Bill on mandatory notification of TB cases to be tabled soon

Islamabad: The government is all set to table a bill on mandatory notification of Tuberculosis (TB) cases across Pakistan.
The measure will make it binding for all health institutions in the public and private sectors, as well as all registered medical and traditional practitioners, to notify a confirmed or suspected case of TB in accordance with established procedures.
“The bill will soon be passed,” stated the manager of the National TB Control Programme (NTP) Dr. Ejaz Qadeer, while addressing participants of an annual stakeholder seminar organised in connection with World TB Day here on Wednesday. Minister of State for Health Saira Afzal Tarar was the chief guest on the occasion. She was flanked on the head table by Dr. Kutbuddin Kakar from the World Health Organization (WHO).
Speaking on the occasion, Saira said public education about the symptoms of TB, and enhanced awareness about the availability of free treatment can help prevent the deepening epidemic of TB. She urged patients to follow the complete course of medication for the prescribed period so as not to compromise their immunity, and generally called upon the public to shun their lackadaisical attitude towards health. She invited the corporate sector and philanthropists to help mount a comprehensive public-private response to TB.
Saira recollected the times when TB was considered a death sentence. Even though it still carries social stigma, which is a major obstacle to treatment, many lives can be saved by raising awareness about the disease. She strongly recommended the involvement of LHWs to spread the word about availability of free treatment for TB across the country.
Pakistan may have made notable strides in its fight against TB but the mere fact that an estimated 1.5 to 2 million cases continue to be missed, with patients silently suffering without access to free diagnostic and treatment facilities, is one of NTP’s major challenges. Pakistan globally ranks 4th among high-burden TB countries, preceded only by India, China and Nigeria.
“An estimated 0.5 million people in Pakistan develop TB every year. Of these, 3.7% will develop Multi-Drug Resistant (MDR) TB, with 18.1% being retreatment cases,” Dr. Ejaz informed. Pakistan’s target is to reduce by 50%, the prevalence of TB in the general population by 2025 in comparison to 2012, “and this requires a decline in TB incidence at the rate of 10% per year,” he stated. At present, China is the only country where TB incidence is declining at the rate of 6%, largely due to a combination of positive factors including rapid development and improved health services, among others.
Dr. Ejaz emphasised that alongside the provision of free drugs and diagnostic facilities, Pakistan will have to involve other stakeholders such as the ministries of education, housing, and agriculture for a befitting response to the TB epidemic. He was happy to inform that new technologies such as gene Xpert-a rapid diagnostic test-has been introduced, and that 30,000 patients have had the test. “This technology will soon be introduced in all district hospitals across Pakistan. Sixty machines have already been procured,” Dr. Ejaz stated. He also shared that 1,396 microscopy centres in the public and private sectors are currently functional, and that a network of 30 TB Culture and Drug Sensitivity Laboratories is being established. “These laboratories will be functioning in the next couple of months,” he added.
Dr. Ejaz emphasised that since free diagnosis and treatment of TB is available in over 5,000 health facilities across Pakistan, no patient seeking services should remain deprived in any way. He also shared details about the 30 designated sites for treatment of MDR TB. “Pakistan has a treatment success rate of 75% for MDR TB,” he said. Outlining the strategic vision of NTP, he said, zero TB deaths by 2025 is our goal. He said, while TB mortality has declined by 50%, there is a need to accelerate the decline in prevalence.
NTP has successfully negotiated US $133 million support from the Global Fund for the next three years (2015-1017). This may be great news, but it is time Pakistan shed its reliance on donor funding and assumed ownership of all health programmes, including TB.
The participants of the seminar were also apprised of the way forward. In this context, the aims include provision of free TB diagnosis and treatment to 1.5 million TB cases; increasing TB case notification from 61% in (2013-14) to 80% (2017-18) of total estimated TB cases; diagnosis and treatment of 15,000 MDR-TB cases; increasing MDR-TB case notification from 18% (2013-14) to 32% (2017-18) of estimated TB cases; screening of more than 110,000 TB cases for HIV infection; increasing TB/HIV screening from 3% (2013-14) to 10% (2017-18)’ and establishment of 12 hi-tech bio-safety level- II and III labs as per national requirement, increasing from 10 (2013-14) to 22 (2014-15). Moreover, the TB case e-surveillance system will be scaled up from 114 districts (2013-14) to all 142 districts (2014-15) to provide 100% coverage for monitoring of all TB patients.
Earlier on, Dr. Kutbuddin Kakar from WHO read out the message of the WHO regional direction for Eastern Mediterranean Region Dr. Ala Alwan. Powerful messages highlighting the need for uninterrupted treatment were disseminated by 7 year-old Aleeza and Majid, both of them TB patients now enjoying the fruits of complete recovery. Unlike events of the past, this year’s seminar was short and crisp, and ended on a high note.