Pakistan
Pakistan ranks seventh among the 22 high-burden tuberculosis countries worldwide, according to the World Health Organization (WHO) Global TB Report 2006. Every year, approximately 280,000 people in Pakistan (primarily adults in their productive years) develop TB. The emergence of multidrug-resistant TB and TB-HIV co-infection
are growing concerns in the country.
The Ministry of Health began implementing Directly Observed Therapy, Short-Course (DOTS) in 1995, with Balochistan as a pilot province. Between 2000 and 2004, DOTS coverage increased in Pakistan from 9 to 79 percent. As the DOTS program expands, the quality of treatment must also improve. Treatment success was just 75 percent in the 2003 cohort, but a high proportion of patients were not subject to follow-up. The steep rise in the number of TB cases reported each year since 2000 represents improved case registration under DOTS. Despite progress over the past five years, the case detection rate for Pakistan was estimated to be only 27 percent in 2004, well below the target of 70 percent. In 2001, the government declared TB a national emergency, which led to a TB budget increase from $1.65 million in 2001 to $26 million in 2006. In addition, the National TB Control Program (NTP) has received a $1.5 million grant from the Global TB Drug Facility.
Despite improvements, the NTP still faces challenges. As TB planning shifts from the national to the district level, technical and managerial capacity at the provincial and district levels require strengthening. Moreover, the private sector may not be oriented to caring for patients using the DOTS approach.
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| Note: All data are for 2004 except where noted otherwise. Source: Global Tuberculosis Control: WHO Report 2006. |
USAID Approach and Key Activities
USAID funding for Pakistan was $1.1 million in FY 2004 and $1 million in FY 2005. USAID assistance focuses on DOTS expansion in collaboration with the NTP and WHO. This support is aimed at strengthening TB control capacity at the provincial and district levels. USAID assistance targets the following activities and interventions:
- Strengthening supervision and coordination at the provincial and district levels through national program officers
- Providing technical assistance for strengthening DOTS expansion at the federal level
- Supporting supervision and surveillance at district and provincial levels
- Conducting advocacy, communication, and social mobilization through province-level sociologists
- Supporting public-private mix activities through nongovernmental organizations in five cities — Lahore, Faisalabad, Khanewal, Rawalpindi, and Karachi
USAID Program Achievements
USAID’s assistance and the support of other partners for the NTP have contributed to the following improvements in TB control in Pakistan:
- Attained 100 percent DOTS population coverage in May 2005 by expanding DOTS activities in the public primary health care network
- Increased the treatment success rate to 82 percent in 2005, close to the global target of 85 percent, with a doubling of detected TB cases from 73,497 in 2003 to 141,741 in 2005
- Supported the development and utilization of technical guidelines for TB control
- Supported the laboratory network and initiated external quality assurance guidelines
- Collaborated with ongoing programs, particularly the Lady Health Worker program, in sharing technical resources
Case Detection and Treatment Success Rates Under DOTS
Partnerships
USAID and the International Union Against Tuberculosis and Lung Disease are the two 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 Relief Association, the World Bank, and the Japan International Cooperation Agency. The Global TB Drug Facility coordinates the provision of drugs. Pakistan has received approximately $35 million in funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
September 2006
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