Pakistan's Crumbling Health Security

Pakistan’s Health Security Crisis: A Vulnerable Nation

The crumbling health security in Pakistan is a matter of serious concern and needs to be addressed on an immediate basis. Pakistan, having ranked 130/195 on the global health security index with a score of 30.4, below an average score of 40.2 makes it one of the most vulnerable countries in the world in terms of health security. Health security remains neglected as is evident from the lack of focus of the policy makers on healthcare. Low quality and unaffordable healthcare facilities, weak disease prevention and surveillance, lack of research and mechanisms to cope with epidemic and pandemic, and overlooking of stunting and malnutrition further signify the need to develop a grand strategy and implementation that includes every aspect of non-traditional security threats, particularly, the threat to health security is inevitable. Health security threats, given poor control, and preventive response mechanisms further worsen the situation. The need to develop a grand strategy for Pakistan to cope with the evolving health security challenges both at the domestic level and global levels is critical. Locally, the challenge stems from low expenditure or budget for healthcare as compared to defense budget which results in poor healthcare infrastructure, and a lack of research institutes, and laboratories to conduct research. Globally, with the advent of modern means of travel and communications, there is a threat of rapid progression of infectious diseases, and viruses which might turn into pandemic or endemic as witnessed in the case of COVID-19, which progressed quite rapidly, and the healthcare system of Pakistan fell victim to this pandemic because of the poor healthcare infrastructure and lack of research institutes which in turn resulted in a poor response in curtailing Covid-19.

The Impact of Globalization and the COVID-19 Pandemic on Health Security

The health insecurity in Pakistan is multifaceted and therefore requires a multi-sectoral and multi-dimensional approach. There is a range of factors that are contributing to the perilous health security situation in Pakistan. In the contemporary globalized world, an outbreak of a contagious disease or virus has the potential to affect the people of the entire world. The outbreak of COVID-19 at the start of 2019 exposed the fragile healthcare system of Pakistan. Due to a lack of research institutes, Pakistan couldn’t produce an effective response to the pandemic. We had to rely on China and various other countries for vaccines and even tiny tools such as masks and ventilators to cope with the virus. The COVID-19 pandemic proved as a wake-up call for Pakistani policymakers and researchers about the sort of national security hazards. The progression of various lethal and infectious diseases such as Ebola, Congo Fever, and Swine Flu remains a challenge that further magnifies the vulnerability of Pakistan. The lack of an effective policy framework and lack of coordination amongst the central, provincial, and local health institutes and officials result in poor health governance. The role of the Ministry of National Health Services of Pakistan has failed to deliver in terms of forming coordination with its provincial and local counterparts. One of the most dominant factors that has crippled Pakistan’s health security is the decades-long corruption and neglect, as a result, the masses who are the most exposed are paying the price. According to the reports of UNICEF, the rural areas in Pakistan are dominated by malnourishment and a high rate of stunted growth, affecting almost 40% of the children mostly in the Thar Parker district of Sindh. Despite the claims made by former Prime Minister Imran Khan to tackle the issue; the health budget had been slashed even in the larger province of Pakistan.  Pakistan’s inability to comply with the international health regulations (IHRs-2005) has resulted in prevailing gaps in the health governance in Pakistan. Over time, the United Nations has been making efforts in the form of global legislation to ensure health security.

The Need for a Comprehensive National Health Security Strategy

The United Nations General Assembly Resolution A/RES/68/98‘, on December 11, 2013, was an attempt to draw an intimidating connection between global health security and the foreign policy of a state. Before this resolution, health was not a priority in any country's foreign policy. Despite being the signature of this resolution, Pakistan has failed to incorporate or include the health security aspect in its foreign policy. Pakistan's failure to execute and implement the global health security governance laws of which it is a signatory has resulted in a lack of coordination with other member states to ensure health security and protect its citizens against global diseases and pandemics.

 Lack of focus on health intelligence which evolved during the Gulf War and was established during the Covid-19 pandemic, which plays a vital role in predicting global health threats by analyzing health data from various sources so that it can be used to take proactive actions also has contributed to the sorry state of health security in Pakistan. Immigration and mass displacement have further deteriorated the health security situation. In the border areas which come near Afghanistan, particularly, in the provinces of Baluchistan and Khyber Pakhtunkhwa (KPK), the already fragile health infrastructure could not accommodate the huge chunk of immigrants.

To conclude, Pakistan’s non-traditional security paradigm, particularly, health security is flooded with loopholes and challenges. The contemporary health security challenges are no doubt, national security challenges that require an implementation plan and a grand national health security strategy. An all-inclusive approach towards tackling human security in general and health security in particular is the need of the hour. The need for an immediate National Action Plan to cope with the changing domestic and global health security dynamics is inevitable.

This issue requires a multi-sectoral and multi-dimensional approach that is not merely limited to the military sphere as suggested by the narrow approach of the traditional approach towards security, it rather needs to be an inclusive approach that also considers the situation of human security, particularly the health security in the country. All the contributing factors to the sorry state of health insecurity in Pakistan serve as a wake-up call for the policymakers to draw their attention to resolving the issue of deteriorating health security in the wake of infectious diseases, poor healthcare infrastructure, and lack of coordination. Reconceptualization of the security paradigm is important in the sense that in today’s contemporary globalized world, the focus is on individuals rather than nation-states. Therefore, the health security aspect of human security which is the most significant part of the non-traditional security threats is inescapable.

Policy Guidelines/Recommendations

An effective health security framework that considers the domestic factors along with the evolving global security dynamics needs to be formulated. The following policy recommendations take into the prominent health security components and propose a future course of action to deal effectively with health insecurity in Pakistan. The policy recommendations are:

• A comprehensive policy framework needs to be developed to strengthen Pakistan’s toughness in future pandemics.
• Initiatives such as the ‘Sehat Insaf Card’ need not be curtailed, as it is efficiently serving the masses who belong to a poor socio-economic background. It is therefore necessary the continue such initiatives to bring healthcare facilities access to the masses who cannot afford healthcare facilities,
• An increase in coordination between the Ministry of National Health Services, Coordination, and regulations and its provincial counterparts is significant to implement the grand health security strategy effectively at the gross root level across the country. This will improve the healthcare infrastructure and delivery,
• Pakistan also needs to focus on developing an effective health intelligence, where progressing health threats are identified and dealt with proactively before they haunt the healthcare system and the people of the country. Proactive action is accompanied by resources and capabilities and effective and early control which requires out-of-the-box thinking, and a competent team that has the legal mandate to eradicate and recognize the potential health threats which is an important segment of national security.
• An increase in the GDP spending on health in Pakistan is inevitable if Pakistan is to improve its position in the global health security index.
• People who have a background in natural sciences, particularly, medical science are to be appointed to the most authoritative positions so that they can formulate an effective policy to deal with the challenges posed by health security
• Health security policy needs to be on the security agenda of Pakistan’s foreign policy in order to form close coordination with other states and international organizations to deal with health insecurity.