ABSTRACT
The travel and tourism industry has emerged as the engine of global economic and employment growth contributing a hefty US$8.9 trillion or 10.3% to the global GDP and supporting 310 million jobs while earning US$1.5 trillion in tourism exports. Pakistan is blessed with rich tourist attractions including diverse enticing landscape as well as archaeological, religious and cultural heritage. However, due to wars in Afghanistan spilling over into Pakistan and conflict with India as well as the government's disinterest, the tourism sector remains underdeveloped with a subpar growth. These issues are also reflected in Pakistan's dismal ranking (122nd. position) in the global competitiveness ranking. Over the last few years, the confluence of propitious developments - eradication of violent extremism, infrastructure upgradation under CPEC and Government's prioritization of the sector- has catapulted the tourism sector on a growth trajectory. Over the last 2-3 years, foreign tourism arrivals have scaled to nearly 1 million while the total contribution to GDP reached US$ 16.7 billion last year. This paper found that the right policies for tourism could earn US$ 27.5 billion for Pakistan while foreign tourist arrivals can also increase manyfold. The Federal government has taken bold initiatives to revamp the tourism sector by restructuring and empowering PTDC, constituting the National Tourism Coordination Board and introducing a comprehensive and well-designed National Tourism Strategy (NTS) to direct the revival of the tourism industry. To date, Pakistan has earned fabulous reviews and ratings by global tourism publications such as Conde's Nest, Forbes and British Backpackers Society and Pakistan finally seems to be making its mark on the global tourism radar. Sadly, the COVID-19 pandemic hit Pakistan's tourism industry like a bolt from the blue leading to the closure of multiple businesses and job losses. However, the quick containment of the virus and government's financial support has somewhat softened the pandemic's impact on the tourism industry. The partial recovery of the tourism industry can be achieved by adopting safety SOPs, focusing on sustainable tourism and encouraging domestic and youth tourism. Eventually, the tourism sector will recover to a large extent in the latter half of 2021 once vaccine is widely available. In the meanwhile, Pakistan tourism authorities seem unfazed and continue to diligently implement the National Tourism Strategy and lay down the spadework for reaping benefits of the global tourism recovery. This paper while taking note of suggestions in NTS has made recommendations that are in line with global best practices which will help complement NTS and catalyse the revival of the tourism industry. Notable suggestions include identifying priority tourism sectors and matching them with target markets, developing an umbrella marketing campaign with a tagline such as "Wonderful Pakistan", as well as improving infrastructure such as access roads, airport and transport services, accommodation, recreation and sports facilities. Regular training courses to enhance the capability of the public sector who will be agents of change is also essential. Upgradation of training institutes through foreign collaborations, syllabus modernisation, inclusion of Work-Based Learning and the induction of foreign qualified faculty will go a long way in improving human resource deficiency. A customised PPP Framework to suit the needs of the tourism sector along with a well-incentivised investment policy offering favourable predictable tax policy, easy dispute resolution, one-stop approvals and easy credit facilities. Pakistan's tourism authorities also need to establish a tourism database to record all tourist arrivals which will help in tourism management, planning and investment. The country also needs to embrace digital technology to showcase its tourism potential and attract foreign tourists. Lastly, enduring success in reviving the tourism industry will need a sustained focus and committed long-term approach f om the federal and provincial governments. © The Author(s) 2021.
ABSTRACT
Introduction/Background This pragmatic cluster randomized clinical trial (cRCT) enrolls patients with multiple chronic diseases (MCDs) who are at highest risk for destabilization (unplanned hospitalizations, increased disability). Patients with multiple chronic diseases are often excluded from clinical trials because of their multiple medical conditions and worse health outcomes, which significantly confound Results. Few evidenced- based strategies exist to comprehensively address the needs of these patients. Objective(s) Among 1920 adult patients with multiple chronic diseases defined as a Charlson Comorbidity Index (CCI) > 4, who are established primary care patients of 16 Federally Qualified Health Centers (FQHCs) in NYC (n=8) and Chicago (n=8), which serve predominantly low income, Black and Latino patients, this pragmatic cluster RCT evaluates the comparative effectiveness of two approaches to preventing significant destabilization ('tipping points') that leads to unplanned hospitalization and increased disability. Methods Federally Qualified Health Centers (FQHCs, n=16) are cluster-randomized to: 1) Patient Centered Medical Home (PCMH) (Usual Care);or 2) PCMH plus a Health Coach (PCMH + HC) intervention that employs a positive affect/ self-affirmation strategy to motivate patients to set life goals, improve self-management and handle psychosocial and other stressors (Experimental). Primary and secondary outcomes include: unplanned hospitalizations and emergency department (ED) visits aggregated by PCORnet Clinical Research Networks, Health Information Exchange (New York City), and hospital alerts (Chicago), at baseline, 6, 12, 24-months and changes in disability. With the COVID-19 pandemic, we shifted to remote recruitment, and added oral consenting, egift cards and mailed letters. Results The PCMH + HC arm is designed to identify and prevent destabilization leading to hospitalization or ED visits that are more often triggered by psychosocial issues-family, community and environmental-than by medical issues. The study is powered to detect a 33% relative reduction in% hospitalized (a 5% absolute reduction) in PCMH + HC compared to PCMH only. Additionally, we expect that reducing hospitalization will result in reduced disability. Conclusion This intervention is designed to help participants manage life events that lead to 'tipping points' or overwhelming situations that result in unplanned hospitalizations and increased disability. FQHCs with PCMH recognition focus on care coordination. Patients need assistance to deal with many social and health related challenges they face and need help in communicating with health care providers and navigating a complex health care system. The PCMH + HC intervention will determine if adding health coaches helps patients to better manage their sources of stress, improve self-care and reduce unplanned hospitalizations. The impact of COVID-19 on changes to study processes and patient outcomes will be examined.
ABSTRACT
Objectives: By the end of this presentation, participants will be able to: 1) appreciate the benefits of culturally diverse mentorship during training and early career trajectory;2) articulate how culturally informed training adds multidimensionality to a “less trodden” career pathway;and 3) reconstruct a journey of change in child and adolescent mental health development in challenging settings. Methods: The presenter will use a TED Talks format to demonstrate how early exposure to diversity and culture at the workplace, and through mentors from varied backgrounds, lays the foundation of a resilient career pathway. Using storytelling, she will validate research findings that support the case for weaving a cultural context in all aspects of pediatric mental health from education and research to service building, if the endgame is to ensure impact in low-resource settings. Results: There continues to be a shortage of child and adolescent psychiatry workforce globally;while the range varies from 47.4 practitioners to 100,000 children in Norway, to 0.004 practitioners in Pakistan, the burgeoning mental health needs of children and adolescents are largely unmet in most regions. The current COVID-19 pandemic will have not only exacerbated the situation, but also has highlighted similarities in challenges and needs, thus pushing the agenda for global mental health and shared solutions. Recent geo-socio-political events, whether concerning refugees, children separated at borders, health disparities in minorities, or acts of racism and terrorism, all mandate that the development of any program ensures diversity and the local context in their design. Diverse workforce in leadership, academia, and service delivery will ensure this context in their tripartite mission, thereby setting the right wheels in motion. Conclusions: Robust training rooted in a transcultural and diverse context allows trainees to have the tools necessary to pursue creative and distinctive career pathways, even in demanding settings. A postpandemic world may just be our opportunity to observe and emulate where culturally informed models of leading change have led to successful outcomes. AC, CAD, REST