Abstract
As the coronavirus disease (COVID-19) pandemic spread, meeting the testing needs to control the spread of infection became a major challenge worldwide. In Pakistan, the lack of the requisite infrastructure and training compounded the acute shortage of testing kits and other consumables. Against this backdrop and to urgently improve province-wide access to high-quality COVID-19 polymerase chain reaction (PCR) testing with rapid turnaround times, the Government of the Sindh (GoS) province of Pakistan entered into a public-private partnership with Indus Hospital & Health Network (IHHN). Under this partnership, the GoS undertook sample collection and Indus Hospital in Karachi, Sindh, centralized testing. We describe the implementation strategies adopted by the partnership, as well as the challenges, opportunities, and lessons learned. Notably, up to 40% and 22% of total COVID-19 PCRs done in Sindh in the first 2 months of the pandemic, respectively, were performed at Indus Hospital in Karachi, though this percentage declined gradually as other centers caught up with their testing capacities. The rapid scaling up was achieved through a combination of mechanisms and factors including building on preexisting partnerships between the GoS and IHHN, pooling resources and harnessing distinct and complementary roles, relocating existing resources, introducing automation and information technology system changes, establishing risk mitigation strategies, and introducing quality measures within testing processes. The primary outcome of the partnership was rapid province-wide access to quality COVID-19 PCR testing with short turnaround times and at no cost to the patient. Furthermore, implementation of the partnership goals established new mechanisms as well as strengthened existing ones to enable rapid response to the future global health security challenges in Sindh, Pakistan.
Highlights
A2017 United Nations Development Programme report on Pakistan’s human development[1] ranks Sindh, a province of 47.9 million,[2] as second among Pakistan’s provinces in terms of human development index—a composite index of health and standard of living of a population— but with the largest intraprovince variation
The partnership was initiated without a formal agreement being signed between the Government of Sindh (GoS) and the Indus Hospital & Health Network (IHHN), the private nonprofit organization of the partnership (Box)
To handle procuring the requisite reagents and consumables, funds were transferred by the GoS to Indus Hospital at Karachi through grant-in-aid
Summary
A2017 United Nations Development Programme report on Pakistan’s human development[1] ranks Sindh, a province of 47.9 million,[2] as second among Pakistan’s provinces in terms of human development index—a composite index of health and standard of living of a population— but with the largest intraprovince variation. The collective leadership of the partnership Task Force, the GoS district health offices (DHOs) envisaged a rapid scaling up of province-wide, from across Sindh administered sample collection high-quality COVID-19 PCR testing with short and transport to Indus Hospital at Karachi where. The partnership was initiated without a formal agreement being signed between the GoS and the Indus Hospital & Health Network (IHHN), the private nonprofit organization of the partnership (Box) This was done because of time constraints and because the pandemonium of the PCR testing was centralized. To handle procuring the requisite reagents and consumables, funds were transferred by the GoS to Indus Hospital at Karachi through grant-in-aid This was a mechanism for legally circumventing the lengthy government procurement procedures. Time meant that circumstances were changing rapidly and formal agreements were deemed a hindrance to the much-needed rapidity of planning
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