The pandemic has pushed more than half a billion people into extreme poverty in the world and the situation could not be different in Pakistan, though credible figures are not available. As a new variant of the pandemic has surfaced, the situation may worsen. It needs urgent measures not only to fight the health scare but also save more people from falling under the poverty line.

Pakistan is among a few countries which tackled the coronavirus pandemic successfully – a strategy appreciated by global leaders, including philanthropist Bill Gates. A relief package of Rs1,240 billion was announced, including cash transfer, to support vulnerable communities. The timely decisions by the government helped mitigate huge losses. To mitigate the suffering of the vulnerable segments of society during the pandemic, the government launched the Ehsaas programme, the country’s biggest ever social safety net, under which Rs145 billion were distributed among 12 million daily wagers. The programme has been enhanced to reach 16 million people.

The government did not impose a complete lockdown to the save the vulnerable segment from its serious effects. Still, according to the government’s own estimate, at least 10 million more people slipped below the poverty line as a consequence of the pandemic. In a report, the Asian Development Bank (ADB) said that between 1.5 million and 2.3 million young Pakistanis had lost jobs during the pandemic. According to the ADB, the pandemic has pushed an estimated 75 million to 80 million more people in developing Asia into extreme poverty as of last year, compared with what would have happened without the pandemic. Assuming that the pandemic has increased inequality, the relative rise in extreme poverty, defined as living on less than $1.90 a day, may be even greater. Progress has also stalled in areas such as hunger, health, and education, where earlier achievements across the region had been significant, albeit uneven. According to the report, about 203 million people or 5.2pc of developing Asia’s population lived in extreme poverty as of 2017. Without the pandemic, that number would have declined to an estimated 2.6 percent in 2020.

The World Bank fears poverty is expected to increase for the first time in two decades in Pakistan. “The pandemic is also expected to exacerbate Pakistan’s human capital challenges,” it noted in a report. According to new evidence compiled by the World Health Organization and the World Bank, the COVID-19 pandemic is likely to halt two decades of global progress towards Universal Health Coverage. The organisations also reveal that already before the pandemic more than half a billion people were pushed or further pushed into extreme poverty because they have to pay for health services out of their own pockets, and that the pandemic is likely to make the situation worse.

The findings are contained in two complementary reports, launched on Universal Health Coverage Day, highlighting the devastating impact of COVID-19 on people’s ability to obtain health care and pay for it. In 2020, the pandemic disrupted health services and stretched countries’ health systems beyond their limits as they struggled to deal with the impact of COVID-19. As a result, for example, immunization coverage dropped for the first time in ten years, and deaths from TB and malaria increased. The pandemic also triggered the worst economic crisis since the 1930s, making it increasingly difficult for people to pay for care. Even before the pandemic, half a billion people were being pushed (or pushed still further) into extreme poverty because of payments they made for health care. The organisations expect that that number is now considerably higher.

“There is no time to spare,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “All governments must immediately resume and accelerate efforts to ensure every one of their citizens can access health services without fear of the financial consequences. This means strengthening public spending on health and social support, and increasing their focus on primary health care systems that can provide essential care close to home.” He added: “Prior to the pandemic, many countries had made progress. But it was not robust enough. This time we must build health systems that are strong enough to withstand shocks, such as the next pandemic and stay on course towards universal health coverage.”

The new WHO/World Bank reports also warn that financial hardship is likely to become more intense as poverty grows, incomes fall, and governments face tighter fiscal constraints. “Even before the COVID-19 pandemic struck, almost 1 billion people were spending more than 10 per cent of their household budget on health,” said Juan Pablo Uribe, Global Director for Health, Nutrition and Population, World Bank. “This is not acceptable, especially since the poorest people are hit hardest. Within a constrained fiscal space, governments will have to make tough choices to protect and increase health budgets,” he added.

In the first two decades of this century, many governments had made progress on service coverage. In 2019, prior to the pandemic, 68 per cent of the world’s population was covered by essential health services, such as pre-and post-natal care and reproductive health services; immunization services; treatment for diseases like HIV, TB and malaria; and services to diagnose and treat noncommunicable diseases like cancer, heart conditions, and diabetes. But they had not made such advances in ensuring affordability. As a result, the poorest groups and those living in rural areas are the least able to obtain health services, and the least likely to be able to cope with the consequences of paying for them. Up to 90 percent of all households incurring impoverishing out-of-pocket health spending are already at or below the poverty line – underscoring the need to exempt poor people from out-of-pocket health spending, backing such measures with health financing policies that enable good intentions to be realized in practice.

Besides the prioritizing of services for poor and vulnerable populations, supported through targeted public spending and policies that protect individuals from financial hardship, it will also be crucial to improve the collection, timeliness and disaggregation of data on access, service coverage, out-of-pocket health spending and total expenditure. Only when countries have an accurate picture of the way that their health system is performing, can they effectively target action to improve the way it meets the needs of all people.

The two reports offer both a warning and guideposts to all countries as they strive to build back better from COVID-19 and keep their populations safe, healthy, and financially secure.