Dr. Sabeena Imran Durrani
In the wake of the catastrophic 2005 earthquake that claimed over 100,000 lives, Pakistan faced an urgent reckoning: how to respond effectively to monumental crises. The establishment of the National Health Emergency Preparedness Response Centre (NHEPRC)—later rebranded as the National Emergency Health Services (NEHS)—marked a crucial step toward ensuring that Pakistan would never again be caught unprepared. However, recent discussions about merging NEHS with the National Institute of Health (NIH) threaten to dilute its vital functions at a time when the country needs it most.
Learning from neighboring countries, particularly Nepal, which is also prone to earthquakes, we see a successful model in the National Society for Earthquake Technology-Nepal (NSET), established in 1993. This multidisciplinary organization comprises professionals from various fields who have contributed significantly to disaster risk management. Following a similar vision, Pakistan established NHEPRC to fortify its disaster preparedness and response capabilities. The importance of these specialized organizations cannot be overstated; they are essential for navigating the complexities of natural disasters.
The 2005 earthquake exposed significant vulnerabilities in Pakistan’s disaster management framework. NHEPRC quickly evolved into a lifeline for emergency health services, embracing the “Cluster Approach,” an innovative strategy for coordinated response that has since gained international acclaim. Between 2005 and 2008, NEHS was held in high regard; its contributions during the earthquake were acknowledged at all levels, serving as a critical support system for the Ministry of Health.
Yet, despite these early triumphs, the years following the earthquake have not been kind. Bureaucratic inertia, compounded by a lack of sustained investment, has compromised NEHS’s effectiveness. Key leadership positions, such as the Director General, have often been left vacant or occupied by individuals not suited for the role. Technical staff were redirected to other ministry duties, while funding for emergency preparedness alarmingly dwindled—often amounting to less than 2% of allocated resources.
The prospect of merging NEHS with NIH raises alarm bells for experts and advocates of emergency health services. While NIH excels in disease surveillance and vaccine production, its focus on communicable diseases starkly contrasts with NEHS’s broader mandate, which encompasses a wide array of health emergencies, including natural disasters like earthquakes and floods. Merging these distinct entities could have far-reaching consequences. The unique skill set that NEHS has cultivated for emergency situations—ranging from trauma management to logistical coordination—would be jeopardized, making the country less prepared for future crises.
Moreover, the National Disaster Management Authority (NDMA) plays a crucial role in disaster response; however, it has no dedicated health component. In times of disaster, the health sector is paramount, as human lives take precedence over shelter or food. If individuals are not alive, the need for food and shelter becomes irrelevant. This underscores the dire need for NEHS to function independently, equipped to handle health emergencies effectively. Instead of reinforcing this vital department, there are plans to merge it, further diluting its essential functions.
Ministry of National Health Services, Regulations & Coordination NHRSC or NDMA, have any set up after abolishing NEHS with required technical expert staff to be responsible for managing health emergencies or they should start again from the scratch to develop a specialised workforce or develop a new institutional arrangement for managing such situations?
Additionally, the merger could create unclear responsibilities, leading to delays in decision-making during emergencies when every second counts. Instead of streamlining operations, such a merger may inadvertently introduce additional layers of bureaucracy, stifling the agility required in crisis response. NEHS’s extensive training programs for healthcare workers and community responders are crucial; a merger could jeopardize these initiatives, leaving the nation vulnerable when disaster strikes. The department actively engages communities in preparedness efforts, and a merger could weaken these relationships, undermining the resilience necessary for effective disaster response.
This discussion is part of a broader trend of “rightsizing” government departments. While the aim is often to streamline operations and reduce costs, rightsizing can have unintended negative consequences. Downsizing essential departments like NEHS could lead to a loss of critical skills and knowledge, disrupt vital emergency services, and overwhelm remaining staff, leading to burnout and reduced effectiveness. The fragmentation of services resulting from such a merger could create confusion, with vital functions split across various entities.
For Pakistan to effectively navigate future crises, it is imperative to maintain a stand-alone structure for NEHS. This department should be fully equipped with resources, authority, and specialized personnel to manage health emergencies effectively. A clear mandate would facilitate prompt decision-making, ensuring that the lessons learned from past disasters inform future responses. Furthermore, a strengthened NEHS aligns with international standards for emergency preparedness, demonstrating Pakistan’s commitment to global best practices in disaster management.The stakes couldn’t be higher.
As Pakistan stands at the precipice of potential future disasters, merging NEHS with NIH could compromise the very systems designed to save lives. The need for a specialized, autonomous emergency health service has never been more pressing. If we do not strengthen NEHS, we risk facing a disaster similar to the 2005 earthquake without the trained personnel and infrastructure to respond effectively. The potential for devastation, particularly if a second fault line were activated, could lead to unimaginable loss and suffering.
Investing in NEHS is not just a bureaucratic necessity; it is a commitment to safeguarding lives and fostering resilience in communities across the nation. With the ever-present threat of natural disasters looming, ensuring that Pakistan is prepared is not just prudent—it’s imperative. As we reflect on our history, we must advocate for a future where our emergency health services stand strong, equipped to meet any challenge that comes our way. The time to act is now; the lives of countless individuals depend on it.
A legal requirement has left the matter at no where. Neither this side nor that side. Decision of the merger of NEHS with NIH was taken 8-9 months back duly approved by the cabinet under Rightsizing program. Till now this decision has not been materialised due to legal issues (NEHS staff is civil servant whereas NIH is a semi govt organisation and merger of civil servant with autonomous body is not possible without changes in the ACT or law) The case of merger is pending with M/o Law.
Last but not the least , one can see in current situation in the country, unprecedented rain, without any technical dedicated forum or org how can such disasters be managed by the govt.
