National TB Control Program (NTP) in connection with Joint Review of TB care in Pakistan arranged a Debriefing meeting of Joint International Review Mission & Meeting of Stop TB Partnership (STP) Pakistan recently at a local hotel in Islamabad.
Pakistan would not have achieved the TB related MDG Outcome Target Indicators of Case Detection Rate of 70% and Treatment Success Rate of 85% without being cognizant of the Public Private Partnership. Since 2001, National TB Control Program gave paramount importance to role of the wide spread private sector in Pakistan. The TB program in collaboration with the private sector envisions greater coverage of high quality TB products, services and information across Pakistan, said Dr. Noor Ahmad Baloch, National Program Manager in his welcome address.
Like many other countries, Tuberculosis is a common health problem for my country men, women and children. Every year almost 300,000 new TB patients add up to existent TB cases in Pakistan. The Government is committed to control Tuberculosis by achieving MDG targets through New Stop TB Strategy. National TB Control Program (NTP) in partnership with Provincial TB Control Programs (PTP) implemented the New Stop TB Strategy and achieved 100% DOTS coverage in 2005. Through sustained commitment, Strengthening Partnership with Public and Private Sectors and introducing new initiatives, the program steadily improved case detection and treatment out come for TB patients. As part of its Human Resource Development and Health System Strengthening policy, NTP has developed a number of national guidelines and publications being used by both the public and private sector.
The overall goal of the TB control in Pakistan is to reduce morbidity, mortality and transmission of TB disease, and to prevent the emergence of multi-drug resistant (MDR) TB while integrating interventions with both public and private sectors. In response to increasing TB incidence, the Government of Pakistan declared TB a national public health emergency in 2001 (Islamabad Declaration 2001) and placed a high priority on TB control in its National Health Policy. The Government confirmed its strong commitment to TB control in the Medium Term Development Framework (MTDF) 2005-2010, the national framework used to guide national annual budget contributions necessary for achieving the country’s Millennium Development Goals. The NTP’s National Strategic Plan (2005-2010) articulates a clear “road map” for achieving the global Stop TB targets. To achieve these goals, strategic plan prioritizes eight programmatic objectives and corresponding key activities including Context-adapted staff training; Functioning laboratory network; Availability of quality drugs; Surveillance, monitoring and evaluation; Intra and inter-sectoral partnerships; Programme based research and development; Public-private partnership development; and Advocacy, Communication and Social Mobilization. Recently the program developed the brand for TB and a full media campaign will be launched near Eid, said Dr. Noor Ahmad Baloch.
The National, Provincial and Regional TB Control Programs can not control Tuberculosis alone and the National TB Control Program and Ministry of Health is cognizant to proactive engagement of the private sector in Pakistan. He further said that more than 5000 promotional boards will installed on all district health facilities including DHQ, THQ, RHC and BHUs providing TB diagnostic and treatment services in addition to general practitioners.
Prof. Masood Hameed Khan, Vice Chancellor, Dow University of Health Sciences (DUHS) as a chief guest on the occasion said that DUHS has four medical colleges and dental college. It was established about 5 years back when it had only three institutions. By the grace of God, presently we have 35 establishments.
We have recently established an Institute of Nursing in which we have produced two batches of Nursing Graduates and the third batch would be passing out later this year. We have Institute of Medical Technology where we are providing 4 year program. We have also established Physical Medical and Rehabilitation centre and an Institute of Health Management.
He further said that he heartily congratulate Dr. Noor Ahmad Baloch, National Program Manager NTP, TB Partnership and WHO for bringing up this project. As far as training program is concerned you would be happy to know that DUHS have developed a web-based training program for the management of TB which we will be submitting to our family physicians soon.
We are also in the process of developing a software through which we will be sending SMSs to the public about the awareness.
We believe in action. After six months time we will come up and we will keep you posted also. We would like to learn from the experience of those nation where they already have this partnership. I am impressed with the work of National TB Control Program. We have to work collectively. We would like to synergize for the TB epidemic. Effort by all of you will help us to achieve the goal.
For the MDR TB, Dow University of Health Sciences has embarked Rs.250 million for the establishment of MDR TB facility. We will need your input and then we will mobilize our own committee of Stop TB Partnership Pakistan.
Every six months, the National TB Control Program had its external review from the international TB experts who go in the field on the fact finding mission and present recommendation to National and Provincial TB Control Programs.
Dr. Akihiro Seita, Regional Advisor, WHO EMR while presenting recommendations of the Review Mission said that the review mission was conducted by Federal Ministry of Health, Provincial Departments of Health, GDF, GLC/WHO, Global Alliance for TB drug development, Green Star / PSI, IUATLD, KNCV, MSH, TBCAP/USAID and WHO from 8 -13 August. The mission visited field in 5 groups – 2 in Punjab, 2 in Sindh, and 1 in both provinces – and assessed TB care at health facilities of public and private sectors.
The mission appreciated good implementation of the recommendations, despite the increasing economic and security difficulties in Pakistan. However, several critical recommendations that have not yet implemented including; support to PPM partners; Drug management; Suspect management; Contact management; Control of sale of 2nd line TB drugs, and; empowerment of patients.
He further said that we analyzed the trend at the district level, the majority of the districts showed either stagnant or even declining in case notifications: 20/30 (67%) districts showed stagnation or decline in Balochistan; 12/25 (48%) in NWFP, 12/35 (34%) in Punjab, 16/23 (70%) in Sindh, 8/8 in AJK, 3/7 in FATA, 6/6 in NA. At the same time, according to the latest WHO estimates (181 per 100,000 for all forms and 82 per 100,000 for SS+), the case detection rate of Punjab, where TB notifications continue to increase, is 85% for SS+ cases and 112% for all forms.
The mission appreciated the efforts made by NTP, and TBCAP and other partners for the preparation of disease prevalence survey and drug resistance survey both are critical to determine the size of TB burden. At the same time, the mission re-emphasizes the need in conducting additional research to indirectly estimate the disease burden, she added.
The mission highly appreciated the PPM efforts made by NTP, PTP and partners. The mission witnessed innovative PPM activities in the field like Hospital DOTS Linkage (HDL) and Prison health services. The mission also appreciates NTP’s ambitious PPM plan for GFATM R9. It is evident that PPM is critical for scaling up of TB care.
The mission appreciated the fact that there has been no shortage of TB drugs in NTP. GDF-supplied drugs and provincial-procured drugs are in principle used appropriately. Operational Research conducted by NTP was highly appreciated. He further said that Pakistan’s pharmaceuticals have a good chance for the pre-qualification to bid international business.
Dr. Aziz Tank, President, Pakistan Medical Association (Centre) said that by the good guidance of Prof. Masood Hamid Khan, Dr. Noor Ahmed Baloch and their team, we will hand to hand work together and make the Stop TB Program a great success.
Dr. Islam Hamid, Chairman Health & Education Sub-Committee, Karachi Chambers of Commerce & Industry (KCCI) on the occasion said that KCCI is the main representative body of private sector. It is the premier chamber of the country and the main representative body of the industry and business community in Karachi which provide more than 60 percent revenue to the national sector. KCCI is also working for the Stop TB Program.
Dr. Noor Ahmed Baloch in his concluding remarks said that it is a forum representing all walks of life. As a program, we are ready to provide our support. I am very much sure that through the good guidance we will further improve our performance.