poor health facilities in pakistan essay

Major Challenges Faced by Health Sector in Pakistan

With the increasing economical pressure and lack of resources, healthcare system in Pakistan is deteriorating day be day. Although during the last decades many improvements are made, there is tremendous fatality rate in Pakistan among infants and women. To know the major challenges faced by health sector in Pakistan, let discus some points.

According to Transparency International surveys , health care in Pakistan is one of the country’s most corrupt sectors; general polls show that the majority of Pakistanis are dissatisfied with the health services they receive.

There are various flaws, including as poor governance, a lack of access and unequal distribution of resources, a poor-quality Health Information Management System, corruption in the health system, a lack of monitoring in health policy and health planning, and a shortage of educated professionals.

Table of Content

What are the Major Challenges faced by Health Sector in Pakistan?

Since Pakistan’s independence, the advancement of the health sector has been impossible to overlook. There are many weaknesses and challenges which are currently faced by the Pakistani health care system. Here are some of the major challenges faced by health sector in Pakistan;

Lack of Resources:

Because of the weak infrastructure of the Basic Health Units (BHUs) and Rural Health Centers (RHCs), the majority of people are unwilling to use the public health system’s healthcare services, and as a result, rural people are diverted to tertiary care facilities. The distance to health facilities, as well as a lack of transportation options with inadequate roads, limit their access to these services. Furthermore, it has been discovered that the public sector in Pakistan is underutilized due to a lack of human resources, a lack of health education, a lack of openness, and impediments due to linguistic and cultural differences. For many people, attending BHUs is a nightmare because of the aforementioned concerns.

Poor Infrastructure:

Poor healthcare infrastructure is one of the reasons of downfall of healthcare system in Pakistan. There is no proper policy making and planning in this department. This leads to inadequate healthcare facilities available to the citizens. A typical government hospital lacks sufficient doctors, nurses, and personnel. Because they serve a big population in the surrounding area, such hospitals are frequently overcrowded. They don’t have enough beds (due to an overabundance of patients).

Hospitals are filthy and unhygienic, they lack security, patient care is unheard of, medicines and consumables are frequently in low supply, employees may be unscrupulous and demand bribes from patients, and they may even lack essential utilities such as a continuous supply of water, power, and fuel. Because of breakdowns or corruption, their ambulances may be unavailable, leaving patients to fend for themselves.

Corruption:

Political and higher authority corruption is one of the reasons of poor health sector in Pakistan. The resources are unavailable in the hospitals and other healthcare centers due to corruption.

Lack of Educated Health Specialists:

In Health sector of Pakistan, there is still a lack of educated and professional individuals although number of students are graduating each year. The main reason is less availability of seats in public sector that hinders the educated people to come and serve the nation.

Another reason for lack of educated health specialists in Pakistan is, many health specialists go abroad for higher education and work there. This is the major loss of the health sector of Pakistan.

Lack of Public Health Insurance:

When public health systems fail, people are forced to seek treatment from private health care providers. Profit is the goal of private health care facilities. There is an obvious demand-supply imbalance, and they take advantage of the low supply to boost their own pricing. As a result, medical treatment in a private hospital may be significantly more expensive than in a government hospital. However, because major part of our population lacks health insurance, they are obliged to pay for their own treatment. As a result, many people are unable to afford healthcare.

High Prices of Imported Products:

Although Pakistan has largest pharmaceutical industries, but many medicines are need to be import from foreign countries. Similarly, many surgical and other health related machinery is imported from other countries. In this way, more budget is needed to fulfil the need of these imported products. But unfortunately, due to the lack of resources and increasing economical pressure, Health sector in Pakistan is unable to meet the need of these products that are necessary for the basic needs of citizens.

Same is the case with medicines that are imported from foreign countries.

Lack of Awareness:

People living in urban areas are more privileged and have access to basic health facilities. Similarly they are well aware about the health issues. But the situation in rural areas in different. People in rural areas are not well aware about the vaccines, treatment, precautions, preventions, etc. of many health issues. This increase the pressure on health sector of Pakistan. So it is need of the hour to start educating people of rural areas and help them to get the basic health facilities.

How can Health Sector in Pakistan be Improved?

The main purpose of improving the health care sector in Pakistan is to improve the life quality and to decrease the mortality rate in public. Pakistani government and private sectors should focus on these points to build a better health sector in Pakistan;

• Encouraging innovation and manufacturing (of medical devices) in Pakistan.
• Increased investment in medical research.
• Improving medical, nursing, and technical education, as well as upskilling current workers
• Public health insurance
• Awareness programs
• Check and balance of hospitals and other health departments to control the corruption.
• International Collaborations can also be done

Conclusion:

Pakistan is facing a lot of economical and political challenges. And after 74 years of independence, Pakistan still have poor health sector that has many challenges to face. From corruption to lack of well educated manpower, Pakistan has to fight with a lot of challenges. It is the high time to implement better health policy and start manufacturing medical devices within the country.

If you live in Pakistan and require medical assistance, you can visit the Marham website or download the app to gain simple access to online doctors, medicine delivery, online appointment booking, and much more.

What is lacking in Pakistan health system?

Numerous flaws exist in Pakistan’s health system, such as poor governance, restricted access to resources, unequal distribution of those resources, a poor health information management system, corruption in the healthcare industry, a dearth of skilled workers, and poor governance.

Is healthcare affordable in Pakistan?

In Pakistan, the health sector continues to get a smaller amount of government financing than is acceptable. In addition, there is no national health insurance system. As a result, the right to ‘affordable healthcare’ will be pushed further into the future.

She is a pharmacy graduate and worked as a hospital pharmacist. Her interests are teaching, blogging, and scientific writings. She likes to write about medicines, health issues, health and beauty-related natural remedies, the nutritional value of different foods, and mental health.

