Effective management structure, strong internal controls and excellent quality services have earned National Tuberculosis Control Programme the accolade of an international independent watchdog.
Overseen by the Ministry of National Health Regulations, Services and Coordination in the post-devolution regime and working for the prevention and cure of tuberculosis epidemic at national level, NTCP is the principal recipient of all international tuberculosis grants, including those of Global Fund, the world’s largest sponsor of fight against TB, AIDS and malaria.
The first Global Fund grant came in during 2003 and from then on, NTCP received millions of rupees worth of financial support from the Geneva-based financing institution for timely detection and prevention of tuberculosis, strengthening of laboratory network, drug resistant tuberculosis management and public awareness.
Global Fund has an independent unit, Office of the Inspector General (OIG), to oversee, examine and evaluate the activities of the programmes funded by the institution.From September 23 to October 11, 2013, an OIG team visited Pakistan first to assess the quality of the Global Fund-sponsored NTCP activities and services and second to examine the reliability of tuberculosis-related data underlying the risk assessment of the Global Fund grants.
During the three-week stay in the country, the visitors reviewed all tuberculosis grants given by Global Fund to NTCP, Mercy Corps Pakistan and Greenstar Social Marketing Pakistan.For security reasons, the visit was restricted Punjab and Sindh provinces and Islamabad Capital Territory.And now, the findings of the OIG assessment are out. They make for very good reading for NTCP.
According to these findings, a copy of which is available with this correspondent, NTCP has demonstrated good quality of services at all levels, has shown good progress on internal controls, is well structured and present in all districts of the country and is on track towards millennium development goals target on tuberculosis and will achieve the target of treating 80 per cent multi-drug resistance cases.
Also, TB drugs are adequately available at national, provincial, district and health facilities; enough stock of TB drugs, including buffer stock, is available in the country until 2017; tuberculosis diagnosis and treatment is being provided to patients in the country according to the World Health Organisation guidelines and standards; adequate trained human resource is present for TB control at all levels of service delivery; quality of laboratory services are well maintained by implementing external quality assurance programme supervised by Supranational Reference Lab, Belgium with the collaboration of WHO.
At the same time, OIG has made recommendations to NTCP for better performance in certain areas of operations.
Among these recommendations are the further strengthening of the NTCP internal audit processes; the building of the capacity of provinces as secondary recipients of the Global Fund grants; judicious management of grants to minimise the impact of exchange rate; development of processes to cut procurement delays, especially through international vendors; the expansion and strengthening of tuberculosis drugs management information system; strict adherence to Global Fund quality assurance and quality control requirements; improvement of coordination with Drug Regulatory Authority of Pakistan in quality assurance and policy implementation; adoption of active case detection strategy to improve case detection rate, especially in high density areas, and implementation of case notification regulations in all provinces for tuberculosis care for private sector.
Also, the watchdog pushes Mercy Corps, the private sector principal recipient of Global Fund’s tuberculosis grants, for paying more attention to grant management.
When contacted, NTCP Programme Manager Dr Ejaz Qadeer expressed pleasure over the international recognition of his programme’s accomplishments and said the success had come from hard work, dedication and teamwork.
He said that he was confident that the OIG assessment would not only help enhance quality of tuberculosis management in the country but would also help secure more international grants for containing the killer infection.
Dr Ejaz Qadeer said that Global Fund began giving grants to Pakistan in 2003 for prevention, eradication and control of tuberculosis, AIDS and malaria.
According to him, NTCP with Global Fund’s financial assistance has so far implemented the DOTS (directly observed treatment, short-course) strategy of Global Fund in 22 selected districts of the country by carrying out timely detection and prevention of tuberculosis, two way referral system and behaviour change communication for awareness regarding the detection and prevention of tuberculosis; strengthened tuberculosis laboratory network, childhood tuberculosis, TB-HIV co-infection, health systems and advocacy, communication and social mobilisation; piloted drug resistant tuberculosis management, and helped the provincial tuberculosis programmes build drug management capacity.
Lately, Global Fund selected the programme as principal recipient for single stream of funding grant in which all other existing tuberculosis grants has been merged.
Dr Ejaz Qadeer said that through Global Fund support, NTCP was not only supporting tuberculosis control efforts for primary tuberculosis but also to control drug resistant tuberculosis, which was very difficult and expensive to treat.
He said that 1,500 tuberculosis laboratories were functioning throughout the country, while more than two million patients of the killer disease received free treatment over the last three years.