Ashfaq Yusufzai discovers that despite huge funding available in KP, hepatitis patients continue to suffer due to maladministration

Despite the allocation of large funds from the government, hepatitis C continues to spread insidiously in our society. It remains invisible because people are either not promptly diagnosed or properly treated and most cannot afford the cost of treatment.

In October 2011, the Khyber Pakhtunkhwa health department allocated Rs500m to provide free investigative and curative facilities for approximately 70,000 hepatitis patients. But due to severe lack of awareness regarding the hepatitis control programme, only 16,000 patients could be treated with only Rs200m utilised.

The reason behind the patients’ reluctance to go for treatment was the lack of awareness about the free treatment facility. Added to it was the painfully long procedure to be able to qualify for medication on government expense.

Initially, the procedure entailed attestation of zakat forms first from the local and then the district chairpersons, once the patient had been diagnosed positive for hepatitis. The following year in 2012, the government amended the conditions so that only the poor were eligible for free treatment, once they were able to present zakat certificates. Free treatment facilities were only available in three Peshawar-based teaching hospitals which were not within reach of the population in 25 other districts.

In 2012, KP allocated another Rs500m in addition to the lapsed amount from the previous year with the total allocation becoming Rs800m. The government also established free treatment centres in each district headquarters hospital to encourage patients, but  the response remained lukewarm and only 9,000 patients turned up for free treatment in March 2013.

An awareness campaign for free treatment of hepatitis was launched but it remained confined only to Peshawar. Banners were put up in teaching hospitals but the campaign remained inaccessible to the rural population outside Peshawar.

Experts claim it was the first time in the history of KP that such a whopping amount had been released for free treatment of any disease, yet it failed to trigger a response.

According to more than 100 studies conducted by ace health institutes in the country, an estimated 5-7pc of the country’s population has hepatitis C and 3-5pc suffer from hepatitis B.

“There seem to be high-level, complex challenges involved in the elimination of hepatitis in KP, although a closer look indicates that the higher prevalence of hepatitis in KP as compared to the rest of the country is due to basic, obvious, recurrent and completely preventable problems. If funding is available, does it all just come down to a matter of greed, ignorance or laziness”? says a government official.

“Several reminders have been issued to government authorities to run further awareness campaigns but all requests have fallen on deaf ears and the disease continues to make inroads in the rural population”, said a doctor working in a teaching hospital in Peshawar. “The challenge in KP is bigger because the rural population mostly depends on unqualified health practitioners who very often use unsterilised syringes. Secondly, their level of awareness regarding the disease is extremely poor”.

In 2005, the World Health Organisation conducted a study according to which, in 70pc people, hepatitis was caused by reuse of disposable syringes, unsterilised surgical and dental equipment as well as unprotected sex. The world health agency had also warned that the disease would become a serious problem if the basic causes were not addressed.

In 2005, the federal government launched a National Hepatitis Control Programme at the cost of Rs5bn. The amount was increased to Rs13bn in 2007 but the programme did not succeed because of its centralised approach. The provinces received their share of the allocated amount on the basis of population, but the authority to purchase and procure drugs and vaccines remained with the federal government. Approvals, implementation and execution were time consuming and little or no headway was made.

After the 18th Amendment, the provinces consolidated their own programmes after the ministry of health was abolished at the federal level. “There is very little demand for free treatment as the people don’t know about these programmes. Campaigns do run in teaching hospitals in Peshawar but hardly generate any response,” said a government official from the health department.

Interestingly, some hospitals opposed full-scale awareness campaigns, arguing that it would be impossible to handle patients who were expected to come in hordes.

While mismanagement may be one problem, corruption is a bigger issue. Last month, the anti-corruption department arrested director-general health KP and two other officials for purchasing substandard injections and vaccines worth Rs160m.

According to officials associated with a hepatitis programme in KP, medicines for approximately 16,000 patients have been purchased, but a mechanism was required to reach out to the patients. The programme includes provision of interferon injections for hepatitis C patients, as well as free vaccinations to prevent hepatitis B.

The health department has shown no interest in starting free investigation facilities despite having bought costly equipment for an important polymerase chain reaction (PCR) test for which the ‘would-be beneficiaries’ have waited for a long time, the officials said.

The new machines purchased for Mardan, Dera Ismail Khan, Kohat, Swat, Bannu, Abbottabad and Peshawar are yet to be made operational, the officials said.