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COVID-19 and its Challenges for the Healthcare System in Pakistan

Atiqa khalid.

1 Sahiwal Medical College (affiliated with the University of Health Sciences, Lahore), Sahiwal, Pakistan

2 Allama Iqbal Open University, Islamabad, Pakistan

This article aims to highlight the healthcare issues raised by COVID-19 in Pakistan’s scenario. Initially, Pakistan lacked “standard operating procedures,” and the government had to ship testing kits from China and Japan. Moreover, due to violations of the lockdown and standard operating procedures (SOPs), the rapidly increasing number of cases created a burden on the healthcare system. More and more, this pandemic and its impact have grown. As vaccine development has not been successful yet, “herd immunity” can only be achieved if about three quarters of the population contract the virus—requiring immunocompromised citizens to be sacrificed for the sake of the country. Moreover, Pakistan has limited testing capacity, so most COVID-19 tests are missing their mark even as the virus spreads. The current scenario is also raising several concerns about the capacity of the government to tackle the prevailing healthcare crisis. In this regard, healthcare professionals suggest that the government must act responsibly to ensure better security provided to healthcare professionals. Identifying suspected cases, introducing personal protective equipment, and taking administrative measures to ensure that better security is provided to healthcare professionals are the needs of the hour to improve outcomes of COVID-19 patients. Testing, tracking, and lockdowns must be focused on areas where clusters are detected. The healthcare professionals must be given utmost protection before this pandemic could wreak havoc in terms of fatalities. Investing in the chronically underfunded healthcare system is needed, so that Pakistan can build capacity to fight the pandemic.

Introduction

The new strain of the coronavirus, which is causing the current pandemic, is called COVID-19. The Chinese authorities distinguished this strain of the virus on 7 January 2020 (World Health Organization 2020a ). It started to spread globally from country to country (World Health Organization 2020b ) and the cases were expanding day by day (Prompetchara et al. 2020 ). As of June 2020, there are no successful vaccines (Ahmed et al. 2020 ; Prompetchara et al. 2020 ) and no drug treatment is specifically recommended (Sanders et al. 2020 ). However, convalescent plasma transfusion can be a potential treatment, but it is in experimental stages (Chen et al. 2020 ).

Preventive measures are highly effective to prevent its rapid spread but for these to be helpful, influential policies must be taken for appropriate health education of people. This pandemic has severely affected some countries and their healthcare systems have reached the point of exhaustion. Amid the chaos and the rising human toll, healthcare services are undergoing decentralization and fragmentation in many severely affected countries (Boccia et al. 2020 ). Vulnerable communities are disproportionately impacted in this catastrophic situation. This pandemic is relentless. In a crisis-stricken world gripped by challenges, it has exposed the vulnerabilities of the global capitalist system, driven by the delayed response (Yang and Wang 2020 ). An avalanche of cases has overburdened healthcare structures in developed countries. In developing nations with long neglected and underfunded public health sectors, the pandemic is leading to mayhem (Gates 2020 ). Experts fear if its spread is not curtailed by taking bold steps and consistent management choices, it may result in unprecedented human catastrophe (Prompetchara et al. 2020 ). The 2019–2020 COVID-19 pandemic began to spread across Pakistan in February 2020. This paper provides an account of the governmental and institutional response to COVID-19 in Pakistan. It explains some of the severe economic and social constraints that have hindered an effective response, and it critically analyzes the policy of pursuing herd immunity. The paper ends with some key take-home messages about lessons to be learned from Pakistan’s experience.

COVID-19 in Pakistan

The current COVID-19 pandemic has cut a swath around the globe due to decentralization and fragmentation of healthcare services in many severely affected countries (Armocida et al. 2020 ). The COVID-19 outbreak has affected the whole world. However, the situation is comparatively worse in the countries having weak healthcare strategies and system. This has become an intense catastrophe due to a brisk increase in the pandemic outbreak from region to region (Lai et al. 2020 ). The Chief of the World Health Organization, Tedros Adhanom Ghebreyesus, urged countries to invest in getting their healthcare system rather than to scramble for solutions when the next pandemic arrives as it is stated “we cannot continue to rush to fund panic but let preparedness go by the wayside. The world spends $7.5 trillion annually on health” (World Health Organization 2020a ). Especially in Pakistan, this pandemic has been a rude wake-up call regarding our weak health infrastructure as it comes under unbearable strain during this period (Spinelli and Pellino 2020 ). Thus, the 2019–2020 COVID-19 pandemic was affirmed to reach Pakistan in February 2020, with over 255,769 cases and 5386 deaths, as of 15 July 2020 (World Health Organization 2020b ).

Lack of Medical Facilities

As a middle-income country, with a weak healthcare infrastructure and a population of around 197 million (Hayat et al. 2020 ), Pakistan is vulnerable to COVID-19 (Raza et al. 2020 ). The Federal Minister of Health reported the first two confirmed cases of COVID-19 on 26 February 2020 in Karachi and Islamabad (Ali et al. 2020 ). Within 12 days, the number of cases reached 20 with 5 cases in Gilgit-Baltistan, 14 cases in Sindh, and 1 in Baluchistan. Bordered with the epicenter of the pandemic, China and Iran, its geographical location required highly influential policies and strategies to counteract against the situation (Saqlain et al. 2020 ). According to the World Health Organization ( 2020c ), countries should take all the preventive measures to limit the virus transmission by continuous surveillance, quarantine, awareness campaigns, and early detection. Besides, counteracting against other healthcare challenges is a major concern today (United Nations 2020 ). On the contrary, during the first few days, Pakistan lacked medical facilities and suspected samples were sent to China (Khanain 2020 ). Moreover, only a few specific quarantine centers were present with limited diagnostics and treatment facilities (92 News 2020 ) until the government received primers, testing kits, and equipment from other countries. As of 27 June 2020, many testing centers were available in Pakistan (Khanain 2020 ). The World Health Organization also established test centers for COVID-19 in seven hospitals countrywide (Saqlain et al. 2020 ). Initially, only a few quarantine centers were present in Pakistan. However, over time, more were established with foreign assistance. Still, centers ran out of rooms. Moreover, before the pandemic, sufficient facemasks were available to fulfill the needs of the general public, but with increased infection rate and exporting them, they became scarce and costly. Many drugs and equipment needed during the time of pandemic ran short in the pharmacies and stockiest started their business. But the Government of Pakistan took actions and the situation is now under control (Daily Times 2020a , b ). Similarly, Karachi, Lahore, and southern Sindh provinces, which make up more than 70,000 of the country’s 98,000 cases, have just 14,000 beds including both private and state-run hospitals. Dozens of patients were contacting hospitals’ administrations but due to lack of medical facilities, hospitals are unable to provide enough medical assistance (Latif 2020a ). Quarantine centers were established in Baluchistan but they lacked standard care and screening process (Khan 2020a ).

