Pakistan ranks 5th among high burden TB countries in the world. An estimated 50,000 new TB cases occur in Khyber Pakhtunkhwa every year. The Government of Khyber Pakhtunkhwa has pledged to achieve the objectives set out in the Global Plan to Stop TB. For this purpose, the Government has allocated adequate resources to provide good quality sputum diagnostics and curative services to more than 22 million inhabitants of the province.
The Government of Khyber Pakhtunkhwa has established Provincial TB Control Program in 2002 with a mission to make the province free of TB. The programme’s goal is to reduce TB prevalence and death rates to 50% by 2015 relative to 1990.
The programme ensured 100% DOTS coverage in the whole province in 2005 while district Tor Ghar has recently been included after its establishment. There are 228 Basic Management Units (Diagnostic Centres) and 810 functional treatment centres all over the province. Among them, 37 BMUs are effectively working in non-public sector. In 2012, TB Control Programme Khyber Pakhtunkhwa was able to register and treat 35848 patients. Sputum conversion rate for registered TB cases remained 92% and treatment success rate was 94%.
INTER-DISTRICT QUARTERLY REVIEW MEETING
Inter-District Quarterly Review Meeting is a regular feature of the Provincial TB Control Program in Khyber Pakhtunkhwa. It is an effective forum to share progress, challenges and opportunities with technical and implementing partners.
The Meetings are chaired by the highest hierarchy of the Heath Department which is indicative of the Government’s priority and ownership. Under the leadership of Provincial Secretary Health, progress indicators and programmatic issues of each district are evaluated and recommendations are closely followed up by the programme.
MULTI-DRUG RESISTANT-TB (MDR)
Multi-Drug Resistant-TB (MDR) is emerging as a major threat to the population of Khyber Pakhtunkhwa. World Health Organization (WHO) has estimated about 1500 cases of MDR-TB annually in the province. The programme’s target is to enhance the capacity of public and private sector to detect and manage 80% of the estimated smear positive MDR-TB incident cases by 2015. The Government of Khyber Pakhtunkhwa has established Provincial TB Reference Laboratory at Hayatabad Medical Complex that has create a new era of quality service provision to MDR-TB patients in the province.
GeneXpert machines have been installed in major tertiary care hospitals in Peshawar and Mardan and these machines will soon be provided to other districts including Swat, Lower Dir, Battagram, Abbottabad, Bannu, D.I. Khan. Programmatic management of drug resistant TB has been implemented at Lady Reading Hospital, Peshawar and it will soon be operationalized at Ayub Teaching Hospital, Abbottabad.
PROVINCIAL TB REFERENCE LABORATORY
Culture and Drug Sensitivity Testing on LJ media and MGIT have been initiated in PTRL and soon validated reports will be issued. Line Probe Assay (PCR) reporting is also in line to be more sensitive. Trainings have been conducted on AFB microscopy, LED microscopy and GeneXpert for lab technicians including technicians of PPM project. LED microscopies, reagents and consumables for diagnosis of TB are supplied to labs in district. The system of external quality assurance is implemented in all laboratories of the province. Mechanism for maintaining data of these laboratories is also being improved. Diagnostic centres are regularly visited and examined by senior laboratory supervisors.
PUBLIC PRIVATE MIX (PPM)
It has been observed that a large number of population in Pakistan including Khyber Pakhtunkhwa prefer to visit private healthcare providers for their medical needs. In order to engage private sector in the provision of quality DOTS service to TB patients, the concept of Public Private Mix was introduced to TB Control efforts. The Provincial TB Control Program launched PPM project in 2006 with support of GIZ in selected districts of the province. Private health practitioners, chest specialists and paramedical staff were trained on TB-DOTS. Free of cost provision of anti-TB drugs was initiated to TB patients seeking treatment from private health clinics. Apart from this, Government health facilities that do not fall under the administrative control of Provincial Health Department e.g. Social Security Hospital, Railway Hospital, Cantonment General Hospital, Federal Government Dispensary and WAPDA hospitals were also taken onboard and capacity of their health professionals was built to diagnose and treat TB according to the WHO/NTP guidelines.
The scope of PPM project is extended to encompass 11 district of the province with support of German Development Bank (EPOS Health MAangement) and Mercy Corp through its implementing partners i.e. ACD, Greenstar and ASD. Road mapping and situation analysis have been worked out to include four other districts with support of EPOS Health Management. The PPM initiative has produced encouraging results in term of 23% contribution to the
total Case Detection Rate (CDR) of the province.
TB DRUG MANAGEMENT
TB Drug Management is an important area of drug quantification, storage and distribution to all districts of Khyber Pakhtunkhwa. International quality drugs with proven efficacy and bio-availability have been made available for every registered TB patients without a single day of stock out in any of the treatment facility throughout the province. With support of National TB Control Program, air-conditioners, exhaust fans, essential furniture, fire extinguishers and hygro-thermometer have been provided to all drug stores in Khyber Pakhtunkhwa to ensure safe storage practices of Anti-TB drugs at district levels. Storekeepers at district levels are trained on drug management through implementing partners of the Provincial TB Control Program.
MONITORING & SUPERVISION
Provincial TB Control Program has a comprehensive system of monitoring for diagnostic and treatment centres in all districts of the province. A well qualified team of experts and advisors exist at district, regional and provincial level to monitor all activities related to TB in order to ensure its quality according to WHO/NTP guidelines.
An accurate electronic recording, reporting and data management system for TB patients of all district in Khyber Pakhtunkhwa is maintained by the program in a precise manner.
ADVOCACY, COMMUNICATION AND SOCIAL MOBILIZATION (ACSM)
ACSM is a vital component of the programme to create awareness on tuberculosis. Commemoration of World TB Day, advocacy seminars, community events, electronic and print media campaigns, development of TB documentary, story books for school children informative material on calendars and diaries, holding TB awareness weeks and media workshops at provincial and district level are various steps in this direction. The role of advocacy, communication and social mobilization was limited to 5 districts of Khyber Pakhtunkhwa till 2012 with supports of the Global Fund.
A comprehensive ACSM strategy has been worked out by the programme to increase awareness on TB in all districts of the province with EPOS Health Management’s assistance from 2013 – 2014 to address the emerging challenges. The Provincial TB Control Program commemorates World TB Day with enormous zeal to raise awareness about this disease through mass media campaigns in Khyber Pakhtunkhwa. Peshawar
city is branded with TB billboards and banners. TB awareness kits, calendars, diaries and news bulletins are developed and special talk shows on TV and radio are presented to educate masses on TB through media.
STOP TB PARTNERSHIP
The Programme conducts periodical meetings of “Stop TB Partnership” at provincial level which is an effective forum where public relationing and lobbying with partners take place for wider sharing and support of TB control efforts. The forum also plays an active role in planning TB awareness campaign for commemorating World TB Day.