Zaidi Shehla, Zaidi Raza, Hussain Shujaat, Safi Malik Muhammad
Global Business School of Health, University College London Faculty of Population Health Sciences, London, UK
The Aga Khan University, Karachi, Pakistan.
BMJ Glob Health. 2025 Jan 11;10(Suppl 2):e016149. doi: 10.1136/bmjgh-2024-016149.
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.
我们运用初级卫生保健（PHC）视角来评估巴基斯坦卫生系统对新冠疫情的应对情况，以确定整合初级卫生保健疫情应对措施的管理经验教训。根据阿斯塔纳初级卫生保健框架对巴基斯坦的应对措施进行分析表明，国家生存的紧迫性有助于在分散的卫生安全背景下迅速做出灵活应对。研究结果显示，在应对疫情的健康和社会方面实现了有效的多部门治理，同时迅速推出了多项公共卫生职能和急救措施。然而，我们发现基本卫生服务的维持力度薄弱，社区参与方面的努力是临时的、短期的。有助于在复杂的权力分享安排中管理应对措施的关键推动因素包括全社会的团结、基于数据的协作决策、利用分散的国内资源以及私营部门的协调。与此同时，以初级卫生保健为中心的应对措施受到基本卫生服务政治优先级低、服务不均衡、民间社会志愿服务社区参与方向薄弱以及私营部门贡献监管不力的制约。我们得出结论，需要从短期战术措施转变为对以初级卫生保健为导向的变革性管理进行长期投资。未来的准备工作必须关注应急基本服务包、动员私营和公共基层医疗服务提供者、在社会行为者和市场监管中建立有效的社区参与愿景，并在协作治理框架内展开。