As the cases of COVID-19 grew in Pakistan, hospitals groaned under the weight of patients. Government policies have failed due to the indifferent attitude of the public. The advice of public health officials was disregarded (Kermani 2020 ) and the government eased lockdown (Hashim 2020b ). A bitter harvest was reaped from this decision. Caregivers were stressed, laboratory facilities were strained, and emergency rooms overflowed with infected patients. Likewise, the workforce dwindled, ICUs ran short of space, and the cost of care has increased (Hashim 2020a ).

Even basic medical equipment was dysfunctional and there was lack of doctors and paramedical staff. No specialized training was provided to health professionals regarding the pandemic (Jaffery 2020 ). Expensive medical equipment remained nonfunctional for years. Elite class got a preferential treatment leaving poverty-stricken people behind (Hadid and Sattar 2020 ). Even maintenance and repair of healthcare facilities was also ignored. Moreover, it was not unusual to witness scenes of general public smashing hospital equipment. Grief of death of their loved ones turned into pandemonium as it was solely “mistake of doctors.” Angry families were beating doctors and ransacking hospitals as healthcare professionals turn away COVID-19 patients—saying their facilities were already in short supply (Kermani 2020 ). COVID-19 cases spike can quickly overwhelm Pakistan’s healthcare system. As it seems this pandemic was here to stay. The state had a shortage of medical equipment and personnel and obsolete infrastructure (Afzal 2020 ).

Preliminary researches suggest that plasma of recovered patients contain antibodies that can be helpful for infected patients (Duan et al. 2020 ) but COVID-19 pandemic had sadly brought out the worst in the people of Pakistan. Instead of donating plasma as a noble gesture to help those suffering from this potentially fatal disease, recovered patients were making it their business. Convalescent plasma transfusion was not cure but a line of therapy and still in experimental stages. It should only be employed in controlled settings. Under no circumstances, should public be experimenting it without doctors’ approval (Epstein and Burnouf 2020 ). Similarly, different drugs including dexamethasone were no more available in pharmacies as they were declared helpful for COVID-19 patients (Qureshi 2020 ). Therefore, much more efforts are needed to cope with the situation. Experts fear if its spread is not curtailed by taking bold steps and consistent management choices, it may result in unprecedented human catastrophe (Yi et al. 2020 ).

Violation of Standard Operating Procedures

Policies, designs, strategies, and actions to cope with infectious diseases change over time. For this purpose, standard operating procedures (SOPs) play a vital role to hinder the virus transmissions as an outbreak generally creates major challenges for the healthcare systems (Singh 2019 ). Besides the local healthcare system, sometimes the public also has to follow the designated SOPs to counteract against the outbreak (World Health Organization Regional Office Africa 2014 ). For instance, during the H1N1 outbreak in the USA, the government introduced SOPs to overcome the crisis condition. Those SOPs contained guidelines for healthcare providers, introduction of the new medical teams, and also certain precautionary measures for the public. As a result, the government effectively controlled the outbreak (Adini et al. 2010 ).

The spread of infection in Pakistan was lower than feared even though we have righted some wrongs and wronged some rights by not completely implementing as well as following the SOP’s (Primary, and Secondary Health Care Department, Government of Punjab 2020 ). As unfortunately, the public in Pakistan appeared to have thrown caution to the wind, seeming to be in no mood to comply with SOPs as if it was somehow immune to the virus. They blatantly flouted government orders, underplayed the threat, and took it casually (Noreen et al. 2020 ). “They dithered, wavered and waffled. After doing this, they Flip Flopped then hemmed and hawed” wasting precious time instead of taking bold steps. After a brief hiatus, unmasked and unloved people violating lockdown seem everywhere who have recklessly abandoned all to fate and chance (Adams 2020 ).

Even as deaths due to this pandemic spiral, life is normalized everywhere. Due to this dangerous and cavalier attitude, a rapid jump in cases was recorded after relaxation in lockdown with total cases crossing 255,769 as of 15 July 2020. The initial public response to COVID-19 was casual and indifferent. Myths largely circulated, reinforcing an explicit violation of lockdown (ur-Rehman et al. 2020 ). Conservative individuals perceived this outbreak as a conspiracy to prevent their religious practices (Khattak 2020 ). Despite the threat, the mass events of prayers continued and public activates largely facilitated the virus transmission (ur-Rehman et al. 2020 ). Individual indices also came into consideration; for instance, people traveling from Spain escaped from screening both after positive test results, which further transmitted the virus to his community and family (Chaudhry 2020 ). Likewise, some patients also broke their quarantine camp in Sakkhar , infected several other people (ARY News 2020 ). Thus, this noncooperative behavior further fueled the virus transmission across the country (Javed et al. 2020 ).

