- The lessons learnt in the pandemic must not be lost
By: Ms Nousheen Akber Pradhan and Dr Rozina Mistry
The pandemic of the novel coronavirus (covid-19) has created havoc globally. While the effects are being observed across many sectors, the disease in particular is testing the nerves of healthcare systems worldwide. Covid-19 has posed huge challenges to fragile states with inadequate healthcare infrastructures and has also stretched the health systems of 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 22,000, with 486 lives lost (as of Thursday morning), the 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 appreciable to see that National Disaster Management Authority and the key players at the federal and provincial levels executing public health measures to prevent virus transmission. The Health and Finance Ministry are in complete sync these days instead of being at loggerheads with each other over funding issues.
Historically, Pakistan’s healthcare system has been operating with very meager funds (2 percent versus 10 percent globally), with a major share going into staff salaries. Approved positions of healthcare providers are often not filled due to budgetary constraints. As a result, most THQ Hospitals are unable to offer 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 district hospitals. This calls for more funding for our health system to effectively manage routine care, and also be more prepared for outbreaks and such pandemics. Also, non-health sector industries also became victims of years of underinvestment in the health system as the lockdown measures rippled through various sectors and reduced their capability to respond. These sectors must also invest more in their employees’ health and keep preventive measures at the core of their businesses.
The covid-19 outbreak has not been contained and it is unclear 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
Covid-19 has huge implications for the national economy and its goal of poverty alleviation. It is commendable how the country (despite its meagre resources) rose to the occasion and introduced the Ehsaas Program to provide emergency relief for 12 million families who have lost their income due to the lockdown. Under the Ehsaas Program, the eligible households are entitled received Rs. 12,000 per family and the total estimated budget is Rs 144 billion. It is indeed commendable that both the federal and provincial Governments have approached the problem through a multi-sectoral strategy. It is also remarkable to witness the rapidness with which the Government managed to allocate Rs 1.25 trillion which will be spent through a multi-sectoral relief package to address the challenges arisen due to the outbreak. However, funding cover 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-pandemic.
To monitor the rise of infection, the Federal Health Ministry has developed a highly sophisticated Incident Command and 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, despite the country 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. An important area of investment is aimed at ensuring standard operating procedure for infection control measures not just for hospitals, but also other sectors. Hospital leadership across public and private sectors is investing efforts in building capacity of health care providers in infection control protocol and ensuring availability of personal protective equipment for their staff. It will therefore be in the interest of patients and health care providers if such investment continues post-coronavirus. As this will allow patients with other infectious diseases and health care providers have a safe environment. Also, as the government is acting to equip hospitals to manage covid-19 cases, such initiatives must 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.
Covid-19 has very aggressively put public health and prevention at the centre of all actions to prevent transmission. While management of patients inside the hospitals requires continuous care, its cure is crucial for strict public health measures in the communities. The focus on testing for covid-19, tracing contacts, quarantine and isolation procedures to reduce the transmission are essential, alongside reinforcement of preventive measures. With covid-19 entering a second phase in some countries; the importance of strict public health measures, while easing the lockdown, is becoming pivotal. It is therefore expected in Pakistan at present and in weeks to come where seriousness in adapting preventive measures from the public will be needed more.
Partnership with private sector has emerged most powerfully. Sponsoring of preventive messages, investment by the corporate sector in promoting public health messages through mass media is indeed commendable. It is important that such partnership in prevention and promotion is continued in future, along with prevention of other infections such as polio, diarrhea, pneumonia, typhoid, hepatitis, and so on. Along these lines, there is also dire need to encourage the private sector to create an enabling environment for actions such as availability of clean drinking water and safe sanitation facilities for communities in urban slums and rural areas.
Another major change witnessed is the respect for doctors, nurses and other frontline workers such as paramedics and auxiliary staff given by the masses for their selfless services. Looking at the current crisis situation, it is also needed to reposition the role of Lady Health Workers (LHWs) in screening covid-19 and other such infectious diseases. With proper training in screening protocols, LHWs and other community health workers can be mobilized during such public health emergencies, and offer a helping hand to those serving on the front line. To keep our health workforce motivated, it is important their services should be frequently recognized and appreciated at all levels, while ensuring an enabling working environment.
The pandemic has also shown the need to invest in the IT industry. The IT sector includes many opportunities for innovations, particularly in communication during lockdown. During lockdown, some private health care organizations are switching to teleconsultation to maintain the ongoing package of services and even provide access to people in rural areas. This initiative is yet to be witnessed across the country’s many public and private healthcare organizations, 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 their IT infrastructure, while becoming more resilient.
Covid-19 has mobilized interest in research and development. The 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 to identify 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 them across various businesses and sectors. This includes improvement in drinking water and sanitation facilities, safe disposal mechanisms in quarantine units, schools, railways, public parks, shopping malls and nursing homes and so on. 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.
It is undoubtedly a challenge for countries, especially for poor and low-middle-income countries like Pakistan to strengthen their capacity for absorbing such shocks. At present, the covid-19 outbreak has not been contained and it is unclear 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 on the Faculty at Aga Khan University, Pakistan and Dr Rozina Mistry is a Health Consultant. The article express the views of authors only, not of an institution to which one belongs.
