{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T00:27:36Z","timestamp":1790036856873,"version":"4.0.1"},"reference-count":43,"publisher":"BMJ","issue":"Suppl 2","license":[{"start":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T00:00:00Z","timestamp":1736553600000},"content-version":"unspecified","delay-in-days":10,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2024,11,29]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:p>We apply a primary healthcare (PHC) perspective to gauge Pakistan\u2019s health systems response to COVID-19, to identify stewardship lessons for integrating the PHC pandemic response. Analysis of Pakistan\u2019s response against the Astana PHC framework shows that the imperative for national survival helped mobilise an agile response across a fragmented health security context. The findings show effective multisector governance in responding to the health and social aspects of the pandemic, as well as the rapid roll-out of several public health functions and emergency care. However, we found weak maintenance of essential health services and ad hoc, short-lived efforts for community engagement.<\/jats:p>\n               <jats:p>Critical enablers that helped steward the response across complex power-sharing arrangements included solidarity across society, collaborative data-driven decision-making, leveraging of siloed domestic resources and private sector coordination. At the same time, a more PHC-centric response was constrained by weak political prioritisation of essential health services, uneven services, weak direction to civil society volunteerism for community engagement and weak regulation of private sector contribution.<\/jats:p>\n               <jats:p>We conclude that a mindset shift is required from short-term tactical measures to long-term investment in PHC-oriented transformative stewardship. Future preparedness must build attention to essential service package for emergencies, mobilisation of both private and public primary care providers, effective community engagement vision across societal actors and market regulation, within a collaborative governance framework.<\/jats:p>","DOI":"10.1136\/bmjgh-2024-016149","type":"journal-article","created":{"date-parts":[[2025,1,11]],"date-time":"2025-01-11T23:40:19Z","timestamp":1736638819000},"page":"e016149","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Stewarding COVID-19 health systems response in Pakistan: what more can be done for a primary health care approach to future pandemics?"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7620-9247","authenticated-orcid":false,"given":"Shehla","family":"Zaidi","sequence":"first","affiliation":[{"name":"Global Business School of Health, University College London Faculty of Population Health Sciences, London, UK"},{"name":"The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raza","family":"Zaidi","sequence":"additional","affiliation":[{"name":"Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shujaat","family":"Hussain","sequence":"additional","affiliation":[{"name":"The Aga Khan University, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik Muhammad","family":"Safi","sequence":"additional","affiliation":[{"name":"Pakistan Ministry of National Health Services Regulations and Coordination, Islamabad, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,11]]},"reference":[{"key":"2025072913200865000_10.Suppl_2.e016149.1","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003675","article-title":"Protecting essential health services in low-income and middle-income countries and humanitarian settings while responding to the COVID-19 pandemic","volume":"5","author":"Blanchet","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025072913200865000_10.Suppl_2.e016149.2","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2020-003047","article-title":"Country performance against COVID-19: rankings for 35 countries","volume":"5","author":"Jamison","year":"2020","journal-title":"BMJ Glob Health"},{"key":"2025072913200865000_10.Suppl_2.e016149.3","unstructured":"Zaidi S , Hussain SS , GoP 2019 . 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