The SARS-CoV-2 (COVID-19) outbreak has highlighted the need for better inter-provincial coordination and planning within Pakistan’s devolved system of Government. The devolution of certain powers to provincial governments through the 18th Amendment has had a significant impact on Pakistan’s healthcare management systems. While the provincial governments have attempted to adjust to their new responsibilities – with varying degrees of success – hurdles in coordination between the federal, provincial, and local governments obstruct their progress, as dialogue between state entities and institutions is only triggered by crises. The aim of this paper by RSIL is to shed light on the major challenges of governance, service delivery, emergency response, regulatory enforcement, and policy coordination in the field of health in Pakistan and its effect on federal and provincial responses to COVID-19. The paper then sets out a series of key recommendations in the law & policy realm which, with the necessary political will and allocation of resources, can significantly improve healthcare governance in the country and the ability of the state to combat health emergencies. While the current crisis undoubtedly poses a potentially overwhelming challenge to Pakistan’s beleaguered healthcare system and has further exposed its shortcomings, it also provides policymakers with an opportunity for bold reform and strategic planning which can not only improve healthcare but also lay the foundations for economic growth and effective governance.