Pakistan
Pakistan ranks eighth on the list of 22 high-burden tuberculosis (TB) countries in the
world, according to the World Health Organization’s (WHO’s) Global Tuberculosis
Control 2009. In 2007, an estimated 297,108 people in Pakistan (primarily adults in their
productive years) developed TB. The emergence of multidrug-resistant (MDR) TB and
TB-HIV co-infection is a growing concern in the country.
The Ministry of Health began implementing DOTS (the internationally recommended
strategy for TB control) in 1995, with Balochistan selected as a pilot province. Much
progress has been made over the past five years. The case detection rate for Pakistan
rose from 13 percent in 2002 to 67 percent in 2007, close to WHO’s target of 70
percent. Between 2002 and 2007, DOTS coverage increased in Pakistan from 44 to 99
percent. The proportion of patients defaulting has decreased steadily over the past six
years, from 17 percent in 2000 to 6 percent in 2006. The DOTS treatment success
rate has improved from 79 to 88 percent between the 2003 and the 2006 cohort, thus
surpassing WHO’s target of 85 percent. The steep rise in case detection and the
number of TB cases reported each year since 2000 is the result of nationwide efforts
to increase involvement of private practitioners and community volunteers in
identifying and referring TB suspects, as well as the general public who have helped
with case finding. Since 2001, when the government declared TB a national emergency,
progress has been steady, with support from USAID and the Global Fund to Fight
AIDS, Tuberculosis and Malaria.
Despite improvements, the National TB Control Program (NTCP) still faces challenges.
As TB planning shifts from the national to the district level, technical and managerial
capacities at the provincial and district levels require strengthening. Moreover, the
private sector may not be fully oriented to caring for patients using the DOTS
approach. New MDR-TB cases rose from 2.0 percent in 2003 to 3.2 percent in 2007.
Pakistan accounts for 57 percent of the MDR-TB burden within WHO’s Eastern
Mediterranean Region. Extensively drug-resistant TB has not been reported in the
country. Pakistan has improved quality assurance of microscopy laboratories and is
establishing a National Reference Laboratory, steps that are critical to successful
implementation of a MDR-TB treatment program.
USAID Approach and Key Activities
USAID funding for Pakistan was $3.8 million in fiscal year 2008. USAID assistance, in
collaboration with the NTCP and WHO, focuses on DOTS expansion. This support is
aimed at strengthening TB control capacity at the provincial and district levels. USAID
activities include the following:
- Strengthening supervision and coordination at the provincial and district levels
through National Program Officers
- Supporting a national TB prevalence survey to provide more concise
estimates of the TB burden in Pakistan and to improve planning for TB
control and prevention
- Providing technical assistance (TA) for strengthening DOTS expansion at the
federal level
- Supporting supervision and surveillance at the district and provincial levels and
improving laboratory capacity
- Conducting advocacy, communication, and social mobilization activities under
the direction of sociologists and public-private partners
- Establishing referral links between the large private sector and the public
sector for MDR-TB patients
- Preventing the spread of MDR-TB through increased diagnostic capacities and increased treatment completion rates
- Providing TA to the NTCP to develop and disseminate MDR-TB care and management guidelines for prevention and
management of MDR-TB at all levels of health care delivery
- Supporting public-private mix activities through nongovernmental organizations in five cities: Lahore, Faisalabad,
Khanewal, Rawalpindi, and Karachi
- Supporting the application for a Round 9 grant from the Global Fund or a regional approach to cross-border activities
for TB patients
USAID Program Achievements
USAID’s assistance and the support of other partners of the NTCP have contributed to the following improvements in TB control
in Pakistan:
- Improved management, supervision, and financial administration of the NTCP through support to 20 National Program Officers
- Trained technical staff who deliver diagnostic and treatment services
- Improved skills of district-level managers who supervise and monitor the quality of diagnosis, treatment, and reporting
accuracy at the facility level
- Provided TA to the NTCP, which is responsible for overall TB control activities in Pakistan, including policy formulation
and strategic planning; technical and material support to Pakistan’s provinces; supervision and monitoring and evaluation
support; coordination with national and international partners; research; and support to the National Reference Laboratory
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
Partnerships
Partnerships have played a critical role in TB control efforts in Pakistan. Increasing numbers of national public and private
partners have worked together for TB control. USAID and the International Union Against Tuberculosis and Lung Disease are
the lead collaborators with the Government of Pakistan. Other international collaborators supporting DOTS expansion include
the Canadian International Development Agency, the U.K. Department for International Development, the German Leprosy and
Tuberculosis Relief Association, the World Bank, the Japan International Cooperation Agency, and the GTZ. The Global TB Drug
Facility coordinates the provision of drugs. The Global Fund awarded Pakistan a Round 2 grant for approximately $4 million in
2003, a Round 3 grant for $9.9 million in 2004, a Round 6 grant for $22.6 million in 2007, and a Round 8 grant for $9.8 million in
2008 for TB control.
May 2009
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