Pakistan’s Current Scenario

The current healthcare scenario (Chart ​ (Chart1) 1 ) is unsatisfactory as Pakistan is a highly populated country, requiring a high level of sustained medical facilities. As compared to developed countries, i.e., the UK, China, and the USA, Pakistan is financially unstable and preventive measures concerning the outbreak were not followed completely (Waris et al. 2020 ). The current scenario of disease transmission in Pakistan is of greater concern. Moreover, developing countries were comparatively more vulnerable to the healthcare crisis, and Pakistan was unable to overcome this briskly growing pandemic (Nafees and Khan 2020 ). As of 15 July 2020, the total 255,769 of the cases reported with 5386 deaths (Government of Pakistan 2020a ). The current surge of the spread of this pandemic in Pakistan was due to the relaxation of lockdown (Adams 2020 ).

COVID-19 cases in Pakistan (Government of Pakistan 2020a )

A number of cases were also rising due to inadequate testing facilities and fear of people to disclose the fact that they have contracted the infection. Pakistan is ill-prepared to encounter a crisis that can arrive in merely weeks (Javed et al. 2020 ).

Furthermore, China flattened the curve, giving a breather to the over-stressed health system. Curve refers to the number of people affected in a particular interval of time. The steeper the curve, the quicker a country’s healthcare system will be overwhelmed, reaching its peak in a shorter duration of time. China showed systematic, comprehensive, and coordinated response through rapid self-correction and building a score of temporary hospitals and imposing countrywide lockdown. These measures lead to fruition (Liu et al. 2020 ). A more detailed record of confirmed cases as of 15 July 2020 is given in Table ​ Table1 1 .

Detailed record of confirmed cases as of 15 July 2020 (Government of Pakistan 2020a )

The “series” of events leading to the current crisis in Pakistan: February 2020 —first case of COVID-19 in Pakistan; March 2020 —the government took action, lockdown implemented; April 2020 —relaxation in lockdown in religious places as the government caved to demands of Muslim scholars; May 2020 —further loosening of lockdown in markets and malls imposed (during the second week of May); June 2020 —lockdown reemployed. Source: Government of Pakistan ( 2020a )

Besides, lifting lockdown for the last 3 weeks of May added 20,000 more confirmed cases as the daily aggregate of positive results escalated, on average, from 11.5 to 15.4% in the subsequent duration (Greenfield and Farooq 2020 ). To learn lessons through this pandemic and willing to take action (Boccia et al. 2020 ), many more efforts are needed instead of showing a muddled approach (Yang and Wang 2020 ). In this regard, the Government of Pakistan is rigorously making new policies and strategies, including awareness campaigns, quarantine facilities, testing services, and lockdown to overcome the outbreak (Waris et al. 2020 ). Along with the government, valiant doctors and overburdened medical staff in Pakistan are on the front line and are essential to the battle being fought against this pandemic trying to take the wild virus by the horns (Shanafelt et al. 2020 ). They are under tremendous stress putting themselves and their family members especially immunocompromised citizens at greater risk. By continuing to attend to patients, many healthcare professionals have contracted the infection (Greenberg et al. 2020 ). They are in constant danger as they do not have adequate personal protective equipment (PPE) and many have lost their lives (Latif 2020b ).

RT-PCR done through nasopharyngeal swabs, though not a perfect test, remains the only dependable investigation as of June 2020 (Chan et al. 2020 ). A positive test clearly shows that a person is infected but the negative test may be false negative due to different reasons. The percentage ratio of people who have been tested positive among the entire population of those who have been tested is very low (Government of Pakistan 2020a ). If people refuse to get themselves tested, the chances of community transmission will increase—because the spread of the virus to elderly, vulnerable, and immunocompromised individuals will go undetected. Therefore, it is extremely important that authorities communicate how crucial testing is and show how citizens can responsibly play their part in curbing transmission by reporting themselves if they experience COVID-19 symptoms. Such fear and reluctance will only add to the spread of the virus. The test, trace, and isolate (TTI) strategy is recommended by the World Health Organization. In Pakistan, testing capacity was half of what recommended by the World Health Organization (Hashim 2020b ). However, according to Pakistan’s policies, symptomatic passengers were tested and quarantined until the availability of test results. Provinces test and track the negative cases that were sent to home. Positive cases were handled as per health protocol. Positive cases belonging to other provinces were quarantined for a 14-day period by the province of arrival and could not be allowed to travel before completion of a prescribed period (Government of Pakistan 2020b ).

Herd Immunity

Many government officials suggested “herd immunity” as a compelling solution to the problem. However, its implementation will be a gamble as the World Health Organization has warned developing countries regarding the potential threat (Greenfield and Farooq 2020 ; Husain 2020 ). As per noted by Fine et al. ( 2011 ), there are certain legal and ethical challenges concerning herd immunity implementation because authorities are required to pressurize, force, or entice individuals to be immunized through herd immunity. Also, immunization can have other side effects that further challenge this idea (Isaacs et al. 2009 ).

The first indication of herd immunity in Pakistan came from Dr. Zafar Mirza who gave remarks after relaxation of lockdown, “For the future of Pakistan regarding this pandemic, it will be better if COVID-19 spreads at a certain rate in Pakistan so that people become immune to it” (Dawn 2020 ). However, if three quarters of the population contract the virus, results would be catastrophic as it can come up with a very high cost (Anderson et al. 2020 ). Still, the Government of Pakistan is indecisive about the implementation of herd immunity as the disease has killed more than 430,000 people worldwide and the COVID-19 vaccination is years away (Siddique 2020 ). Allowing the virus to spread among the general public is unacceptable and inhumane as it will require vulnerable community members, immunocompromised citizens, and elderly to be sacrificed to achieve this strategy (Khan 2020b ).

