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The COVID-19 pandemic has had a devastating effect across the globe, with more than 6 million deaths and over 500 million cases recorded, economies shaken and services decimated.
However, many countries, although still tested, had easily accessible health systems in place prior to the health crisis. Others weren’t so lucky.
Take Pakistan. Pakistan’s expenditure on health services has commonly been low, with the healthcare allocation in the 2021-2022 budget (a massive increase on the previous year) of nearly Rs28.3 billion (€136.5 million) paling in comparison to the Irish health and social care allocation in the same year of €22 billion. (Pakistan has a population of 220 million, as opposed to 5 million in Ireland.)
Many Pakistanis rely on private health services and pay out of pocket for assistance, even in urban areas with more accessible services.
However, the situation worsens in rural areas, like those in Sindh province. The third largest province and second most populous in Pakistan, Sindh is home to hundreds of remote rural villages, the communities of which struggle to access basic health facilities.
At any time, this would cause great distress during emergency situations but when the COVID-19 pandemic struck, communities were left feeling helpless.
Basran, who lives in a remote village in Sindh, said: “Hospitals are too far away from our village. We cannot go to the hospital because we cannot afford expenses. We are poor.”
Covid-19 response in Sindh
As COVID-19 began to spread in 2020, the delivery of personal protective equipment (PPE) to frontline workers, particularly healthcare workers, was paramount, but there were major difficulties in PPE provision and shortages across the globe. In Sindh, health workers were particularly at risk as they lacked the essential supplies to keep them safe.
“During the peak of COVID-19, standard operating procedures were not implemented properly,” Dr Raval Rai, medical officer at the basic health unit of the People’s Primary Healthcare Initiative (PPHI), explained. “We lacked personal protective equipment, such as face masks and temperature guns. Everyone was fearful of getting COVID-19.”
As we all know, the pandemic didn’t just impact the healthcare system and public health.
Places of education, from kindergarten to third-level, were shut down at the peak of the virus and when they reopened, some parents were fearful about sending their children back.
This was an issue in Sindh, with Jamil Ahmed Shah, a teacher at Government Boys High School in Matiari, saying that at the height of the pandemic, “parents did not let their children out of the home.”
This disruption in education can have devastating effects on child development and literacy and numeracy levels within a community, while many of those out of school for a long period of time will not return.
COVID-19 created further challenges for already vulnerable countries struggling with the impact of conflict, climate change and malnutrition, but Concern remained committed to our humanitarian work, and our teams mobilised in response to the global threat to help those most at need - including people who depended on manual labour to make income - but found this impossible due to lockdown restrictions and thus struggled to feed their families.
Alongside our current programmes, we played our part in the raising awareness and implementation of the tools used in the fight against COVID-19, including vaccinations, hygiene kits, face masks and other PPE.
One of our projects, Health Systems Strengthening and Response to COVID-19 in Vulnerable Districts of Sindh, has been implemented, funded by European Civil Protection and Humanitarian Aid Operations (ECHO), the EU's humanitarian funding arm. Running from July 2020 to April 2022, this project targeted five districts in Sindh province - Tharparkar, Matiari, Sajawal, Sanghar, and Badin - and was primarily focused on the health, nutrition and WASH sectors.
The objective of the project is to address the needs of the health system and the communities affected by and at risk of COVID-19.
The integrated programme aimed to strengthen the government and community capacity to prepare and respond to health and nutrition emergencies including COVID-19. This project ensured the provision of PPE, non-medical equipment and hand-washing stations, as well as disinfecting health facilities and schools.
This not only benefited health facilities, allowing staff to work safely, but education has been restored in affected areas by implementing hygiene plans and spreading awareness in the community. Teachers told parents about disinfectants being sprayed in schools to make them safe and operational, resulting in parents feeling less worried about their children returning to the classroom.
Health camps were established to provide primary health care and reproductive health services, with lady health workers (LHWs) provided with data recording tools to improve the quality of community outreach services. Through nutrition interventions, the programme has also provided treatment to acutely malnourished children in the districts.
In its 22 months, Health Systems Strengthening and Response to COVID-19 in Vulnerable Districts of Sindh has supported 90 health facilities and 60 schools across five districts with the provision of PPE, disinfection, solid waste management and non-medical equipment.
This includes:
In addition, as part of our outreach campaign, Concern broadcasted video and audio messages from the Sindh health department in the districts’ local language to share information on avoiding the spread of COVID-19 and the importance of vaccination and preventative measures.
In terms of health and nutrition services, 340 integrated mobile health and nutrition camps were established to provide general outpatient care, antenatal care, family planning, the screening of malnourished children, screening of suspected cases of tuberculosis, and vaccination services - with these camps seeing 61,927 people attend.
Other key achievements included:
These health camps have made a huge difference for people like Basran who previously struggled to access much-needed medicine in times of need, due to distance and cost. “We are grateful for the health camp in our village,” she said.
