In past I have had the privilege to closely observe the Ministry of Health and its workings. Unfortunately, I noticed that after the 18th amendment Ministry of Health lost its focus. While the 18th Amendment dissolved Ministry of Health at the federal level there were federal subject pertaining to health that were left unattended. Some of them were brought into the ambit of the newly created ministry called the Ministry of National Regulations & Services (“MoNRS”) yet some remained with the cabinet division. Up until the interim government of 2013, the dysfunctional MoNRS was clueless of its functions thereby severely effecting the administration of its subordinate subjects. During 2013 interim government as a Federal Minister for MoNRS, with help of my colleagues, I successfully consolidated all the scattered subjects of pre-18th Amendment Ministry of Health and brought them under a new ministry called Ministry of National Health Services Regulation and Coordination (“MoHSRC”). This is something the previous minister should have done but failed to do so, causing massive financial and administrative irregularities and inefficiencies – a conversation for another day.
Upon the outbreak of the novel Coronavirus (“COVID-19”) that turned pandemic, MoHSRC was lethargic in its response. MoHSRC was caught napping and unprepared to timely address COVD-19 issues. The most critical of the shortcomings was failing to promptly understand the scope of COVID-19, analyze all options keeping in view the strategies employed by other countries especially China, and promptly advising the Prime Minster with an action plan. A Prime Minister can only be as prepared as he is kept informed and advised by his cabinet. It is the very duty of the cabinet to keep the Prime Minister abreast of all the developments. I am not sure if the Special Assistant to the Prime Minister for MoHSRC promptly warned the Prime Minister with the looming dangers of COVID-19 and a comprehensive preemptive plan to combat this issue before it became a menace. Untenable failure to devise such a plan and advise the Prime Minister in a timely fashion is at the core of what we face today.
There are certain things that the Honorable Prime Minister is requested to consider at this critical time. I will begin with the most important aspect that is the social distancing. We must understand that social distancing is not a trendy term but a reality and the most effective way to stop the spread of COVID-19, short of the development of a vaccine or rather the more painful way, which is letting the population get infected and build immunity at large. To date most of the Pakistanis are not aware of what it really means to socially distance themselves or completely understand its benefits. If our Government imposed the lockdown and enforced social distancing measures from the very beginning, by this time we would be in a much better position. Since the Prime Minister was not properly advised in a timely manner, he remained indecisive about the lockdown. Nevertheless, a partial lockdown was observed without calling it a lock down. Many businesses stopped functioning and many individuals voluntarily went into self-isolation. A good sign, but it did not accomplish the desired results for it was a partial lockdown where the majority of the people remained socially engaged and active. As long as the last person exposed to COVID-19 is out there, and not isolated (quarantined) we cannot comfortably assume or calculate the end of the incubation period.
It will take longer, but as a nation we can beat COVID-19 – just as we can observe the flat and now downtrend in China, it’s possible to achieve the same in Pakistan. Even today if people at large act responsibly and according to the direction of the health care specialist we can control this menace within weeks and quickly move towards normality again. The chain of a person to person infection can only be broken by self-isolation by social distancing, and it is the only effective way. There cannot be enough emphasis on voluntary social distancing by people as government can do only so much to manage the day to day affairs of the masses. There seems to be a lot of emphasis on Pakistan’s capacity to test the suspected patients for COVID-19, and the need for mass testing. However, where it is important that we must have the ability to test the patients with symptoms, there is not an urgent need to test the population at large unless people who get tested also abide by the prevention methods i.e. self-isolation or social distancing. A person tested negative can easily become positive if he is not careful, hence, making the entire testing exercise futile.
The Prime Minister must call an emergency meeting of all the Pharmaceuticals operating in Pakistan. He must emphasize that in the time of crises they need to do more to make medicines available and at lower costs. A while back I had recommended and placed a moratorium on the prices of drugs and drug related products. This was an endeavor to compel the Pharmaceutical industry and the Drug Regulatory Authority of Pakistan to mutually devise a pricing formula to control drugs prices in Pakistan. After I left the office, moratorium was lifted, and the prices were arbitrarily dealt with. Since then I am not sure whether the idea of the pricing formula was seriously revisited. The Prime Minister should also call upon all the major corporations in Pakistan to utilize their social responsibility funds to aid government in its COVID-19 relief efforts. Especially, the Prime Minister should call upon the manufactures with the capacity to make ventilators and follow the example of the United States, and mass produce ventilators for the hospitals at cost or deferred payments. The Adviser to Prime Minster on finance may propose relevant tax incentives to entice the corporations to comply.
