By Dr. Vaqar Ahmed
THE three major challenges faced by Pakistan’s government to combat COVID-19 include the decision to lockdown (or not) and to ensure respect for standard operating procedures (SoPs) during these containment measures; supporting local healthcare systems during various rounds of COVID-19 and addressing exclusion in Ehsaas, fiscal package, and central bank support announced to protect the vulnerable.
I argue here that these three challenges have created an urgency for reforming several institutions – the reform of which have been pending for ages. Let’s take the first challenge. The incomplete 18th amendment and fiscal decentralization process which resulted in weak local administrations, ultimately leading to weak compliance with SoPs formulated for lockdowns.
It is only now that citizens are being informed that the country lacks information management systems at the local level which could inform provincial and federal administration regarding any food or medical supplies shortages. By the time information regarding such shortages at district and tehsil level arrived in provincial and federal capitals, public unrest had already begun.
Our second challenge of weak health care infrastructure and service delivery at the local level explains why Covid-related pressures on public hospitals in major cities remains high. This has affected the morale of our doctors and paramedics and threatened their safety.
From ventilators to face masks, all sorts of medical supplies were in deficit. Despite being a provincial subject, augmenting health sector service delivery requires big-push investment from the federal government. This in turn needs a coordinated effort by ministries and provincial departments dealing with health and development budgets.
The Ministry of Planning, Development, and Special Initiatives is best placed to lead this effort as its minister is also heading the National Command and Operation Centre – having relatively greater knowledge than others in the Cabinet regarding health sector needs. A way forward could be not only to create more fiscal space for the health sector in the budget 2020-21 but also to introduce greater efficiency and care in existing health sector spending.
The third challenge regarding how to address exclusion and the needs of citizens left out in the government’s fiscal response is closely linked to the need for strengthening statistical bodies across the country.
The survey tools implemented by Pakistan Bureau of Statistics (PBS) or provincial bureaus have not been regularly evaluated from the lens of improving targeting of the marginalized. The national socio-economic registry could also not be updated for the past several years. Provincial bureaus of statistics often do not agree to a lot of data and findings of PBS. Our statistical systems are also unable to help Ehsaas programme in identifying people without civil registration documents. Likewise, data collected on migrant, informal, or disabled workers is not comprehensive.
These institutional gaps are not new. They were there when PTI government assumed charge. Over 40 task forces were constituted to work on a war footing and maneuver change. Similar task forces were also constituted by chief ministers in Khyber Pakhtunkhwa and Punjab. On paper there must be reports prepared and solutions offered to the government. It will help the Cabinet revisit some of the ideas presented and perhaps expedite those relevant to the current emergency.
While ideas offered by task forces on NAB laws, civil service reform, and the housing sector make it to the popular media, much less is known regarding the output of other task forces including the one on health, education, science and technology, and policy reforms. It is also unclear if perspectives from citizens were taken into account while proposals for each of these sectors were framed.
The government would do well to ask all task forces to urgently revisit challenges in their domain and offer Covid-specific advice, and also to make all task force reports public and invite citizen inputs.
A failure to put in place a transparent consultative mechanism beyond party lines and to ask for perspectives from all segments of the population weakens the spirit of empathy which the government is supposed to demonstrate during these times.
A case in point is Pakistan’s Preparedness and Response Plan (PPRP) which was prepared to seek pledges from donors. Not only did the plan come with a significant delay, but due consultation with community and civil society organizations from across the country was not undertaken. The donor coordination mechanism – necessary to avoid delays in response from abroad and any duplication of efforts, requires much improvement at both federal and provincial levels.
Finally, relevant institutions need to take stock of how the world is leveraging artificial intelligence, machine learning, and block chain to combat the pandemic. AI technology, globally available, is now helping to overcome the shortage of doctors and paramedics, and also to prevent undue pressures on intensive care units.
(Dr. Vaqar Ahmed is an economist and former civil servant. He is author of ‘Pakistan’s Agenda for Economic Reforms’ published by the Oxford University Press. Twitter: @vaqarahmed)