Today marks a milestone in #Pakistan that hasn't attracted much attention-the 10-year anniversary of the 18th constitutional amendment.
It devolved power & resources from the center to the provinces.
It's had major and lasting political impacts, including for the COVID response.

What was initially encouraging about the 18th amendment was its democratizing potential-the opportunity to empower governments and communities, including minorities and other marginalized demographics, often given short shrift by central authorities. And yet there was a problem.

The devolution set in motion by the 18th amendment doesn't go far enough-it doesn't extend to sub-provincial levels, where service delivery is a key function. @MadihaAfzal wrote an excellent essay on this dynamic in this volume I edited several years ago: https://www.wilsoncenter.org/sites/default/files/media/documents/publication/2018-06-pakistansinstitutions.pdf

Health was a key sector devolved to the provinces, resulting in the elimination of the fed health ministry. Health is now a provincial issue. But health policy still must be coordinated w/ the center (a new fed health svcs regs ministry emerged in '12 & focuses on coordination).

Accordingly, one of the persistent questions about Pakistan's response to COVID so far has been the level and efficacy of coordination between the provinces-which thanks in great part to the 18th amendment are overseeing their own responses-and the Imran Khan government.