Functional readiness as the linchpin of integrated tuberculosis and comorbidity care in Pakistan: a health-system and ethical imperative

In Pakistan, for the effective management of tuberculosis and its comorbidities, functional readiness at the point of service delivery, including the preparedness of health facilities in terms of infrastructure, human resources, screening and diagnostics, coordination mechanisms, and culturally sensitive service delivery, is of utmost importance. Despite having a nascent TB services infrastructure, Pakistan's health system faces persistent challenges, such as inadequate diagnostic capacity at basic health units, logistical obstacles in patient referrals, workforce shortages, and sociocultural barriers that impede timely and effective TB comorbidity management. These challenges are exacerbated across all care levels, from primary to tertiary hospitals, and thus restrict the extent and effectiveness of integrated interventions. In this viewpoint, we discuss these barriers in detail and propose that comprehensive health system strengthening to enhance functional readiness and ultimately improve clinical outcomes for patients with TB with comorbid conditions.