reported at Gulfnews.com). However, funding envelop will indeed needs to be further enhanced to institutionalize these capacities and to ensure that proper investment is made in the monitoring and maintenance of these services during and post coronavirus pandemic.

In order to monitor the rise of infection, Federal Ministry of Health has developed a highly sophisticated Incident Command & Control system for inter-provincial coordination on COVID-19. District-wise, gender-based and age-specific information is now being collected from the provinces and is being disseminated promptly for careful action. Unfortunately, in spite of the fact that the country is facing many challenges brought upon it by various epidemics, the Pakistan Bureau of Statistics does not seem to be actively engaged.

The COVID-19 pandemic has also drawn attention to the need for inter-country coordination and support for health systems strengthening through strategic action. One of the important areas of investment is aimed at ensuring standard operating procedure for adopting infection control measures not just for hospitals, but also for other sectors. Hospital leadership across public and private sector is investing efforts in building the capacity of health care providers in infection control protocol and ensuring the availability of personal protective equipment for their staff. It will therefore be in high interest of patients and health care providers if such investment is continued in post-coronavirus period also. As this will allow patients under treatment with other infectious diseases and health care providers to have safe environment. Also, as the government is taking action to equip hospitals to manage COVID-19 cases, such initiatives are needed to be sustained in future too to avoid delays in patient care treatment and reduce preventable deaths due to poorly equipped healthcare infrastructure, especially in government managed hospitals in Pakistan.

COVID-19 has very aggressively put public health and prevention at the center of all actions to prevent the virus transmission. While management of the virus-affected patients inside the hospitals require continuous care, its cure is indeed crucial to institute strict public health measures in the communities. The focus on testing for COVID-19, tracing contacts, quarantine and isolation procedures to reduce the transmission is most essential, alongside reinforcement of preventive measures. With COVID-19 entering into second phase of disease in some countries; the importance of putting in place strict public health measures, while easing the lockdown is becoming pivotal. Likewise, it is therefore expected in Pakistan at present and in weeks to come where seriousness in adapting preventive measures from the general public will be needed more.

Partnership with private sector has emerged most powerfully during this pandemic. Sponsoring of preventive messages, investment by the corporate sector in promoting public health messages through mass media particularly television, radio, telecommunication and social media is indeed commendable. It is important that such partnership with the private sector in prevention and promotion is continued in future, along with prevention of other infections such as polio, diarrhea, pneumonia, typhoid, hepatitis etc. Along these lines, there is also dire need for encouraging the private sector to engage in creating an enabling environment for actions such as availability of clean water for drinking and safe sanitation facilities for communities residing in urban slums and rural areas.

Another major change witnessed during this pandemic is the respect that doctors, nurses and other frontline workers such as paramedics and auxiliary staff were able to garner from the masses for their selfless services in saving lives. Looking at the current crisis situation, it is also imminent to explore and reposition the role of Lady Health Workers (LHWs) in screening of COVID-19 and other such infectious disease cases. With proper training in protocols for screening, LHWs and other community health workers can be mobilized during such public health emergency, while offering a helping hand to those serving on the front line. To keep our health workforce motivated, it is important that their services should be frequently recognized and appreciated at all levels, while ensuring an enabling environment for them to work.

The current pandemic has also built a strong case for investing in the IT industry. IT sector enfolds a lot of opportunities for innovations particularly in addressing the challenge of communication during lockdown. During lockdown, some private health care organizations are switching to teleconsultation and telehealth to maintain the ongoing package of services and even provide access to the population living in rural areas. This initiative is yet to be witnessed across the wide range of public and private healthcare organizations in the country, because people’s hardships in accessing health care services for their illnesses are being reported due to the closure of health services in few provinces. We need more replicas of teleconsultation for health care services such as “Sehat Kahani” to offer consultations and health care services remotely. As predictions continue to come from every corner in the world about the post-COVID-19 world order, it is therefore a golden opportunity for health systems in the country to build its IT infrastructure, while becoming more resilient.

Furthermore, COVID-19 has mobilized lot of interest in research and development. Higher Education Commission, Pakistan has set up research funds for academic institutions to investigate the disease process. There is also an opportunity for public and private healthcare hospitals to inquire how their own institutions are managing the pandemic with focus on identifying, facilitating and impeding factors for future learning.

Moreover, it is also important to reflect as a nation that as we are trying to cope with the current public health emergency, government in partnership with private sector needs to invest more in public health measures and enforce it across various businesses and sectors. This includes improvement in drinking water and sanitation facilities, safe disposal mechanism in quarantine units, schools, railways, public parks, shopping malls and nursing homes etc. It also includes strict enforcement for physical distancing and use of masks during an outbreak of any respiratory disease across all sectors, alongside paying special attention to care for children, elderly citizens and people who are having other co-morbidities etc.

In conclusion, it is undoubtedly a challenge for countries around the world, especially for poor and low-middle-income countries such as Pakistan to strengthen their capacity for absorbing such shocks. At the present moment, the outbreak of COVID-19 has not been contained and it is unclear by when it will die off. Our greatest fear, however remains that our health system is still not adequately prepared to deal with the surge of very seriously infected patients. Multisectoral approach to collective public health is indeed the way forward, alongside strengthening of health systems in the country.

Ms Nousheen A. Pradhan is the Faculty at Aga Khan University, Pakistan and Dr Rozina Mistry is a Health Consultant.