June 14, 2024

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Coordination strategies and concept of operations implemented during activation of public health emergency operations center for COVID-19 response in Pakistan

Before COVID-19, Pakistan has not formal existing mechanism of multisectoral public health emergency response coordination. Most of the agencies engaged in the pandemic response, faced legal, financial, administrative challenges in developing and maintaining operational support for the emergency. Existing record within the agencies, suggest that an informal and ad-hoc inter-agency coordination strategies were established during COVID-19 response which extended during whole period. Interagency coordination system was backed by the strategic heads of government but not on the basis of on agreements or understandings. Findings reveal some of the agencies and departments were engaged in multiple tasks whereas a few were not clear in their roles and concepts of operations during COVID-19 response. Most of the emergency response coordination arrangements were made on need basis which supported response objectives at national and intermediate level.

It was found that since inception of pandemic Pakistan started emergency response coordination by engaging some relevant sectors especially Point of Entries (POEs), NDMA, NEOC, Central Health Establishment (CHE), WHO country office, UKHSA, CDC and other partners18. As the incident escalated the PHEOC expanded coordination and collaboration with all relevant agencies in both, health and other than health sectors. The developmental partners including WHO, UKHSA, JSI, UNICEF and many others supported government agencies in maintaining coordination, workforce capacity building and tactical operations during pandemic response.

The study results highlighted that almost all of the organizations faced challenges in developing their routine capacities in emergency response coordination. Main problem was with legislative and financial support (Fig. 2) in the implementation of activities. Studies have demonstrated that financial and logistics challenges have also been observed for many of the departments and sectors engaged in COIVD-19 response19,20. Most of the organizations were not having dedicated funds to support day to day COVID-19 response activities (including testing, surge staff and deployment, quarantine, door to door vaccination etc.)21. For immediate nature of tasks, NCOC has coordinated with national and international developmental partners for logistic support in surveillance, medical countermeasure and lab services12. The World Bank’s PPR Tool assesses pandemic preparedness in various countries, revealing similar financial and logistics gaps in areas like surveillance, laboratory capacity, and risk communication in Kenya, Cameron and Nigeria22.

NIH took the initiative of planning for COVID-19 and developed the National Action Plan for COVID-19 by coordination with stakeholders in March 202023. Although plan including various activities of prevention, detection and response but not facilitate the partner organization’s roles, involvement level, financial regulation, and resources utilization with a clear concept of operation24. In May 2020, MoNHSR&C developed a draft of the Pakistan Preparedness and Response Plan for COVID-19, including funding details12. It aimed to strengthen disease surveillance, detection, case management, risk communication, infection prevention, and control and provided the ways to reduce coordination gaps. NDMA also developed a Stakeholder Engagement Plan (SEP) under Pandemic Response Effectiveness in Pakistan in May 202025. The plans developed by the agencies facilitated pandemic response but could not fulfill all requirements emergency response coordination26,27. Results of present study also reveal that most of the agencies in health sector, faced challenges in developing agreements, activities and timeline, and a clear concept of operations for COVID-19 emergency.

Most of the organizations engaged in pandemic management have different functions and strengths. Prior to COVID-19, the concept of operations and level of engagement for other branches/departments of government organizations and other partners was not clear in Pakistan28. Evidence revealed that COVID-19 related planning and operations were being supported by the different ministries and departments including, animal health, law enforcement agencies, information and broadcast, agriculture, civil administration and finance etc.25.

The roles and responsibilities were assigned on need basis from the strategic level authorities. There was no clear framework of actions and task assigned to each of the response organization notified in the NAP23. Only few of the organizations have defined emergency response activities, parallel to normal day-to-day business.

None of the agencies had endorsed the concept of operations plan or level of engagement for other than health agencies. Evidence from the present study (Table 2) demonstrates that it was unclear how different agencies engaged its branches in the absence of a shared comprehensive response plan. Thus, the unavailability of the documented concept of operations affected the overall planning and emergency response operations collectively.

Prior pandemic, health agencies were deficient in existing coordination for emergency response in Pakistan29. At the strategic level, the government of Pakistan constituted a high-level National Coordination Committee chaired by the Prime Minister of Pakistan24,30. The aim was to enhance coordination of information and actions required by all national and provincial level agencies31,31. Later, NCOC developed effective coordination mechanism among all partners in addition to the COVID pandemic response. Although many agencies involved in coordinated response to COVID, but there was very little evidence on joint planning for the emergency response. During desk review it was found that MOUs with the different departments and partners were not in place at national level.

During the COVID-19 pandemic, Pakistan faced challenges in the field of technical professionals and logistics to manage the emergency33. Data show that most of agencies expect developmental partners have a lack of workforce and technical resources for response and coordination (Fig. 1). Literature and departmental record reveal that NCOC is also lacking in permanent trained human resources support to perform all its functions.

Inter-agency human resources exchange was also a big challenge. Pakistan’s Joint External Evaluation (JEE) indicates that Pakistan lags behind in strategic emergency planning, preparedness, resource identification, and mapping34. NIH facilitated in capacity building of provincial and regional health departments to generate trained human resources for the emergency response coordination in 2020 and 202135. But the national level response organizations were lacking in capacity for their human resources to be engaged in emergency response at time of escalation. Most of the agencies did not deploy permanent liaison staff at operations center on regularly basis but called for specific assignments.