With approximately a year since COVID-19 spread rampantly across the board, with economic and political ramifications being brought to the surface, the virus is still unfolding. Since the emergence of the disease in Wuhan, China, in December 2020, there have been more than 15.2 million confirmed global cases of the virus with the number of deaths 2.5 million as of January 2021, with that number only going up. Nobody could have imagined the multitude of ways this virus would affect the lives of many across the globe. Despite its close geographic proximity and economic ties with China, the first 2 cases of Covid-19 in Pakistan were reported around mid-February of 2020, with over 560,000 cases and over 12,000 deaths currently. To curb the spread of the virus, provincial governments established lockdowns in their respective areas during the months of March and April.
While in the case of Pakistan, there were already prevalent patterns of unequal economic opportunities, health care systems, and social condition pre-pandemic, the spread of COVID‐19 and the gradual release of strict lockdowns and subsequent implementation of social distancing protocols has further perpetuated indirect adverse effects on unequal medical accommodations, economic development, and social conditions towards the lower-middle class citizens of Pakistan. This paper will provide a comparative analysis and frame the current conditions in the health system, economic spectrum, and social life within Pakistan as a whole, concluding with what actions have taken place to mitigate the impact Covid-19 has left in these domains and what further action can be taken from the government and local people for substantial change to occur.
Healthcare System and Covid-19 Challenges
Prior to the pandemic, Pakistan’s neglected health care sector was already a point of contention. As of May 2020, it was reported that Pakistan spends approximately less than 1% of its GDP on the national healthcare system, despite recommendations from the World Health Organization (WHO) positing an allocation of about 6%. As expected, when coronavirus hit the country, many national and private hospitals were up against quite complex challenges. In the initial stages of lockdown procedures in March andApril, only a few specific quarantine centers were present with limited diagnostics and treatment facilities until the government received primers, testing kits, and equipment from other China among other countries. The focus was on infrastructure, supplies and staff management. The wards were redesigned and upgraded. Even now that conditions have somewhat improved, centers continue to run out of rooms, and thus make it difficult for non-Covid patients to receive prompt and attentive care.
In terms of the provision of healthcare in Pakistan, rural populations have inadequate and inappropriate facilities compared to their counterparts. There are many stories of patients waiting to be treated even with the most dire COVID-19 symptoms, but are mostly seen only through bribery – paying powerful relatives, friends, etc. to admit these patients as promptly as possible. COVID-19 has exerted substantial impacts on “at-risk” groups: older people, healthcare providers, children, the homeless, daily wage laborers, and the economically poor, and over here there are many present case studies displaying the effect COVID has had on vulnerable patients, such as pregnant women. Where the government of Pakistan has taken necessary and strict actions to overcome the spread of the virus, no efforts have been seen to address the effects it has had on maternal health issues within the country. The pandemic has also seriously affected the availability of essential pregnancy‐related medications, vitamins and supplements, not only affecting the mother’s health but the child’s as well. The contagious nature and high mortality rates tied to COVID-19 has led to many pregnant women being apprehensive to attend doctor’s visits, and has caused higher rates of psychological distress, depression, and anxiety. Pakistan, a low‐income country suffering from under-investment for decades, has been slow to recognize maternal health conditions coupled with the pressure to mitigate the further spread of covid-19; therefore, these issues experienced by pregnant women are considered at the end of priority list and are undertreated.
While this remains as a brief outline of the complex healthcare challenges Pakistan continues to experience it clearly displays how these challenges disproportionately affect people at a disadvantage due to their class, gender, etc. in receiving basic, proper healthcare. There is a simple reality prevalent here: the wealthy are able to find loopholes to receive the care they need. The lower your socioeconomic status is, the more difficult it is for you to receive these basic necessities.The Covid-19 pandemic is only highlighting these cyclical issues in Pakistan’s healthcare system.
Covid-19 and the Economic Challenges in Pakistan
According to a Dawn News report, the most who have economically suffered have been Pakistan’s daily wage workers and urban slum settlers. Pakistan is estimated to undergo a loss of 2.5 trillion rupees ($15.5 billion) due to the Covid-19 pandemic. Pakistan's already fragile economy had only just begun stabilizing and moving towards recovery when the health crisis struck. Unemployment has risen enormously due to a large decrease in exports. With Pakistan primarily exporting textile products, the pandemic has put a halt to this consistent means of financial stability, with some orders even being cancelled altogether. When Pakistani prime minister, Imran Khan took office, Pakistan’s GDP growth was around 5.8%, now with the pandemic this has taken a major downfall at a mere 0.98%. This plethora of statistics underscore the fact that the pandemic has hit an already fragile economic system in Pakistan.
