Pakistan makes headway in TB care: 10 day joint monitoring mission to the country to help achieve the 2020 TB vision

06 June 2015 - Pakistan - The Government of Pakistan, along with the Stop TB Partnership, WHO and other technical and donor partners recently concluded a ten-day joint monitoring mission to review Pakistan’s National TB Control Programme.

The team headed by Dr Mohamed Abdel Aziz, WHO's Regional Adviser for TB, visited four provinces and assessed the achievements, challenges and opportunities of the TB programme in Pakistan. For the first time in ten years, the review mission visited the provinces of Balochistan and Khyber Pakhtunkhwa – the team’s first visit to these provinces post-devolution, giving the team members an insight into provincial TB programmes.

The team focused its efforts on reviewing Pakistan’s progress in the implementation of the National Strategic Plan including following up on the recommendations of the last mission held in November 2013. The monitoring team also reviewed the country’s progress towards improving access to TB care, challenges and plans for TB efforts and advising the government and partners on the path towards strategies in line with the set targets. The structure and function of disease control within the framework of health services in country was also examined, along with identifying opportunities for health systems strengthening and recommending priority areas of investment.

The mission recognized the substantial progress made by the Pakistan TB programme, the great political commitment of the government and the hard work of the National TB Programme teams at both federal and provincial levels. The mission suggested that the provision of TB at the primary healthcare level should be strengthened by building upon the services provided through the Basic Health Units and Rural Health Centres. The review mission stressed the need for continued engagement of the extensive network of private providers by leveraging and expanding on the private sector engagement initiatives. TB REACH led into supporting many grantees to evaluate strategies to do this, including the innovative approaches of Interactive Research & Development (IRD) who have set up social enterprise models to screen for TB in the private sector and subsidize testing. Other recommendations focussed on mobilizing domestic resources at both national and provincial levels, increasing political commitment at provincial and district levels, improving TB diagnosis in children, and increasing case finding through more effective involvement of lady health workers.

Three civil society and community representatives participated in the mission to assess the engagement of civil society organizations, TB affected community and the rights and gender issues affecting the TB programme. These members met with various NGOs and civil society organizations including the National Stop TB Partnership. They suggested strengthening the role of community health workers in the TB programme and appreciated the efforts of the national Stop TB Partnership to engage parliamentarians of the Sindh provincial assembly in the fight against TB. They also recommended expanding this to other provinces.

"Pakistan’s National TB Programme has successfully set up testing (with Xpert) and treatment sites around the country, rapidly increasing the number of drug-resistant TB patients started on treatment, and with high treatment success. However MDR-TB is already relatively common and may have pre-XDR, with strains resistant also to the MDR drug Ofloxacin which makes it difficult to treat," said Mr Einar Heldal from the KNCV Tuberculosis Foundation following a review of the Programmatic Management of Drug-Resistant TB sites.

"It is very promising that the National TB Programme has strengthened its collaboration with the private sector. Laws on mandatory notification and stopping over-the-counter sale of TB drugs are in process which should reduce practices in the private sector which may lead to drug-resistant TB," he added.

During the mission, drug management experts from the Stop TB Partnership’s Global Drug Facility (GDF) worked with the National TB Programme to further strengthen the support that GDF can provide to Pakistan’s TB programme. For GDF colleagues, the joint mission underlined the importance for the National TB Programme to ensure that locally produced anti-TB medicines in the country are in line with international standards with regards to quality. The existence of an agency in the country that can obtain WHO accreditation as a quality control laboratory to perform bioequivalence testing could also ease the process of getting more local medicines pre-qualified by WHO.