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 2008. In 2006, an estimated 291,743 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 (directly observed treatment, short
course) 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 in
2002 to 50 percent in 2006, but this is still below the WHO target of 70 percent.
Between 2002 and 2006, DOTS coverage increased in Pakistan from 44 percent to 100
percent. The proportion of patients defaulting has decreased steadily over the past
eight years. The DOTS treatment success rate has improved from 75 percent to 83
percent between the 2003 and 2005 cohort. The steep rise in case detection and the
number of TB cases reported each year since 2000 represent increased 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 3.4 percent in 2005.
Pakistan accounts for 60 percent of the MDR-TB burden within the 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 $1.0 million in fiscal year (FY) 2007 and $3.89 million in
FY 08. 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 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 public sector
for MDR-TB patients
- Preventing the spread of MDR-TB through increased diagnostic capacities and increased treatment completion rates
- Providing technical assistance 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 to Fight AIDS, Tuberculosis and Malaria for 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 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 technical assistance 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
 |
Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2008. |
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.
February 2009
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