Thus, with each passage of time, the pandemic is amplifying its presence and magnifying its impact on our lives (World Health Organization 2020a ) as the number of infections and deaths in Pakistan has risen nearly 500% (Gul 2020 ). Providing PPE and resources to healthcare staff in the best possible way helps them fight this pandemic (Kiani and Malik 2020 ). As COVID-19 is a global healthcare concern that greatly halted the normal life, coping with this phenomenon demands quick and effective decision-making ability. The best approach will be introducing new policies and making influential strategies to bring changes on the grass-root level (Kiani and Malik 2020 ). Therefore, this pandemic should be accompanied by the realization that health should be treated not as a privilege, but as a right (UN News 2019 ).

In a developing country like Pakistan, disease outbreaks greatly challenge the healthcare system. Lack of basic health facilities, insufficient health policies, weak governance, and an indifferent attitude of the public towards general protective measures further worsen the scenario (Jaffery 2020 ).

The crucial lesson to learn from struggles is that our dilapidated and shabby healthcare system is a finite source. Epidemiology and microbiology lack the exactness of physics. Hence, our experts can provide only guesstimates and advice on management choices. Although Pakistan has limited sources, it can make better use of them. It needs to show a disciplined, clear, tangible, swift, comprehensive, rational, and collective response. This can be achieved by testing a significant proportion of individuals and then isolating those cases after positive test results of COVID-19, introducing PPE, building healthcare capacity, and taking administrative measures to ensure better security is provided to healthcare professionals. Also, to provide resources to healthcare staff in the best possible way helps them fight this pandemic. Fixing primary and secondary healthcare systems is also needed, as they will take the pressure off the tertiary healthcare systems. If major issues in the management system are fixed, a profound impact can be created (Mukhtar 2020 ).

All provincial authorities and government officials must ensure better security provided to healthcare professionals, spreading awareness campaigns and addressing the fear of citizens.

• Hospital staff must be given utmost protection at all cost before this pandemic could wreak havoc in the healthcare system in terms of infections and fatalities.
• Government must act responsibly educating the public and ensuring the fact that its message must lay out the fact that there is no guarantee that Pakistan’s numbers will remain lower than in the West.
• After positive test results of COVID-19, quarantine and social distancing must be aggressively implemented.
• The ramshackle public health sector must get the funding and the priority it deserves.
• Testing, tracking, and lockdown must be focused on areas where clusters have already been detected so infection transmission rate must be locally contained. Meticulously, locate all who might have encountered the virus

Take-Home Message

By keeping the current pandemic under consideration, some basic guidelines can help to mitigate the potential impacts of this pandemic. According to the World Health Organization ( 2020c ), sustaining essential practices by following the recommendations can create an impact. Therefore, these guidelines may include the following:

• Local governments should implement health and social measures to halt the virus transmission by ensuring equal engagement from all members of society. In this regard, the World Health Organization ( 2020c ) suggests media-based campaigns to spread awareness among the public.
• Evidence showed that COVID-19 can exist in humid places and low temperature for at least 9 days on the surface of shared rooms and areas, i.e., bathrooms, smoking areas, offices, and changing rooms. Using adequate sanitary measures can help to disinfect these areas by using hydrogen peroxide (0.5%), ethanol (61–71%), or hydrogen hypochlorite (0.1–0.5%). Therefore, disinfecting and extra cleaning can greatly help to hinder the virus transmission (Cirrincione et al. 2020 ).
• In order to address the specific challenges being faced by Pakistan in responding to the COVID-19 pandemic, we suggest that the following recommendations—permitted from official bodies and existing literature—are a defensible and ethical start for the country to get on track in clamping down on this virus. The government should establish a psychological hotline to provide psychological assistance to active doctors and other medical staff. Moreover, the hospitals’ staff should be adequately provided PPE to save them from the infection (Beijing Center for Disease Prevention and Control 2020 ).
• Healthcare professionals should be given sufficient training to choose suitable protective equipment as during the current pandemic. They may have a variety of options, but they can find it difficult to choose the appropriate ones (Balachandar et al. 2020 ).
• The healthcare professionals should be provided with the basic equipment including N95 and surgical masks, face sheets, and spaces to later dispose of this equipment as (Public Health Ontario 2020 ) this equipment cannot be reused and if not properly discarded can become a source of virus transmission.
• Proper collection, transfer, and elimination of waste material is an important concern. Especially, menstrual hygiene material and tissues used for coughing and sneezing should be properly managed. Likewise, the local government should rethink about sanitation system, as public lanterns can also become a potential source of virus transmission. Moreover, human feces can be one of the most common sources of microbial pathogen transmission. In this regard, only a well-managed sanitation system would limit transmission of virus especially in developing countries where the governments have to remake its waste management plan (UNICEF 2020 ).
• The risk of infection much relies upon the distance to an infected person and the type of facemask worn. From policy debates and research evidence, minimum 1-m physical distancing is highly recommended as a basic protective measure (Chu et al. 2020 ). Due to this reason, keeping an appropriate distance and wearing facemask in public settings, outside of home, are highly recommended measures to prevent the rapid spread of COVID-19 (Centers for Disease Control and Prevention 2020 ).

Limitations and Recommendations

This study is based on COVID-19 situational reports, lacking any methodological analysis, which limits its scope. Moreover, due to a limited number of relevant studies in Pakistan, the data is mostly taken from websites of local and national newspapers, which further narrows down its scope. However, the researchers made every possible effort to bring clarity in the topic and recommend studies on theoretical and methodological grounds to highlight the healthcare challenges raised by COVID-19 in Pakistan.

Author Contributions

AK conceived the paper and constructed a first draft. SA elaborated arguments and contributed to subsequent drafts of the paper. All authors revised the document for critical intellectual input, and all authors approved the final version.

Compliance with Ethical Standards

Informed consent was received from all the sources whose data and figures are used.

The authors declare that they have no competing interests.

