An estimated three-quarters of all drug-resistant cases of tuberculosis (TB) go unidentified in Pakistan, which has the world’s fifth-highest burden of TB in the world. As the world marked World TB Day on March 24 (this past Sunday) with the theme ‘Yes We Can End TB’, the battle to do so seems as far from over as it can be in the country. The date marks the day in 1882 when Dr Robert Koch announced that he had discovered the bacterium which causes TB, allowing for rapid advances towards diagnosing and curing the disease. However, as is the case with many, if not most, of Pakistan’s healthcare woes the tools to ward off this disease remain out of reach for far too many, and even when they are available poor screening and health awareness means people suffer unnecessarily. This explains to a great extent why diseases that much of the rest of the world appears to have defeated still endure in Pakistan today including hepatitis and polio.
An annual count of 608,000 TB cases, with 15,000 of them of the drug-resistant variety, is not going to disappear any time soon. The fact that the vast majority of these cases go undetected points to glaring loopholes in the existing healthcare system and is arguably the first thing health authorities must rectify to eradicate the disease. After all, one cannot fight what one cannot even see. In January, the country launched the National TB Strategic Plan 2024-26 with the aim of identifying around 528,600 TB cases per year by 2026, which comes out to around 87 per cent of the annual case count in Pakistan. This is an encouraging step forward as the polio eradication campaign has proven the efficacy of our healthcare workers once they know where the problem lies. It is hoped that the TB campaign will be able to chart a similar course as it aims to raise the number of cases treated from 424,559 in 2022 to the 528,600 benchmark by 2026.
This is an ambitious target and attaining it will require a significant expansion in healthcare accessibility. In particular, free screenings and mobile clinics that can reach the urban and rural poor might be critical. Wider screening and diagnosis can also help closer study and research of the drug-resistant varieties of TB prevalent in Pakistan, paving the way towards better treatment. Of course, none of this is possible without the requisite funds. It has been said time and again that the country spends too little on its health and is, unsurprisingly, very unhealthy for it. As per the Sustainable Development Policy Institute, current public health expenditure is around 0.05 per cent of GDP at the federal level, while experts claim that it needs to be around 6.0 per cent of GDP in total. One gets what they pay for and health is no exception. In most advanced countries this does not mean everyone is left to fend for themselves but that those with more help carry the costs for those with less. This is the kind of spirit Pakistan will need to show.