However, some industries, such as retail within Pakistan, despite enduring shock from the strict lockdowns, were able to withstand the challenges. Pakistan’s grocery retail space, estimated by industry insiders to be worth more than $50 billion (7.91 trillion Pakistani Rupees) in revenues annually, is mostly operated through a means of ‘karyana bazaars’ or ‘Khattaks.’ These are essentially small shops, often in large markets that cater to household basics like flour, rice, sugar, cleaning products etc. With the spread of Covid-19 becoming rampant back in March and April 2020, these small,crowded stores took an immediate hit with the loss of customers and thus revenues. These owners and their respective businesses were impacted differently and for different periods of time. The solution for all of this? Online grocery shopping. Many Pakistani retail business owners and entrepreneurs took advantage of a growing technology sector and opted for grocery orders made online and through mobile apps, achieving a profit jump by 50 to 70 percent month on month. Despite suffering initial challenges, the innovative nature of the retail sector ultimately allowed these businesses to survive and grow amidst the covid-19 related economic hurdles.
The farming sector of Pakistan, primarily in the northern areas, has not only served as a backbone for food security but has always been a major support to the economy, being the highest contributor to GDP. There have been major disruptions in production of wheat, rice and various crops due to the limiting work force and restriction of transport facilities for dispatching harvested crops. As more people were being pushed into poverty, Imran Khan took it in his hands to place what he called as ‘smart lockdowns’ – in light of the country's high levels of poverty and unemployment, the government taking made a decision to keep the businesses and the factories running and close down only non-essential activities. Despite a major loss of agricultural sector activity and food security during this time, Khan still felt the need to proceed with the larger vision of creating wealth through industrialization and ‘all about creating wealth.’
Covid-19 and Society in Pakistan
Our inherently social nature, regardless of nationality, means that our desire for connection and interaction is the most normal thing in the world - but we have been forced to adapt to the “new normal” of physical distancing. The social ramifications of covid-19 highlights the disproportionate effects covid-19 has had on students and the education sector as a whole, as access to technology and high-speed internet have turned into the new issues many students have had to overcome.
In March of 2020, the Government of Pakistan had mandated that all schools and universities would be part of the nationwide lockdown. This ultimately prompted the Ministry of Federal Education and Professional Training (MoFE&PT) to seek educational alternatives to ensure learning continuity. However, learning continuity presented itself as an issue given the unequal access to technology and internet for many in Pakistan. The transition towards online learning has meant a large allocation of resources to cater towards the academic requirement of approximately 47 million students who have discontinued their in person education. Along with this are the stresses students have had towards the online setups. In recent studies, women exhibited higher levels of anxiety and depression in comparison with men pertaining to the pandemic and its social consequences, which suggests that they hold a greater psychiatric burden of the COVID-19 pandemic.
With the new dominance of virtual learning systems, the issue of digital divides among urban and rural populations are more prevalent than ever before. In relatively less technologically privileged countries like Pakistan where only 22% of the population have access to full internet facilities. This is attributed to the already established high poverty ratio and lack of technology infrastructure, which limit the access of high-end internet facilities to students living in conditions outside of the urban or semi-urban regions and who do not usually belong to middle and upper societal classes. In December, the government launched its first Radioschool, a virtual educational program which aims to accommodate for and expand student outreach in response to the second school closure.
However, its effectiveness and accessibility still remains in the shadows, due to a lack of transparency and training in providing these same programs to provinces across all of Pakistan. Furthermore the federal government should also help the provincial governments prepare educational content according to their respective boards so that education in these trying times can continue in the country. While the government was quick to recognize the issue students being able to access their course materials from home, Pakistan has attempted to shift to hybrid learning, with educational institutions being caught in a cycle of opening in phases and closing up again when covid-19 cases begin to rise; thus being an ineffective way to curb the spread of the virus and prevent an anticipated spike.
Pakistan has been labelled as one of the top ranked countries in Asia with the highest response to social protection during Covid-19 crisis. Nonetheless, the COVID-19 positivity rate and number of deaths due to the virus have increased. Now more than ever, it is critical to recognize that these issues were not just periodical challenges of March/April of 2020. A lot of the research and studies allude to these issues and the immediate relief efforts to be solely focused in the early months of 2020. The pandemic is prevalent as ever and has every potential to become widespread and rampant with the lack of enforcement for social distancing and lockdown rules coupled with overall public apathy to the virus.
There is a need to establish rehabilitation centers across the country for mental health crises and provides 24 hours assistance to the public.The improvements of covid-19 units in hospitals and online learning initiatives should not be temporal and timely actions that were done in 2020. Imran Khan claims that a second lockdown will be detrimental to the economy, but this should not take priority over an already fragile healthcare system and the potential lives that can continue to be at risk. There needs to be consistent efforts on behalf of the government, preferably accepting that a second lockdown is must in order to ensure medical, economic, and educational security.