This study was approved by Sahiwal Medical College Ethical Review Committee and Government of Pakistan.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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The poor state of Pakistan’s healthcare system

Goal 3: Good health and well-being • Targets: end communicable diseases, achieve universal health coverage, and provide access to safe and effective medicines and vaccines by 2030 • Pakistan is ranked 149th out of 179 countries in 2015 on the Maternal Mortality Ratio Index • New healthcare blueprint needs increased funding, efficient cross-sector linkages

By Shahnaz Wazir Ali

The eight United Nations Millennium Development Goals (MGDs) were time-bound and quantified global targets ranging from halving extreme poverty rates to providing universal primary education by 2015. Pakistan signed off on the MDGs in 2000, however, despite all the rhetoric around policy, budgetary and implementation commitments, and subsequent efforts, the country’s track record fell short of the targets, placing it next to those nations ranked the lowest in the Human Development Index. Then, last year, the Sustainable Development Goals (SDGs), an ambitious set of 17 goals with 169 indicators set to impact seven billion people, with a single deadline of 2030, were framed on the bedrock of human rights, inclusivity and justice. However, they are yet another articulation of aspirations reflected in development terminology crafted in the halls of the UN and subscribed to by governments without always comprehending the level of effort and resources required. As signatory, Pakistan is committed to aligning its development agenda towards low-carbon pathways over the next 15 years. But skeptics argue that evidence on the previous 40 MDG indicators precludes Pakistan’s ability to achieve the SDGs. That said, the therapy being proposed is that countries should identify goals based on their resources and try to achieve them rather than opt for a one-size fits all framework.

According to Unicef, despite significant improvements over the past two decades, Pakistan ranks towards the bottom among other countries when it comes to infant and neonatal mortality.

With Goal 3 – promoting good health and well-being – calling for an integrated approach crucial for progress across multiple goals, including alleviating poverty and hunger, the focus includes a commitment to end the epidemics of AIDS, tuberculosis, malaria and other communicable diseases by 2030. It also aims to achieve universal health coverage, and provide access to safe and effective medicines and vaccines for all.

Consider the challenges to mother and child health in Pakistan. Especially severe, they can be attributed to poverty, and compounded by social exclusion and discrimination. Behind every statistic, there is a child in distress calling for immediate attention of state and society. According to Unicef, despite significant improvements over the past two decades, Pakistan ranks towards the bottom among other countries when it comes to infant and neonatal mortality. This is why 44pc of all children are stunted and 9.6 million experience chronic nutrition deprivation. Compounding the nation’s state of poor health, for example, is the toll taken by pneumonia killing approximately 92,000 children annually. Pakistan’s ranking in the Maternal Mortality Ratio Index has slipped from 147 in 2014 to 149 in 2015, recording a staggering 276 deaths per 100,000 births. Excepting Afghanistan, all the other countries in this region have better health indicators than Pakistan.

To add, Pakistan has the third highest rate of infant mortality in the world. The mortality rates among children are often seen as a proxy for the level of social development. And for good reason, because they reflect the level of nutrition, parents’ education, and access to health services. Consider the impact of the Benazir Income Support Program – the largest social protection intervention – which targets women living in chronic poverty. Despite its flaws, the BISP must have had significant impact on maternal or child health indicators. Learning lessons from the past, the recent initiative to condition cash payments on primary school enrolment and in partnership with provincial governments will further encourage women to send their girls to school.

Pakistan’s ranking in the Maternal Mortality Ratio Index has slipped from 147 in 2014 to 149 in 2015, recording a staggering 276 deaths per 100,000 births.

If one examines the recently announced National Health Vision, it may present an alignment of socio-economic commitments, but is also reminds that without national consensus the state-owned health sector will continue to suffer. With no universal medical care, overhauling the health sector not only requires that health be put at the top of the political priority list, but increased funding, efficient cross-sector linkages and medical training are also imperative if the NHV is to be implemented.

With the government’s development blueprint premised on an enabling environment essential for socio-economic development, Vision 2025 is to be implemented in sync with the SDGs. For now, all such plans look good on paper. However, sustainable development is achievable through the process of devolution. If implemented effectively, the SDGs will serve the needs of the people by bringing accountability and decision-making within provincial jurisdiction. Worth mention is that optimism amongst policymakers came to the fore when the minister for planning, development and reforms, Ahsan Iqbal, pledged ‘the highest priority to achieving the [SDG] goals’, which would imply that there is sufficient political interest.

The reality may be that poverty will not be eradicated by 2030, and the state may not be able to feed around 215m children, nor ensure healthy living for all, but what can be achieved is tailoring programs to the demographics of different geographical regions by looking at the evidence of success and deriving contextual formulas for efficient delivery.

This story is part of a series on the SDGs, continue reading the previous stories.

Dawn's special coverage of the SDGs continues tomorrow. Coming next: Right to education: Where do we stand?

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Primary health care strengthening and health financing reforms – a priority for the federal and provincial governments in Pakistan

Pakistan is the fifth most populous country in the world, with a population of around 212 million in 2018. Most health services in the country are concentrated in tertiary and secondary hospitals; Pakistan’s universal health coverage (UHC) index is 45 out of 100. Despite some increases in the health budget in recent years, the health system is underfunded. Other challenges include limited human resources, poor health infrastructure, fragmented procurement mechanisms, an unregulated private sector, weak health information systems and frequent health emergencies.

© Sebastian Liste / NOOR for WHO

As a direct result of discussions on the GAP, the Global Fund, Gavi, GFF, UNICEF, the World Bank and WHO have planned a joint appraisal mission to strengthen PHC and health financing by aligning financing, technical assistance and support for priorities identified by Pakistan’s federal and provincial ministries of health.

Pakistan’s PHC system is underpinned by the flagship Lady Health Worker Programme, through which more than 90 000 community health workers provide basic health services to 115 million people who would otherwise lack access, mainly in marginalized, remote, rural and urban slum communities. 1 The programme also plays a key role in making referrals to health facilities and increasing the uptake of public health initiatives, such as the Expanded Programme on Immunization. This focus on the most marginalized communities and those who are left behind underpins the SDGs and the GAP.

