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Stop Tuberculosis

Pakistan ranks sixth amongst the high TB burden countries of the world and contributes to a total of 43% of the Eastern Mediterranean Region TB burden. Every year about 250,000 new TB cases are added to the pool of TB patients. Tuberculosis is one of the leading health hazards that the population of Pakistan is facing. 

The estimated incidence rate of all TB cases is 181 per 100,000 and the sputum positive incidence is 82 per 100,000 population. The estimated number of new TB cases occurring every year in the country is 300,000. In 1993, the WHO declared TB a Global Emergency and introduced the DOTS strategy for the effective treatment of TB. 

Given the importance of TB in the community, the Ministry of Health has prioritized TB control and started DOTS implementation in 1995 and 100% coverage within the public health network (DOTS ALL OVER) was achieved in May 2005. In 1999, a total of 2,269 smear positive new cases were detected in 1999 in DOTS areas, and 75% of them were successfully treated. 

At the end of the year 2000, 14% of the total population had access to DOTS. In 2006, 179,067 cases of TB were notified in DOTS areas, of which 44% were pulmonary smear positive cases and 86% of them were successfully treated. 

Activities and Outputs

Support to enhance quality DOTS: After achievement of DOTS ALL OVER in Pakistan, WHO continues to assist MoH in collaboration with other partners (USAIDS, CIDA, DFID, GFATM and other national partners) to achieve the global targets, i.e. 85% treatment success rate and 70% case detection rate (CDR). Monitoring and supervision, surveillance system and capacity building at province and district level was done mainly through WHO/USAID umbrella grant for TB control programme, and CIDA supported lady health workers (LHWs) involvement to DOTS services and expansion of the external quality assurance (EQA) to strengthen lab network. One international medical officer is recruited at federal level and national staff at federal and provincial levels.

• To support monitoring and supervision

• To strengthen surveillance system from peripheral to National level

• To enhance capacity building at provincial and district level

• Strengthening national and international partnerships

• Expansion of EQA of lab network with additional support to provincial and district labs

• To enhance integration with the LHWs programme

• Development of health education materials

• To conduct operational researches

• Support to rehabilitate TB services in conflict-affected areas

• Programme review missions by all partners

Enhancement of partnerships

• WHO is assisting NTP in enhancing partnerships for TB control

• Involvement of tertiary care hospitals and enhancement of PPM activities results in prominent increase of case notification through increasing the access to DOTS services of the people.

Achievements of the DOTS Program

• Treatment success rate reached 86%

• Case detection rate for new sputum smear positive cases has increased to 69%

• Enhanced partnership for TB control.

Technical Documents Produced

• Guidelines for planning and implementing DOTS in a district

• Case Management Desk-guide for care providers

• Health worker’s Manual for tuberculosis control in Pakistan

• Category-specific training packages for; i) doctors, ii) paramedics, iii) laboratory

• Technicians, and iv) community health workers

• Referral Guidelines for difficult/complicated adult TB cases

• Guidelines for diagnosis and management of TB in Children

• LHWs training modules

• Module for supervision and monitoring

• National guideline for Quality Assurance of Sputum Smear Microscopy for TB DOTS

• Programme in Pakistan developed

• Laboratory manual (JICA/WHO)

• Basic lab training module revised, session on QA include in 2nd edition (JICA/WHO)

• National guidelines for diagnosis and management of TB in children

• Guidelines for the management of difficult to diagnose and complicated TB cases