Public Health and Health System's Responsiveness During the 2022 Floods in Pakistan: What Needs to Be Done?

OBJECTIVE: In 2022, Pakistan witnessed unprecedented flooding, submerging one-third of the country under-water, ruining millions of houses, taking lives, afflicted injuries, and displacing scores of people. Our study documents not only the public health problems that have arisen due to this natural calamity but also the state of health systems' response. METHODS: We conducted a qualitative study asking key questions around prevalent health problems, health-care seeking, government's response, resource mobilization, and roadmap for the future. We purposively selected 16 key frontline health workers for in-depth interviews. RESULTS: Waterborne and infectious diseases were rampant posing huge public health challenges. Disaster mitigation efforts and relief operations were delayed and not at scale to cover the entire affected population. Moreover, a weak economy, poverty, and insufficient livelihoods compounded the tribulations of floods. Issues of leadership and governance at state level resulted in disorganized efforts and response. CONCLUSIONS: Pakistan is famous for its philanthropy; however, lack of transparency and accountability, the actual benefits seldom reach the beneficiaries. Such climatic disasters necessitate a more holistic approach and a greater responsiveness of the health system. In addition to health services, the state must respond to financial, social, and infrastructural needs of the people suffering from the calamity.

Confusion and denial: need for systems thinking to understand the HIV epidemic in Pakistan.

The first case of HIV appeared in Pakistan more than 25 years ago, and since then the prevalence of the disease is creeping up apparently at a dawdling pace, with only 3,983, cases registered till November 2010, of which 1,725 are undergoing treatment. The National AIDS Control Program is responsible for managing the epidemic. Pakistan has moved from a 'low prevalence-high risk' to a 'concentrated epidemic' state, yet the forcefulness required for managing this silent escalation of HIV infected numbers is not being highlighted, as it should be. A more holistic focus is the need of the hour, and for this purpose the WHO's Health Systems Building blocks have been used to discuss the state of affairs in Pakistan, with reference to the HIV/AIDS concentrated epidemic. This paper attempts to present a narrative, based on extensive literature review, with a focus on the six building blocks of health, systems strengthening. No doubt, the service delivery has to be responsive; but skilled human resources, a robust information system, an uninterrupted supplies and use of latest technology, adequate financing, and above all good governance at operational level are essential ingredients, which call for re-orienting the national programme today. Lack of coordination, capacity and interventions with questionable sustainability pave a perilous path. Hitherto the issue can be addressed by involving stakeholders from all levels of the society and managing the void between policy and implementation. Furthermore, interventions that focus on the long term future are imperative to combat the menace threatening the human lives.