In its National Health Vision 2016–2025, Pakistan pledged to increase federal and provincial allocations to health to 3% of gross domestic product and identified better coverage and more functional PHC services as a strategic priority for the federal and provincial governments to achieve UHC. In parallel, several initiatives have been launched to reduce financial hardship by introducing federal and provincial social health protection for poor families. The Ministry of National Health Services Regulation and Coordination is steering planning with the provinces to scale up PHC, including promotion of a national family practice model, evaluation of the Lady Health Worker Programme to identify barriers and opportunities for scaling up and upgrading and digitalizing the district health information system. Pakistan plans to roll out new UHC benefit packages for community and PHC centres and for first- and tertiary-level hospitals in mid-2020.

The GAP agencies are learning from and building on existing collaborations in Pakistan, such as the National Immunization Support Project, through which Gavi and the World Bank have already aligned financing. Discussions among the agencies on providing joint support for scaling up PHC in line with the National Health Vision began in July 2019, led by the WHO Country Office. These focused on the design and financing of expanded UHC benefit packages for different settings. Additional opportunities for joint support were identified and discussed after presentations to the GAP PHC accelerator working group and the GAP Sherpa group in January 2020, including scaling up PHC interventions in demonstration districts; engaging private physicians in a family practice approach; strategic realignment of human resources for health; mapping and aligning federal and provincial resources; strengthening public financial management; and reforming the Lady Health Worker Programme based on development of a strategic framework and investment case. Other opportunities include strengthening existing health coordination mechanisms, such as the Population, Nutrition and Development Partners Forum and the federal and provincial inter-ministerial health committees.

As Gavi, the Global Fund, GFF and the World Bank open new funding windows over the next year, these signatory agencies and other partners, such as the Global Polio Eradication Initiative, are exploring opportunities for alignment to support health systems strengthening and delivery of essential health services at the primary care level. As a direct result of discussions on the GAP, the Global Fund, Gavi, GFF, UNICEF, the World Bank and WHO have planned a joint appraisal mission to strengthen PHC and health financing by aligning financing, technical assistance and support for priorities identified by Pakistan’s federal and provincial ministries of health. The mission, which has been delayed by the COVID-19 pandemic, will be led by the Government of Pakistan with support from WHO and UNICEF as co-leads of the GAP PHC accelerator working group and Gavi, the Global Fund and the World Bank as co-leads of the GAP finance accelerator working group.

Joint and coordinated support under the auspices of the GAP will help to reduce the burden on Pakistan of managing multiple donors and funding streams, ensure that technical support for PHC is aligned with the country’s Health Vision and help to lay the foundation for better access to health care for the Pakistani people.

_______________________________________________________________________________________________

1. Lady Health Worker Programme, Pakistan. Performance Evaluation. London: Oxford Policy Management, UNICEF and Ministry of National Health Services Regulation and Coordination of Pakistan; September 2019.

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Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward

Affiliations.

• 1 Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan.
• 2 Catco Kids, Karachi, Pakistan.
• PMID: 28712245

Background: Pakistani health care system is in progress and since last year, Pakistan has tried to make much improvement in its health care delivery system and has brought out many reforms.

Methods: A systematic search of national and international literature was looked from peerreviewed databases form MEDLINE, CINAHL, and PubMed.

Results: There is little strength in health care delivery system in Pakistan like making health policies, participating in Millennium Development Goals program, initiating vertical programs and introducing Public Private Partnership, improving human resource development and infrastructure by making Basic Health Unit and Rural Health Centres. However, these all programs are very limited in its scope and that is the reason that Pakistan's healthcare system is still not very efficient. There are numerous weaknesses like poor governance, lack of access and unequal resources, poor quality of Health Information Management System, corruption in health system, lack of monitoring in health policy and health planning and lack of trained staff.

Conclusions: Pakistan is improving very slowly in the health sector for the last five decades as is evident by its health indicators and above mentioned strengths and weaknesses. Therefore, the Government needs to take strong initiatives to change the current health care system.

Keywords: Basic Health Unit (BHU) and Rural Health Centres (RHC); Millennium Development Goal; Public Private Partnership; health care delivery system.

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Pakistani youth uses e-health to change rural lives

Young trailblazer muhammad sarim raza is using technology to deliver healthcare services to medically underserved communities in pakistan..

Even before the COVID-19 pandemic, visiting a doctor in rural Pakistan was an expense few could afford.

Almost 70% of the Pakistani population lives in underserved rural areas, where healthcare services are hindered by the lack of medical personnel, sparse facilities, and the high cost of treatments.

Things worsened in the wake of COVID-19, which disrupted supply chains and interrupted the delivery of vital medicines.

Reimagining health care

As the country fights the pandemic, Muhammad Sarim Raza (24) is using technology to reimagine how health care is delivered to the most vulnerable people in Pakistan.

He’s the founder of Riayat, a social enterprise. He also coordinates the Youth Action Hub Pakistan, an UNCTAD youth network of young change makers running innovative programmes to improve the lives of local people.

Mr. Raza has partnered with Idara al Khair, a local nonprofit organization, to improve health-care coverage for rural dwellers.

They are using telehealth – the provision of health-care services via electronic information and telecommunication technologies – to offer virtual medical consultations to patients in remote locations, and in the comfort of their homes.

“Many people can’t afford to physically go to a doctor. Our e-health initiative makes consultations affordable and available to low-income communities,” Mr. Raza said.

Saving lives amid the pandemic

As the pandemic pushed more people into extreme poverty, Mr. Raza and his team are seeking to save Pakistani lives by expanding access to health-care services and spreading information on disease prevention measures.

