LAHORE: The Punjab government has drafted new standard operating procedures (SoPs) and regulations 2014 with a view to ‘reducing burden of dengue from the province’.

This time Punjab, which had faced the worst-ever epidemic in 2011 with more than 300 deaths, has introduced ‘ultimate reforms’ and a ‘long-term planning’ on the basis of some reports that Pakistan will have to face burden of the disease for many years.

The regulations draft has redefined the role and responsibilities of the health and 33 other allied government departments besides a number of institutions.

Declaring the dengue a ‘socio issue’ rather than a disease, the Punjab government in the 43-page draft has also proposed to involve society for eradication of dengue. A copy of the draft is available with Dawn.

According to the draft, seven high-profile committees have been constituted and notified. The composition and main terms of references (ToRs) of these committees have been elaborated.

The Central Emergency Response Committee (CERC) will be headed by the chief minister and the nominated members included ministers/parliamentarians, representative of the Federal Ministry of Health, chief secretary, additional chief secretary, all administrative secretaries, P&D chairman, the Lahore commissioner, Board of Revenue senior member and the Chief Minister’s Inspection Team chairman.

The Cabinet Committee on Dengue (CCD) will be headed by the adviser to chief minister on health. The chief secretary will head the Provincial Implementation Committee (PIC).

The other notified committees are: Technical Advisory Committee (TAC) headed by the health secretary, Dengue Experts Advisory Group (DEAG) headed by the Institute of Public Health Dean, District Emergency Response Committee (DERC) and Town/Tehsil Emergency Response Committee (TERC).

Looking at the magnitude of dengue-related morbidity and mortality, more than 33 departments of the Punjab government have been assigned a clear role. And the health department has been declared maximum responsible for implementing SoPs.

The major objectives of the SoPs included assessing the true burden of dengue in Punjab, developing inter-sectoral, inter-provincial coordination and global partnership to prevent and control dengue.

The major activities defined in the draft included clinical case reporting, lab case reporting, case management, case referral, lab referral, case response, vector surveillance, arrangement for logistics and human resource, capacity building/trainings (preventive/clinical), standards for wards, health education/ social mobilisation, operational research, legislative/administrative support and financial allocation, etc. As several scandals emerged in the past about the shortage and quality of insecticides and spray, the SoPs 2014 have clearly defined a system to avoid such incidents in future. According to the draft, annual demand for replenishing stores for next financial year estimation will be prepared by the end of May by the Punjab additional director general health services (DGHS).

Only WHO-approved products will be procured from WHO-recognised firms. The approved uniform doses of insecticides will be notified and disseminated to all health EDOs by the communicable diseases (CD) director. The DGHS will finalise the procurement by the end of December. The government will regulate the use of insecticides by private sector as per set standards.

Physical inspection and stock-taking of all entomological lab and spray equipment & personal protective equipment (PPE) will be done during December by all health EDO and will be ensured by the DGHS. All equipment should be available and functional by Feb 10 annually.

The draft has also proposed legislation for effective prevention and control of dengue.

“It is necessary to have legislation which ensures prevention of mosquitogenic conditions. The TAC will nominate a sub-committee to formulate/review by-laws regarding dengue prevention and suggestions for improvement,” the draft says.

The regulations proposed the following statutes:

(i) Model civic bylaws: Under this act fine/punishment is awarded if breeding is detected. These measures are being strictly enforced by city governments.

(ii) Building Construction Regulation Act: Building bylaws are to be made for appropriate overhead/underground tanks, mosquito-proof buildings, designs of sunshades, porticos, etc for not allowing stagnation of water vis-à-vis breeding of mosquitoes.

(iii) Environmental Health Act: Suitable bylaws will be made for the proper disposal/storage of junk, discarded tins, old tyres and other debris, which can withhold rain water.

(iv) Health Impact Assessments: Appropriate legislation will be formulated for mandatory HIA prior to any development projects/major constructions.

(v) Insecticide regulation laws: These regulations need to be developed with feedback from WHO, health, agriculture and law departments.