While all the efforts are being focused on how to combat COVID-19 we must also prepare our frontline doctors, paramedics and other individuals. Foremost important is their health and life. Government must make certain that every frontline person’s health and life is insured. This is important in case they become a casualty or develop any post-crises condition while they are putting their lives in harm’s way to serve the nation. In fact, government should encourage mandatory health insurance in the private sector as part of its health policy. Health is one of the most fundamental human rights and the utmost responsibility of any government. Any government that professes the legitimate authority to collect taxes and govern must look after the wellbeing of the very people it governs; and health of an individual is the most essential element of wellbeing.
Political point scoring must come to a complete halt. There should be no politics on wellbeing of the people. Time is to bring nation together in fighting this pandemic by all means necessary. Provinces and the Federation must stand together. Accordingly, the Prime Minister should also reconsider the name of his newly formed task force. Nothing should alienate people to associate themselves to fight COVID-19 as one nation. Similarly, leaders and people of all parties should assist the Prime Minister in his relief efforts. This is the time to understand that we are one as a nation, political differences aside. While considering urgent changes the Prime Minister may also review his very bulky cabinet and heads of the institutions where ineptness and non-professionalism is causing massive drainage to national exchequer. It’s time for the Prime Minister to rethink and reassess his cabinet and appointments. Two years is enough time to evaluate the performance of his team. He should start axing those who have been inefficient and underperformed. Clear Islamabad from inefficient career politicians holding technical positions, and appoint the professionals based upon their work and not just reputation. The biggest argument behind the 2018 mandate of the Prime Minister was that he is someone who will fix the system. Something that the majority of the people who voted for him are still waiting to see that happen. There are numerous institutions which are headed by inept pseudo-professionals drawing exorbitant salaries from the government. After all it’s the revenue collected from taxpayers hard earned money. Government and semi-government contractual employees and all individuals in the services of Pakistan grade 20 and above should also show solidarity with the nation and voluntarily commit to contribute certain percentage of their salaries to Prime Minister’s relief efforts. One fine example is that of the Chairman of the Senate of Pakistan who has contributed his entire salary.
Post COVID-19 the Prime Minister’s health care policy must focus on fixing the health care system, mainly government hospitals. Government hospitals are run by doctors who have become rather career bureaucrats, which is someone neither better than a doctor nor a professional. We need professionals heading the hospitals, specialized in administration and the management of the health facilities. Heads of all government hospitals must be from private sector. In the short term, highly trained professionals even from international market should be considered. This is necessary to make hospital management and administration professional. I am certain that many Pakistanis working abroad will be willing to come back (even with pay cuts) to serve the nation and train young professionals and students in the universities.
Improve the funding mechanism for hospitals by approaching foreign donors and investors who can assist Pakistani hospitals on long-term partnership basis. Enticing the investors abroad will not only improve the capacity and conditions of our hospitals but it can also create research and development opportunities- an element that should be integral to any partnership government proposes with foreign entities. Comparatively, cheaper labor cost and the cost of living can attract the foreign investor if the Government can guarantee to safeguard their interests from political instability and random policy shifts. Research at hospitals should be the long-term vision of the government. International investments in our hospitals can turn them in to research institutions. A necessary step forward cultivating myriad of possibilities from indigenous research to job creation for the highly qualified professionals – eventually slowing the human capital drain where our best and the brightest can come back after studying and training abroad.
To increase Pakistan’s health care system’s capacity to curb future COVID-19 like crises, the Prime Minister should initiate special program to open Emergency Units (“EUs”) all over Pakistan. EUs are small medical facilities that are well equipped to handle medical emergencies and life-threatening conditions. They are very effective to address most emergency situations and quickly make assessment on patient’s condition for further course of action. In COVID-19 like crises they can enormously lessen the burden on the major hospital by not only treating patients, but also serving as quarantine centers, information and awareness points and by performing any tests if and when required. This is something that is achievable within a relatively short period of time. EUs can be easily be established with help of private partnerships. There are many privileged individuals across Pakistan who would be willing to donate land and money to the government to build and run EUs in their areas. In return Government should name the facility after the donor. Besides improving the capacity, it will also create jobs in far and remote places where non-professional staff must be hired locally. Government should develop SOPs and make such proposals public so that interested people can approach. While addressing the COVID-19 pandemic, assessing his cabinet the Prime Minister must also strategize the course of action for tomorrow. He must act on battle footing and all of us should stand together in assisting him as one nation.
