TY - JOUR
T1 - Stewarding COVID-19 health systems response in Pakistan
T2 - what more can be done for a primary health care approach to future pandemics?
AU - Zaidi, Shehla
AU - Zaidi, Raza
AU - Hussain, Shujaat
AU - Safi, Malik Muhammad
N1 - Publisher Copyright:
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.
PY - 2025/1/11
Y1 - 2025/1/11
N2 - We apply a primary healthcare (PHC) perspective to gauge Pakistan's health systems response to COVID-19, to identify stewardship lessons for integrating the PHC pandemic response. Analysis of Pakistan's response against the Astana PHC framework shows that the imperative for national survival helped mobilise an agile response across a fragmented health security context. The findings show effective multisector governance in responding to the health and social aspects of the pandemic, as well as the rapid roll-out of several public health functions and emergency care. However, we found weak maintenance of essential health services and ad hoc, short-lived efforts for community engagement. Critical enablers that helped steward the response across complex power-sharing arrangements included solidarity across society, collaborative data-driven decision-making, leveraging of siloed domestic resources and private sector coordination. At the same time, a more PHC-centric response was constrained by weak political prioritisation of essential health services, uneven services, weak direction to civil society volunteerism for community engagement and weak regulation of private sector contribution. We conclude that a mindset shift is required from short-term tactical measures to long-term investment in PHC-oriented transformative stewardship. Future preparedness must build attention to essential service package for emergencies, mobilisation of both private and public primary care providers, effective community engagement vision across societal actors and market regulation, within a collaborative governance framework.
AB - We apply a primary healthcare (PHC) perspective to gauge Pakistan's health systems response to COVID-19, to identify stewardship lessons for integrating the PHC pandemic response. Analysis of Pakistan's response against the Astana PHC framework shows that the imperative for national survival helped mobilise an agile response across a fragmented health security context. The findings show effective multisector governance in responding to the health and social aspects of the pandemic, as well as the rapid roll-out of several public health functions and emergency care. However, we found weak maintenance of essential health services and ad hoc, short-lived efforts for community engagement. Critical enablers that helped steward the response across complex power-sharing arrangements included solidarity across society, collaborative data-driven decision-making, leveraging of siloed domestic resources and private sector coordination. At the same time, a more PHC-centric response was constrained by weak political prioritisation of essential health services, uneven services, weak direction to civil society volunteerism for community engagement and weak regulation of private sector contribution. We conclude that a mindset shift is required from short-term tactical measures to long-term investment in PHC-oriented transformative stewardship. Future preparedness must build attention to essential service package for emergencies, mobilisation of both private and public primary care providers, effective community engagement vision across societal actors and market regulation, within a collaborative governance framework.
KW - COVID-19
KW - Health policy
KW - Health systems
KW - Public Health
UR - http://www.scopus.com/inward/record.url?scp=85215434981&partnerID=8YFLogxK
U2 - 10.1136/bmjgh-2024-016149
DO - 10.1136/bmjgh-2024-016149
M3 - Review article
AN - SCOPUS:85215434981
SN - 2059-7908
VL - 10
JO - BMJ Global Health
JF - BMJ Global Health
IS - Suppl 2
M1 - e016149
ER -