Pakistan’s COVID-19 Response: To Test or Not to Test

With so much information floating around and being absorbed or otherwise, I will not bore you with the numbers but simply provide a distillation of our on-going discussions focused on “should we be testing everybody in Pakistan?”

This is an important discussion as it impacts other on-going discussions around the cost of testing, the mode of testing (which test), access to testing kits, delivery of these tests (citizen goes to test or test comes to citizen), and handling of those testing positive.

From the discussions I have been a part of the consensus seems to be emerging towards testing through symptomatic targeting and, definitely, against universal testing! Here is the logic leading to this conclusion.

The cost of universal testing is a prohibiting variable but not primarily due to the outright fiscal burden but rather the procurement aspect. Even if delivered cost of the testing was around USD 50 (~PKR 8,000) per unit, we are looking at 3 to 4 percent of GDP as the cost (same as the annual defense spending of Pakistan). Then is the issue of procuring and delivering over 200 million tests.

This does not stop here, as this is followed by a review of how these tests will be delivered. Whether the citizen is asked to approach a test delivery site, or the test is delivered to the citizen’s doorstep, the universal testing process is time un-wieldy and impractical based on simple back of the envelope calculations.

Should the universal testing somehow become practical, there are daunting social challenges. Since more than 95 percent either fall in the no effect plus recovered bracket, and almost half the population will eventually be infected (based on present predictions), knowing that a citizen is positive will create a social stigma and a social pandemic in the ability of society to deal with each other.

Symptomatic and citizen responsibility driven testing as opposed to universal testing is thus the right approach which also appears to be followed by most including by the Pakistan government. We suggest using technology in both push and pull modes supplemented by radio and TV broadcasts and further supplemented by the volunteer (the “Cororna Tiger Force” being assembled by the Prime Minister).

A mind-mapping exercise around the symptomatic and citizen responsibility driven testing shows that with these options working in parallel, we can cover almost all of Pakistan in about 45 to 60 days and really understand the magnitude of the pandemic allowing us to rapidly assemble coping and mitigation strategies!

Pakistan’s COVID-19 Response: Getting Rations to the Needy

As is often the case with solutions, it is the simplest ones that are the most elegant and applicable. Problem statement is as follows: delivery of food or rations to needy in urban and in rural areas.

Solution can be as follows: use the local kiryana-stores and hawkers supplemented by mohalla and village volunteers.

Constraints to be overcome include the following: identifying the needy; keeping basic food and household consumer goods supply chains operational; avoid people to people physical contact; avoid lines and congregations; avoid prompting households to leave homes.

I must have forgotten some, but I narrow down the problem as to how unpaid distribution of such rations can be managed. The assumption here is that such rations will preclude perishables.

Almost every community knows its needy—by and large. Exceptions are the sprawling urban and peri-urban kothis’ based neighborhoods, like in Islamabad and in the Bahrias and DHAs of this country’s many large cities. We should use the mosques and the mohalla committees and the community and village and union-council based organizations to do the targeting. This also holds for all katchi-abadis and other illegal settlements. These sources can be farmed using smart phones or regular phones with IVR type technology.

Once needy are identified the aim should be delivery to the doorstep. For this to happen the government can through the army utilize local kiryana-stores and other small to medium general merchandise stores in urban and rural localities as the source points for the deliveries to originate from. Utility stores can also be coopeted and so can the armed forces CSDs. These locations can be geo-tagged for ease of ensuring the supply chain. Supply chains and related logistics can be ensured through a communion of army and civil logistics and depots of such supplies can be martialed by force if required. This entire exercise, if crowd sourced, can cover Pakistan in two weeks or thereabouts. Deliveries can be started in one to two days in without waiting for the overall exercise to complete.

Once these lowest distribution points are established these rations can be delivered through the store employees and mobile-vendors, thereby creating a second tier benefit of employment continuity through food-for-work or cash-for-work options for these delivery agents. These delivery agents can be supplemented through army and other civil agencies lead and coordinated through a single entity throughout Pakistan (also read We can also request the National Incubation Centers and the Digital Pakistan effort to attempt technological innovations to supplement these delivery agents and this overall approach.

Pakistan’s COVID-19 Response and the International Financial Institutions: Where is the Rapid Needs Assessment and a National Action Plan?

In times of disaster, and we are in one, almost all nations opt for a national action plan to both react and to proactively prepare for relief, recovery, and restoration/rebuilding; often including building resilience post disaster. In global vernacular it is called DRM or Disaster Risk Management, also often Disaster Risk Mitigation and Management. Disasters often lead to or exacerbate existing fragilities and conflicts leading to localized or spreading violence. Pakistan has hitherto been well served by always timely preparing such disaster needs assessments and plans—not only for internal consumption but to manage external offers of assistance. Has Pakistan done so for the CONVID-19 pandemic at our hands? I provide here, some suggestions unless these actions have already been undertaken and the public has not been informed.

On the Corona assessment, the govt can request the ADB, WB, EU and UN to do a joint assessment under the 2008 Protocol of Cooperation, or it can ask the Bank only (both options have pros and cons). This could be a simple letter to Bank from MOF, requesting for “support the Government of Pakistan in carrying out and Covid-19 Impact and Needs Assessment (CINA), in accordance with the global EU-UN-WB PDNA/DALA methodology. PDNA is Post Disaster Needs Assessment and DALA is Damage and Loss Assessment (which is a sub-tool of PDNA used by EU, UN and WB).