At the peak of the COVID-19 outbreak in the country, his team created an e-health platform and mobilized local teachers to conduct door-to-door visits to introduce residents to it, offering general medical check-ups free of charge.

They also established an e-clinic at a local school and organized a virtual workshop to train the teachers on how to register patients on the platform and book appointments with doctors.

A psychologist trained the teachers on how to identify mental health problems such as stress, anxiety and depression.

After the two-week course, the teachers were deployed to visit needy families and collect data on their incomes and prevalent diseases, information that was later used to create a pricing model for the e-clinic.

The team visited 90 families comprising about 540 people and registered them on the platform.

“Physical health was not the only concern. We found that people didn’t realize their mental health was deteriorating due to the stress and anxiety caused by not being able to provide food to their families,” Mr. Raza said.

They also found that many people didn’t know the benefits of good mental health. “They believed that if physical needs were met, mental health didn’t matter,” Mr. Raza said.

The collected data also showed that many people suffered from ear, nose and throat diseases. Mr. Raza’s team arranged for the sick people to speak to specialized doctors and receive targeted care at the e-clinic.

Today, the e-clinic has evolved into a subsidized medical centre with doctors, nurses and technicians. With specialized care and emergency treatments now available to the local community, the number of patients is steadily growing.

Using technology for good

Mr. Raza is committed to using technology for good – expanding access to health care, education and employment opportunities for all.

“Internet connectivity and access to a digital world is a critical part of an equitable future,” he says, “whether it’s food insecurity or unemployment, lack of digital inclusion will exacerbate existing inequalities.”

His enterprise’s first project involved distributing food supplies to more than 300 low-income households around Karachi, Lahore and Multan cities in Pakistan to tackle hunger, while creating awareness on how to curb the spread of COVID-19.

During the project, he identified weak internet connectivity and the lack of digital literacy as key barriers for many people. He then mobilized Youth Action Hub Pakistan to launch the “Right to Technology” initiative to advocate for digital inclusion.

Mr. Raza plans to work with more young people across Pakistan to use digital tools to deliver value to their communities. “The choices we make right now will shape the digital transformation around us,” he said.

Created in 2018, the Youth Action Hubs initiative empowers young people to think globally and express their views on matters within UNCTAD’s mandate.

It enables them to act locally as game changers in their communities by setting up projects related to the UN Sustainable Development Goals. Currently, there are 46 Youth Action Hubs worldwide.

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The significance of putin-kim summit , combating corruption and inefficiency in pakistan’s power sector, burning blasphemers, poetry, philosophy, and translated fiction, patience and passes, lying on tables not allowed, ch ashiq elected as chairman of apnsf, us says it supports direct discussions between pakistan and india, china firmly opposes japan’s illegal unilateral sanctions, chinese defense ministry urges u.s. to stop arming taiwan region, president xi stresses yellow river basin ecological conservation, high-quality development, armenia recognises state of palestine amid gaza conflict, babar, rizwan might lose category a in pcb central contract, pakistani shooters clinch gold and silver at thailand championship, pakistani athlete samar khan conquers europe’s highest peak, mount elbrus, cristiano ronaldo under fire for mocking czech team after portugal’s win, shahid afridi breaks silence after his picture with zionist group surfaces, wb approves $535m for pakistan.

The World Bank’s (WB) Board of Executive Directors approved $535 million in financing for Pakistan to support two projects, a statement from the institution said Friday.

The additional financing for the Crisis Resilient Social Protection (CRISP) Programme aims to strengthen the country’s social protection system and build shock resilience among poor and vulnerable households.

At the same time, the Sindh Livestock and Aquaculture Sectors Transformation (LIVAQUA) Project will promote climate-smart and competitive small and medium producers in the livestock and aquaculture sectors in Sindh.

“The catastrophic floods that hit Pakistan in 2022 were a tragic reminder of the importance to build resilience to such disasters, including by strengthening both social protection and sectors that support economic growth and recovery,” said Najy Benhassine, World Bank Country Director for Pakistan.

“It is also imperative to help the vulnerable absorb climate shocks through innovative climate-smart technology and contingency planning.”

The additional financing for CRISP ($400 million) will build on the programme’s ongoing efforts to equip Pakistan’s social protection system with the policy and delivery system foundations necessary for more effective and rapid responses to future crises.

The programme will focus on longer-term policy actions to further improve the national cash transfer program’s effectiveness, coverage and federal-provincial coordination.

“Since its inception, the CRISP program has achieved significant results with regular safety net support to more than 9 million families and a demonstrated capability of quickly reaching 2.8 million families during the recent floods,” said Amjad Zafar Khan, Task Team Leader for the Project.

“The additional financing would not only assist families in becoming more resilient to climate and economic shocks but also encourage the use of provincial capacities to take up a larger role in social assistance.

LIVAQUA ($135 million) will finance interventions to promote climate-smart production, value addition, and inclusive access to markets, and help create opportunities for growth in the livestock and aquaculture sectors.

These will include improving sector policy and strategic frameworks, as well as evidence-based decision-making.

It will also contribute to strengthening the capacity of public and private providers to deliver essential knowledge, inputs, and services such as disease surveillance and control, diagnostic laboratory services, breeding programs, food safety, and the development and transfer of green technologies.

LIVAQUA will cover all districts in Sindh using a phased approach. It is expected to directly benefit more than 940,000 farm families, including 930,000 livestock households and 10,000 aquaculture producers.

The project also includes measures to ensure female farmers’ participation in the project and narrow gender gaps.

“The project will improve the livelihoods of small and medium livestock and aquaculture producers, increase their resilience to animal health and climate-related shocks, strengthen the overall growth of these two sectors in Sindh, and more broadly improve food and nutrition security and reduce the sector’s contribution to greenhouse gas emissions,” said Myriam Chaudron, Task Team Leader for the project.

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