Pakistan’s Fragile Health System Faces a Viral Catastrophe

By FaseehMangi

The country of 210 million is ill-prepared for the pandemic.

Syed Mohammad Yahya Jafri, 22, a Pakistani student from Karachi, was coming to the end of a two-week pilgrimage to Iran when his head started spinning. He felt weak and feverish but decided the best thing to do was head home. It was mid-February, and most countries weren’t yet blocking people with flu-like symptoms from traveling.

No one stopped Jafri at the airport in Tehran when he arrived for his Iran Air flight, or on landing in Karachi. He went about his routine there, encouraged that his symptoms seemed to be intermittent. But when they became constant, along with a nagging cough, Jafri went to a local hospital and insisted on being tested for the novel coronavirus. He soon learned he was one of the first two confirmed cases in Pakistan.

A little more than a month later, the country has about 4,000 official cases—likely a fraction of the true figure—and is preparing for an outbreak that could drive its fragile health-care system to the breaking point. Pakistan’s health expenditures, according to the World Health Organization, are just 2.9% of gross domestic product, significantly below neighboring India and less than half the global average. The country is one of only three with ongoing polio transmission, and it’s struggled in recent years to contain AIDS and dengue outbreaks.

Health care in Pakistan “continues to suffer from coordination challenges and an acute shortage of resources,” says Arsalan Ali Faheem, a consultant at DAI, a Bethesda, Md.-based company that advises on development and health projects. “The country has been hard-pressed to find resources for health delivery.”

Pakistan’s biggest problem is money. Health care competes for scarce funds with the armed forces, which absorb a huge share of the national budget. Ambulances are funded largely by charities, and even when hospitals do have critical-care equipment, they may lack staff trained to operate it. Prime Minister Imran Khan has tried to improve services, but the government has limited influence over the provincial authorities that deliver much of the care. Together, federal and provincial health spending in the last fiscal year was the lowest since 2016, according to Asad Sayeed, an economist at the Collective for Social Science Research in Karachi.

“The camp was a breeding ground for the virus” Proximity to one of the first hot spots outside East Asia has been an important factor in the local outbreak. Shia Muslims such as Jafri represent a bit more than 10% of the Pakistani population, and thousands travel every year to holy sites in neighboring Iran. Until mid-March, when Pakistan closed its land borders, most were able to return home without disruption. At one border crossing, thousands of travelers without symptoms were waved through. Those who felt ill were sequestered in a makeshift tent city on the Pakistani side that, according to patients, had no soap or hand sanitizer. “If one is affected, everyone would get it,” says Mohammad Hussain, 42, who spent more than two weeks there. “The camp was a breeding ground for the virus.”

Khan’s administration is playing catch-up. Public gatherings have been banned and travel sharply curtailed, though the government struggled to reach a deal with religious authorities to close most mosques and shrink crowds at Friday prayers. Bolstered by the military, officials are going door to door looking for possible cases, a daunting task in one of the world’s most populous countries. In Karachi, local authorities have converted a convention hall into a 1,200-bed field hospital in anticipation of a surge in patients.

The number of tests for Covid-19 performed in Pakistan is less than 50,000

So far, Khan has ruled out a nationwide lockdown like that in India, arguing that suspending economic activity in a country where a quarter of citizens live in poverty would be a humanitarian disaster. Provincial governments in Punjab and Sindh, which contain about three-quarters of the national population, have tried to close workplaces and keep people at home, but compliance has been spotty, with residents still crowding snack carts and supermarkets.

Pakistan’s other obstacles would be familiar to doctors elsewhere. Diagnostics are in short supply: Fewer than 50,000 tests have been performed, compared with about 2 million in the U.S. The Aga Khan University Hospital, one of Karachi’s top medical facilities, closed its doors to new coronavirus patients in late March after crowds overwhelmed a screening clinic, potentially exposing staff to infection. Protective gear for physicians is a problem. One of the first Pakistanis to die from Covid-19 was a 26-year-old doctor.

With such limited resources, keeping the disease under control will fall largely to regular citizens. Jafri, now recovered, says he’s fearful that message isn’t getting through. After a slow start, “the government is doing all it can,” he says. “The biggest problem are the people who are not taking the virus seriously.”

BOTTOM LINE - With underfunded hospitals and disjointed management, the coronavirus could push Pakistan’s health-care system to collapse.

https://www.bloomberg.com/news/articles/2020-04-08/pakistan-s-fragile-health-system-faces-a-viral-catastrophe