1. stop
TB
Pakistan
National TB Control Programme
Pakistan
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2. Islamic Republic of Pakistan
 Population:140 million
 1/3rd below poverty line
 6th highest TB burden
 TB Incidence: 177/100,000
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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
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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
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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
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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
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7. DOTS STATUS PAKISTAN 2000 till 2003
Year 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
(Thousands)
DOTS population coverage % 9% 26% 35% 63%
Estimated Cases of Pulmonary TB 110,180 113,077 111,881 116,791
Smear positive *
Cases notified in DOTS areas 11,050 19473 38337 68,715
(all Cases)
Cases notified in DOTS areas 3285 6441 12,621 19,894
(Smear Positive)
Treatment success rate under 75 76 72**
DOTS ( % )
DOTS Case detection rate for new 3 6 11 17
smear positive ( % )
* Estimated Cases of Tuberculosis All types : 171/100,000 popn.
** till Q4 2002
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Pulmonary Smear +ve : 77/100,000 popn.

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

9. DOTS SITUATION
80%
70%
60%
50%
DOTS Coverage
40%
All Types
30%
CDR %
20%
Treatm ent
Success
10%
0%
2000 2001 2002 2003
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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
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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…..
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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)
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13. Challenge
 Adequately equipped Public Health
Sector
 DOTS In place
BUT
CDR and Treatment out come not
achieved
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14. Response
There is need for broader and
more intensified collaboration
involving other sectors and
partners
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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 .
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16. Striving for TB free future
stop
TB
Pakistan
National TB Control Programme, Pakistan
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