Health Security Governance Initiatives in North and South Waziristan Districts in Post 25th Amendment: An Appraisal

Abstract

The 25th Constitutional Amendment of 2018 changed the constitutional, political and administrative position of the formerly Federally Administered Tribal Areas (FATA) of Pakistan and merged it with Khyber Pakhtunkhwa (KPK). The merger was an important effort to integrate historically separate, and conflict-prone region into a constitutional and administrative system of Pakistan. One of the sectors that underwent this transformation was the health sector which institutional integration paved way to widen healthcare accessibility, rejuvenate infrastructure, enhance human-resource capacity, enhance disease surveillance and increase emergency preparedness. North and South Waziristan are especially significant in investigating these developments since a long history of conflict, physical isolation, displacement, insecurity, and a poor infrastructure and health supply shortage have been limiting the provision of healthcare in the past. This paper will analyze and evaluate the health-security governance programs in post-25th Amendment North and South Waziristan. It follows a qualitative approach to research with secondary materials, such as official government documents, provincial health-sector records, peer-reviewed literature etc. Through the analysis of the post-merger governance, it is revealed that such important developments involving the integration of the district health administration into the provincial system, rehabilitation and upgrading of the health facilities, sustained immunization and disease-surveillance, increased emergency response and increased involvement of non-state actors. These developments are, however, limited by the infrastructure gaps, national shortages and inequitable distribution of health workers, scarce and uneven number of women working in the frontlines, rugged terrain, insecurity, poor routine immunization efforts and information systems, poor community resistance.