However, this is more complex that a PDNA. In FCV situations, the tool that comes closest to this kind of situation is the Recovery and Peace Building Assessment (RPBA)—previously known as the Post Crisis Needs Assessment (PCNA). A very successful PCNA was conducted in Pakistan by WB, UN and EU (and ADB) under Govt leadership in 2009-10 for the FATA crisis. Hence there is a precedence that can be established and used.

The tool that I propose using is a PDNA-RPBA hybrid that was developed in Ukraine, later used in Nigeria and many other places. A recent one was the Rohingya crisis in Bangladesh.

While some may rebut this idea, this can be an enormous management tool for the government even post crisis and can be done by a dedicated team while reactive measures are being taken to manage the pandemic. Do let us know if we can assist in any way.

Pakistan Needs a Single Situation and Reaction Room for CONVID-19: why no “war footing”?

Where is the Pakistan Government’s “situation and reaction room”? Who is leading and managing this “situation and reaction room”?

We continue to get multiple view points on what the “government” is doing to respond to the CONVID-19. We have the Prime Minister dealing with media flanked by the Health Minister and the Chairman of NDMA. We then have the Chief Minister of Sindh issuing a statement on how he is handling “lock-down”. We have the erstwhile Finance Minister coming on flanked by the Health Minister and the Chairman of NDMA–looking and sounding imperious–and briefing the press on Government’s efforts. The Leader of the Opposition who flew in from BorisJohnsonland walked out of the joint Cabinet Briefing and ordered his party workers to work along the lines of his ‘plan’. A few minutes later, and no less imperious, Minister for Information gets control of the State TV channel and lectures the public on how the opposition political forces are scoring political points rather than helping respond to the pandemic. So, the public is asking, who is in charge! Conflicting narratives alone can break the back-bone of an otherwise strong Pakistani public.

Then there is the private sector or shall we simply call it the the ‘non-state apparatus’ which is well intentioned though tiered and in-efficient in its response. While most are on busy on social media, some are actually trying to deliver required responses like simply providing food and rations to the needy in the times of this CONVID-19. Duplicity of efforts and absence of coordination is leading to a waste of resources. It is not just the government but also the non-state apparatus that requires coordination!

The book on handling disasters is long since available and needs no rewriting on principles even if we can argue that tools of response have evolved. This book states the following key principles: a) one organization handles the response; b) this organization has unbridled powers over all tiers and sectors of government; c) this organization operates all assessment and intervention and monitoring through a single window; d) this organization is supported and enable through the “political will”; and e) it is lead by a single person who also is the only spokesperson. This is what worked for Pakistan and the reason why the 2005 Earth Quake response by our country is written as the best-practice to be adopted globally. The powers to be at present seem not to have read this simple but powerful book–panic not, just read this paragraph again.

Nested in this response approach is getting the single ‘institution’ right. Who will take on this mantle in the present scenario in Pakistan? National Disaster Management Authority (NDMA) presently castrated through the 18th Amendment? The National Security Council (NSC)? What should the roles of Economic Affairs Division (EAD) and the Federal Ministry of Health (MOH) be? The answer to these questions lies in the enabling mandates of these very institutions. NDMA per its raison d’ etre is the natural institution for this leadership and single window operation. Its original act allows it the requisite powers and what that lacks can be provided through political will. NDMA’s website alone at this time shows that it is far from its role and is under performing by miles.

Which brings us to the personality who should lead this effort!? Views are solicited. More soon.

Pakistan COVID-19 response working group

We have set up a group of disaster, conflict and fragility experienced and concerned professionals who under the aegis of PIDE using a 360 degree approach are identifying, analyzing, discussing, and formulating responses to Pakistan CONVID-19 and socializing the same. The 360 degree approach horizontally covers all sectors and vertically integrates the various tiers of government [including union councils and communities].

Daily, we widely disseminate bulletins and blogs and newsletters based on our daily deliberations and analytical work. The advisories have covered diverse issues from cost of lay-offs to identifying the sectors where employment vulnerable including who they are to technological approaches to tracking and monitoring to delivery; public health and logistics and energy and relief to the flow of information—critical in a pandemic—to how to work with the international financial institutions in aid of Pakistan; from food security to conflict and religion to communities and volunteerism. We are casting a wide net to share and understand and sift through diverse ideas and analytics.

We are now trying to create a single situation room in the country to house this effort and unify the multiple and often inefficient singular and otherwise efforts that waste precious time and resources despite their good intentions—be they in the government or in the private sector. The situation room also requires to rapidly and proactively identify and assess potential impact and resulting needs from people to energy to finance to water to food security to developing resilience and recovery post crisis. This must be done now!

The aim is to strengthen the governments’ hands and its institutions tasked therein. NDMA is the front line of any such response. My own experience in working with NDMA (at its inception) during the 2005 Earthquake in Pakistan and then again during the 2010 Floods, makes me sure that we need to house this situation room within the NDMA. We are continuing to make this effort, and hope that through this blog, some of the readers can socialize the idea with NDMA of Pakistan.