Ntp

1. 1
National TB Control Programme
Pakistan
stop
TB
Pakistan

2. 2
Islamic Republic of Pakistan
Population:140 million
1/3rd below poverty line
6th highest TB burden
TB Incidence: 177/100,000

3. 3
TB Situation in Pakistan
• Major public health problem
• Harbors 43% of disease burden in EMR/WHO
• 250,000 new cases every year
• 75% of patients between the age group of 15 – 59
years
• Social stigma

4. 4
TB Control Programme:
Historic Review
1960s Program launched
1980s Dormant programme
1995 DOTS strategy adopted
1996 TB Directorate abolished
1998 TB integrated with PHC – Roles and
responsibilities redefined
2000 NTP revived to operationalize DOTS
strategy in the country
2001 National Emergency - Islamabad declaration

5. 5
NTP OBJECTIVES
National policy, strategic and operational
guidelines
District capacity building for DOTS
Training, supervision and monitoring
Advocacy and community mobilization
Quality assured microscopy network

6. 6
NTP OBJECTIVES
Partnership building:
International technical and financial partners
Inter-sectoral and intra-sectoral collaboration
Public-private partnership for enhanced case
detection and treatment outcomes.
Operational Research  program decisions

7. 7
2000 2001 2002 2003
Total population (Thousands) 141,256 142,435 145,385 151,677
Population covered by DOTS 12,713 38,139 50,544 95,478
DOTS population coverage % 9% 26% 35% 63%
Estimated Cases of Pulmonary TB 110,180 113,077 111,881 116,791
Cases notified in DOTS areas 11,050 19473 38337 68,715
Cases notified in DOTS areas 3285 6441 12,621 19,894
Treatment success rate under 75 76 72**
DOTS Case detection rate for new 3 6 11 17
* Estimated Cases of Tuberculosis All types : 171/100,000 popn.
** till Q4 2002
Pulmonary Smear +ve : 77/100,000 popn.
(all Cases)
(Smear Positive)
DOTS ( % )
smear positive ( % )
DOTS STATUS PAKISTAN 2000 till 2003
Year
(Thousands)
Smear positive *

8. 8
TB Situation :Case Notification
DOTS Areas
Case Types Notified 2003
Relapses
2% NSS+
29%
EPTB
17%
NSS-
48%
Others
4%
NSS+
NSS-
EPTB
Others
Relapses
68715 cases

9. 9
DOTS SITUATION
0%
10%
20%
30%
40%
50%
60%
70%
80%
2000 2001 2002 2003
DOTS Coverage
All Types
CDR %
Treatment
Success

10. 10
Achievements
•PARTNERSHIP DEVELOPMENT
•IACC
•Drugs received from GDF (153,100 patients)
•GFATM (BCC and NGO Support)
•Provincial Referral Laboratories Strengthened
•Additional BCC Funding – GoP.
•Additional Support for Developing Public & Private Partnerships (DFID,WB)
•FIDELIS (Intersectoral Collaboration, Tertiary Care Hospital, NGO Support )
•District Capacity Building for DOTS (USAID/WHO)
•CIDA –reaching poorest of poor( Through LHWs )
• STOP- TB PAKISTAN

11. 11
Future plans
Strengthen Smear Microscopy Q/A system.
Resource gaps in Public-Sector DOTS expansion
Build district capacity to consolidate and sustain
quality DOTS
Strengthen Drug Management / QC
Cont…..

12. 12
Enhance case detection & Treatment Outcome by:

Strengthening community mobilization

Involving NGOs & private practitioners

Involving Tertiary Care Level Hospitals in
DOTS

Promoting sector-wide approach in DOTS
(Social Security, Police, WAPDA, Railways etc)

DOTS in migratory populations (Nomads,
Afghan refugees)

13. 13
Challenge
Adequately equipped Public Health
Sector
DOTS In place
BUT
CDR and Treatment out come not
achieved

14. 14
Response
There is need for broader and
more intensified collaboration
involving other sectors and
partners

15. 15
ISAC
Involvement of District Government
local opinion/community leader
Infra structure available (devolution)
>100,000 councillors
To mobilise local political support.
To enhance public and political perception of TB
and DOTS.
To increase TB awareness throughout Pakistan
Proposal Submitted to mobilize communities .

16. 16
stop
TB
Pakistan
Striving for TB free future
National TB Control Programme, Pakistan