KARACHI, Oct 7: The federal government may pull out from dispensing free medicines to thousands of viral hepatitis-C patients registered with the Prime Minister’s National Programme for the Control and Prevention of Hepatitis, which was launched in 2005 for a period of five years with the projected cost of Rs2.594 billion.

Sources said that since the procurement of medicines and their free-of-cost provision to hepatitis patients involved huge funds, health managers in the centre were contemplating that the procurement of interferon injections, used in the hepatitis-C treatment, be done away with gradually so that other components of the programme could be given due attention.

A source privy to a recently held meeting on the control and prevention of hepatitis said the participants discussed that the number of hepatitis patients could not be reduced unless the provincial and district governments gave an equal priority to the prevention and treatment aspects and extended financial support to the programme.

At the meeting proposals were also sought to minimise the federal government’s responsibility regarding the registration of patients and the procurement of medicines. Besides, the participants were urged to come up with proposals that ensured improved focus on activities containing the spread of hepatitis B and C in all provinces.

Major components of the programme include hepatitis-B vaccination of health-care workers, prison inmates, intravenous drug users, frequent blood recipients and other high risk personnel; establishment of 150 hepatitis B and C screening, counselling and treatment facilities at teaching and district headquarter hospitals in a phased manner; development and implementation of proper hospital waste management system at the district level; strengthening of the safe blood transfusion services; installation of 150 water purification plants in teaching and district headquarter hospitals; advocacy and behaviour change communication strategy’s development and execution on a persistent basis and strengthening of routine immunisation services of hepatitis-B vaccine for infants and capacity building of partners for effective prevention and control of viral hepatitis in the country.

At present about 104 hospitals and health-care centres at the federal, provincial and district levels are facilitating diagnostic tests and treatment to eligible and poor patients under the programme. Twenty such centres are located in Sindh, which are believed to be housing the maximum number of hepatitis-B and C patients or people from the high-risk groups.

Of the 34,000 hepatitis-C patients registered in the country, about 10,000 lived in Sindh. Only 40 per cent of the patients registered in Sindh were provided with the prescribed treatment though the overall percentage of people provided with treatment in the country was 70.

Sources said that a regular supply of medicine to hepatitis-C patients was missing since July 2007. Even hundreds of patients, including those registered at the Jinnah Postgraduate Medical Centre, in Karachi had not been provided with hepatitis-C treatment.

When contacted, coordinator of the programme in Sindh Dr Zulfiqar Ali Gorar told Dawn that despite a very meagre supply of hepatitis-C medicines from the federal government, the demand and supply gap had been reduced because many districts had owned the programme and started allocating funds for the purpose on a yearly basis.

Except Karachi and Ghotki, all the districts agreed to contribute a total sum of Rs350 million for the programme this year, which was Rs255 million higher than the amount contributed last year, he added.

He said the federal government was not withdrawing itself from the PM’s programme; instead, it was involving local and provincial governments as the real stake-holders by making them realise the gravity of the disease.

He described it a success of the PM’s programme that Sindh was going to launch its own hepatitis control programme with an estimated cost of Rs2.3 billion. Besides other facilities, hepatitis-C medicines would be provided to about 50,000 patients during the next three years under the programme, he added.

Moreover, he said the federal government was working on a plan to introduce more diagnostic and treatment centres in Sindh and enhance the relevant capacity at different health-care centres. Shortly, two centres would be established at a provincial government hospital in Karachi for hepatitis-B and C screening, diagnosis, counselling and treatment facilities, he added.

In reply to a question, Dr Gorar said that Sindh had recently received interferon injections meant for a full six-month treatment of about 200 persons from Islamabad after a gap of about one year. He said the medicines would shortly be handed over to the patients.

About 6,000 patients registered under the programme are still awaiting the promised free treatment. It is estimated that about 3.6 per cent of Sindh’s population is infected with hepatitis-B and 5.4 per cent suffers from hepatitis-C.

Under the mechanism evolved by the Prime Minister’s Programme for the Prevention and Control of Hepatitis, committees have been formed in selected hospitals to determine patients’ eligibility and register them for free treatment.