Case Study: The Establishment and Operational Resilience of the COVID-19 Ward at Abbasi Shaheed Hospital (ASH)

Abstract

The impact of the coronavirus 2019 (Coronavirus disease 2019, hereafter Covid-19) pandemic in 2020 was a severe stress-test on the health-care infrastructures in the developing world thus revealing fundamental structural frailties in urban governance. The case study explores the development and sustainability of a Covid-19 ward at Abbasi Shaheed Hospital (ASH), the third- largest state-owned hospital in Karachi, Pakistan. Located within the overcrowded District Central, ASH serves as a life-or-death safety net of millions of poor residents in various districts like Nazimabad and Orangi, as they otherwise have no access to private health-care services. The institution was at risk of being crippled due to chronic underfunding, the dysfunction of laboratory services, and massive infrastructural negligence during the pandemic. The story of how ASH transformed itself into a resource-strained municipal institution to a frontline defence is fully described in this paper with the event climaxing in the opening of a 120-bed Infectious Diseases and Research Centre (IDRC). This turnaround operation was propelled by the strategic leadership of the Metropolitan Commissioner, federal allocation resources via the National Disaster Management Authority (NDMA), and philanthropic resources. A significant accomplishment was to create the first municipal molecular testing laboratory in the country, which broke the provincial monopoly for diagnostics and offered free laboratory services to the population. Critically, the case study demonstrates the complex stakeholder scenario and the political "Cold War" between the local (KMC) and provincial (Sindh) government which hindered funding and the release of salaries, posing a threat to the stability of the workforce. Through extensive SWOT and PESTEL analyses, the research project found that while the purchase of "hardware" (ventilators, oxygen) was manageable, the "software" of healthcare (human capital, consistent financing and governance) proved to be the most volatile. The results highlight the fact that resilient disaster management requires legal reforms to ensure municipal financial autonomy, pre-established emergency protocols and the protection of human resources.