Interview: The Global Health Security Agenda and Fighting COVID-19 in Pakistan

Dr. Nabeela Ali, chief of party of JSI’s Integrated Health Systems Strengthening and Service Delivery Activity (IHSS-SD), discusses the Global Health Security Agenda in the context of Pakistan’s COVID-19 response.

Dr. Nabeela brings 31 years of experience working with both the government and non-governmental (NGO and private) sectors for effective health programming in Pakistan. As an expert in RMNCH, with experience managing both systems strengthening and direct service delivery programs with the public and private sectors, she is a well-respected public health leader and practitioner.

The IHSS-SD Activity, funded by the United States Agency for International Development (USAID), is providing critical support to Pakistan’s COVID-19 response in addition to its ongoing work to improve access to basic health services and strengthen disease surveillance and response systems to support the Global Health Security Agenda.

What is the Global Health Security Agenda and why is it important for countries to have an emergency preparedness plan that is reviewed and updated regularly?

In 2014, 27 nations, along with three international organizations, launched the Global Health Security Agenda (GHSA). The GHSA is a collaboration by governments, international and non-profit organizations, and private sector companies to implement the World Health Organization’s International Health Regulations (IHR). The goal of the GHSA is to build national, regional, and international capacity to prevent, detect, and respond to public health emergencies. JSI, through investments from USAID, is working in Pakistan to strengthen the health system to support global health security. This includes support for creating policies around strong legal and regulatory frameworks, building data management systems and the capacity of health actors to use them, and providing training for health care providers. Establishing, reinforcing, and implementing international and national-level guidelines will ensure that Pakistan is prepared to respond to current and future health emergencies.

What has emerged in Pakistan in terms of developing a stronger surveillance and response system as a result of COVID-19?

The critical role of public health surveillance in detecting and preventing the spread of infectious diseases is a lesson reiterated by COVID-19. The current pandemic is a case study for global health security and amplifies both the strengths and weaknesses of a health system. In Pakistan, each district has made human resources available with the mandate to respond in the case of an outbreak. However, there are still fiscal and capacity gaps and a lack of clarity around roles and responsibilities for this or any future epidemic response. 

Since March 2020, USAID has provided additional support for Pakistan’s COVID-19 response, which has allowed JSI to work with the Government of Pakistan to address gaps identified in the disease surveillance system through investments in infrastructure and human resources. JSI is supporting provincial and district governments to create or strengthen Disease Surveillance and Response Units. These units use technology solutions to capture real-time data on suspected cases and contacts and alert rapid response teams to identify, test, and, with positive cases, isolate patients for additional care to halt transmission. 

What groundwork had already been laid at the federal level to be prepared to respond to this crisis? How has JSI supported this work?

In 2017 Pakistan was the second country in the World Health Organization’s (WHO) Eastern Mediterranean region to participate in a Joint External Evaluation (JEE) to assess Pakistan’s IHR core capacities. A multi-sectoral External Evaluation Team, assembled from technical experts representing different countries and international organizations, conducted the assessment using the WHO International Health Regulation Joint External Evaluation tool. The assessment report outlined recommendations and priority actions based on discussions between the External Evaluation Team and their Pakistani counterparts. Recommendations included developing internal health regulations and anti-microbial resistance guidelines, as well as allocating budget to support requirements for disease surveillance at points of entry.

Based on the JEE findings and recommendations and with funding from USAID through the JSI-led Health Systems Strengthening Component, the Ministry of National Health Services, Regulation, and Coordination conducted seven consultative workshops (one for each province/region and one national) to tailor provincial responses to the JEE findings. Based on these consultations, a national, five-year costed IHR-GHSA roadmap and work plan were prepared and launched at the end of 2017.

This was the first milestone towards implementation of the GHSA, followed by several other activities that paved the way for national guidelines on health regulations, antimicrobial resistance, and notifiable diseases and for securing funding for Integrated Disease Surveillance and Response (IDSR) and a public health lab network to test and diagnose samples sent from districts. This strong foundation for addressing infectious disease prevention, detection, diagnosis, and control has prepared the Ministry of National Health Services, Regulation, and Coordination to respond effectively to the current pandemic. 

What role does the community play in stopping the spread of infectious diseases?

Infectious diseases like tuberculosis, HIV/AIDS, and others have long been associated with stigma, and people who have contracted these infections are often isolated by their communities. We’re seeing a similar situation with COVID-19 in which people hide their diagnoses for fear of being isolated in their homes and shunned by their families and communities.

Community influencers, activists, and opinion leaders have a specific responsibility to mitigate the myths and associated stigma with infectious diseases by leveraging their positions and rapport within their communities. In Pakistan, where 65% of the population has low or no literacy and many live below the poverty line with limited access to information and technology, school teachers, imams, local political representatives, and social workers are well-placed to share accurate information on infectious diseases and treatment options and on recommended health-seeking behavior. Informal health care is rampant in Pakistan and people who are poor and/or illiterate are more likely to resort to dangerous or ineffective treatment options because they don’t trust government health facilities and can’t afford private health care services. By dispelling myths and providing accurate information, community leaders and health workers can reestablish people’s confidence in the health care system and encourage them to seek treatment for infectious diseases at public health facilities where they can receive services for free. 

Communities should have accurate, accessible information about infectious diseases and their prevention, detection, and treatment. Governments should be proactive in improving in access to service delivery, including vaccinations and treatment, as well as screening, education, counseling, and other strategies to minimize exposure to diseases. Governments should also ensure health departments and health care providers are trained and equipped to implement and monitor appropriate infection prevention and control procedures to safely provide services to people who may have contracted infections. Routine oversight will ensure greater accountability for health facilities which will improve patients’ trust in the health care system.    

What lessons do you think the global health community should learn from this crisis to continue making the world safer from infectious disease threats?

COVID-19 has been an eye-opener on cross border infections. It is evident now that the global health community has struggled to combat the disease because of insufficient research, lack of cost-effective solutions, and limited preparedness of the health systems- even in the richest countries. It has illustrated the importance of investments in health and social systems to both prepare for and respond to health crises. The health system alone cannot address global health emergencies and their broad impact. The health sector must now re-orient its policies and strategies and return to the concept of inter-sectoral collaboration articulated in the 1978 Alma Ata Declaration. If investments are made in primary health care, health promotion, and preventive services, the burden of health crises on health facilities and the associated financial toll will be lessened in the long term.