ISLAMABAD: With the emergence of the second wave of Covid-19, the country may face serious health governance challenges both at the policy and implementation level that if not addressed might jeopardise and reverse the gains made in the first phase of the fight against the pandemic.

The first monthly Covid-19 response monitoring report, released by the Trust for Democratic Education and Accountability-Free and Fair Election Network, observed an increase in the number of cases in October from 313,431 on Sept 30 to 333,970 on Oct 31 and deaths from 6,499 to 6,823 in October.

The report is based on data collected through stakeholders’ surveys and direct observation of enumerators deployed in 20 project districts.

The sense of urgency for a more serious and focused response by the government is not only dictated by the rampant increase in infections but also by the state of critical factors such as limited infrastructural capacity at the district level, need for capacity building of first-line responders as well as stakeholders like members of civil society organisations (CSOs) and journalists.

The report found that coordination mechanisms established to manage response during the outbreak of the pandemic earlier this year largely remained intact in 14 of the 16 observed districts with key stakeholders, including healthcare staff, elected leaders and CSOs, represented on coordination platforms. The research respondents’ opinion about the effectiveness of coordination mechanisms in 16 districts reflected a variance with majority (78pc) rating it between average and highly effective.

Inclusive approach is another area where most of the districts claim to have developed and implement safety standard operating procedures (SOPs) in consultation with key stakeholders, including schools, business and trader associations.

However, as per the opinions of key stakeholders, and observation of enumerators, implementation and enforcement of SOPs remained an area of serious concern.

Capacity to handle the pandemic at the district level also remained an issue that engenders significant variance in response by key stakeholders. Whereas government officials in all 16 districts claimed sufficient stock of personal protective equipment (PPE), most representatives of doctors and paramedics only partially endorsed the statement. Health facilities in the districts overall remained a significant concern as the testing, quarantine/isolation capacity and other provisions such as ventilators are feared to fall short if the rate of infections is not slowed down/checked.

Capacity in terms of the numbers and skill set of healthcare providers is yet another area of concern with the doctors in the majority of districts (11 of 16) and paramedic representatives in a third of districts (5 of 14 districts) agreeing that their colleagues were not adequately trained/skilled to deal with Covid-19.

While the challenge of capacity and coordination cannot be overlooked, political and policy dynamics of the Covid-19 response are becoming increasingly critical. In October, legislative oversight remained marginal while the politicisation of Covid-19 response gathered momentum in the wake of opposition’s ongoing agitation against the government.

The government on its part announced steps with the dual consideration of keeping the economic activity running while issuing guidelines, implementing SOPs and protocols for offices, businesses, and individuals to curb the spread of the pandemic.

While the usual challenge of limited resources remained relevant, efforts to control the second wave infections have to contend with increased politicisation and lack of adherence to the SOPs among the general public as major policy challenges - factors that were not as significant during the first wave of the pandemic.

Published in Dawn, December 6th, 2020