Continuation and response to Govt led COVID-19 strategy in the shape of scaling up  government efforts to strengthen IPC measures, essential health services, including MNCH,  psychosocial support, vaccination and disease surveillance in the high-risk District of Peshawar - KP Pakistan is struggling to contain a 4th wave of delta coronavirus infections, reporting close to 3,752 active cases in the last 24 hours, the highest number of daily infections in nine months during the third wave, The rate of people testing positive for COVID-19 had alarmingly to more than 10% from a low of about 3% a couple weeks ago, suggesting the actual number of infections is likely much higher than the reported cases. The overall number of infections and deaths from COVID-19, In Khyber Pakhtunkhwa is 4411, there have been 141495 total cases as of July 23, 2021. The active cases in district Peshawar is 963. In the last 24 hours 510 tests conducted having 72 positive cases in district Peshawar with 14.12% positivity rate. The total test conducted so far is 2271331 as of July 23, 2021 in KP. Total of 75872 vaccine doses have been administered so far in last 24 hours in all categories.
Government imposed a partial COVID-19 lockdown in March 2020 to contain the virus spread. However, the restrictions were neglected, and most people did not follow the SoPs and health guidelines. Large gatherings both religious and political resumed in July, with most people believing the pandemic was over. Moreover, winter is usually a wedding season in Pakistan, and although the government has imposed a ban on large-scale weddings, it is likely that indoor wedding events would continue to take place amid the fourth pandemic wave.
Inadequate health facilities/personnel and low testing capacity is also a big challenge to the Government health services delivery and hospitals are unable to deal with the burden. "Hospitals are already short of beds, Medical and paramedical staff are also getting infected by COVID-19 and no substitute is available to fill the gap. The capacity of health services delivery is slowly decreasing with the COVID-19 patient’s flow. The situation is getting worse day by day due to increase in new cases and deaths statistics due to the delta variant virus in different parts of KP, the situation may remain the same for coming some months and another lock down may be impose in the country due to the 4th wave. Furthermore, vaccination is also a big challenge for health department due to multiple rumors and false concept regarding the vaccine, a smaller number of RRT teams, community engagement and support in vaccination is extensively needed to control widespread of the deadly C-19 virus. 
Keeping in view the above situation as per the government and WHO reports, the corona cases are abruptly increased during the 4th wave of the COVID-19 and it is expected that the fourth wave will be more severe if not complement Govt. response on time, the repercussion will be more dangerous and fatal. 
EHSAR had already implemented a COVID-19 project in district Peshawar and Swat with financial support from PHPF during the first and second wave and provided immediate support to government and affected community through essential health services and screening activities. Keeping in view the consistent spread and high ratio of confirmed COVID-19 cases need urgent support to the DoH, District Administration in the most affected district of Peshawar K.P.
Following identified need and gaps through EHSAR need assessment and district Peshawar govt. health department coordination were analyzed, which needs immediate support in COVID-19 fourth wave of the Pandemic.
Gaps Identified: 
1. Tools, Supplies and deployment of 4 number of One Stop PHC COVID-19 Centres
2. Additional infection prevention and control 
3. Community engagement and awareness
4. Community-based delivery of essential health services including MNCH services
5. Strengthen the COVID-19 response in the community
6. Mobile vaccination in the rural areas especially COVID-19 stricken places
7. Provision of Psychosocial and Referral Support