PM’s transformative policy package for elimination of hepatitis unveiled

Islamabad : Pakistan Sunday announced a transformative policy package to eliminate Hepatitis and other blood-borne diseases, as well as their underlying causes and risk factors. The initiative, which features six key intervention areas, envisages active screening of 140 million people and provision of free treatment to an estimated 20 million patients, making it the world’s largest public health screening and treatment programme for Hepatitis.

The announcement was made at the opening of a two-day conference hosted by Pakistan in connection with the World Hepatitis Day (WHD) 2019 global campaign. Organized by the Ministry of Health Services, the Aga Khan University, and the World Health Organization (WHO), the event centred on this year’s theme to ‘invest in eliminating hepatitis’ by 2030.

The high-profile conference had President Arif Alvi as the chief guest, with the Regional Director of WHO EMRO Dr. Ahmed Al Mandhari and WHO Assistant Director General for Universal Health Coverage for Communicable and Non-communicable Diseases Dr. Ren Minghui as special guests. Pakistan acted as the global host of the observation this year because it has the highest prevalence of Hepatitis C in the world, with 15 million people suffering from hepatitis B and C.

Addressing the gathering, President Arif Alvi said, Pakistan is on the tipping point of socioeconomic development, making it imperative for all citizens to play their role in uplifting the country’s poor segment through equitable provision of education, health and other opportunities. “Unsafe blood transfusions and reuse of syringes are responsible for the growing incidence of both Hepatitis and HIV, and this needs to be tackled to avert a volcanic situation,” he said. Quoting an example, the President said that if Egypt can secure a decline in hepatitis prevalence from 13 to 3 per cent in 10 years, the same is doable in Pakistan too. He said, health practitioners need to learn treat patients by prescribing minimum possible medicines, particularly antibiotics, and hoped that physical interactions with leady health workers, as well as appropriate use of the print, electronic and social media would help bridge the existing public awareness and information gap.

Sharing the salient features of the ‘Prime Minister’s Policy Package for Elimination of Viral Hepatitis from Pakistan,’ the PM’s Special Advisor for National Health Services Dr. Zafar Mirza emphasized that even though the programme is highly ambitious and resource-intensive, nothing less will suffice. He said, a national plan will be developed during the next six months, followed by active implementation requiring hundreds of thousands of dollars. “We are engaging with international and regional development banks, development partners, the private sector and philanthropists for resource mobilization. Domestic resources will also be garnered. The supply of diagnostics and medicines for this massive program will be a huge challenge but not one that is insurmountable as the President and the PM will themselves provide strong political commitment and leadership to the initiative,’ Dr. Zafar said.

In addition to screening and treatment, the policy package features a component aimed at minimizing the manufacturing and import of disposable syringes in Pakistan, replacing it with autodestruct syringes. Reuse of syringes is the most important underlying cause of blood-borne diseases in Pakistan, which is conspicuous for having the world’s highest (8+) injections per capita annually even though 95% of these injections are unnecessary. “Using the Larkana outbreak as a springboard, we have developed a National Action Plan for Injection Safety and have established a National Taskforce on Injection Safety which is finalizing many regulatory and technical interventions along with developing a National Injection Safety Campaign. Syringe manufacturers and importers have been taken on board,” Dr. Zafar announced.

Another intervention enshrined in the policy package focuses on eliminating unscreened blood transfusions in a country where an estimated 80% of all transfusions are unscreened. “With German support, work is on-going to establish regional blood banks which will be governed by a National Blood Service to achieve 100% safe blood transfusion in the public and private sectors—a goal to be achieved before the end of this government’s term,” Dr. Zafar said.

The fourth intervention, which will be launched in November this year, will be the ‘Patient Safety Friendly Hospital Initiative’ under which hospitals and other health facilities will be undertaking self-assessments using a set of more than 100 indictors, which will then undergo external evaluation. Successful health facilities will be declared Patient Safety Friendly Health Facilities in both public and private sectors. This will enable infection prevention and control as a prelude to addressing the challenge of Antimicrobial Resistance.

The fifth element of the package focuses on redesigning and reestablishment of the National HIV/AIDS Programme, which has weakened due to devolution of power and a resultant weakening of government financing, while the last element pertains to strengthening of the disease surveillance system as a part of National Integrated Health Information System so that real time primary data about prevalence and incidence of diseases is available.

The event drew attention towards the four key underlying causes of blood borne diseases in Pakistan namely, lack of prevention and control of infections in health care facilities and practices; reuse of contaminated syringes; transfusion of unscreened blood; and unprotected sexual practices especially by high-risk groups. Barring the last factor, all the other three originate from the health care system itself, which is a very sad state of affairs. “Unhygienic health care facilities and irresponsible healthcare providers (quacks) have themselves become vectors for spread of diseases,” Dr. Zafar stated, underlining the need to root out quackery in all its forms.

The WHO also announced to support Pakistan in eliminating Hepatitis. WHO Director-General Dr. Tedros Ghebreyesus praised the Prime Minister’s initiative in a video message while Dr. Ren Minghui underlined the importance of using integrated approaches and Dr. Ahmed Salim Saif Al-Mandhari acknowledged Pakistan’s political leadership in responding to the crisis. He said, Pakistan’s efforts will help strengthen the basic health system and could serve as a positive example for other regional countries.