PAKISTAN’S lack of political will when it comes to prioritising effective responses to a host of preventable illnesses is responsible for the country’s abysmal health indicators. Even after receiving millions in donor assistance to tackle communicable diseases, national control plans remain in a state of disarray. This is evident in the poor implementation of the country’s 10-year plan to reduce tuberculosis by 70pc. A Senate sub-committee was recently informed that TB diagnostic services and essential medication for treating the disease were unavailable in hospitals in Balochistan and KP. Senators were told that not even one out of 95 TB diagnostic mobile vans earmarked for both provinces was operational. ‘Inadequate security’ is hardly an excuse; security personnel can accompany diagnostic vans, just as they provide protection to vulnerable polio workers in the country. It is critical to reach vulnerable communities in remote areas where TB cases multiply when individuals missed by the health system remain undiagnosed and untreated.

With 510,000 TB cases reported last year, Pakistan has the fifth highest incidence of the disease in the world. A highly communicable infection, delay in diagnosis and unsupervised drug regimens make it difficult to control TB. The usual therapy requires a six-month uninterrupted course of drugs to ensure efficacy, and most TB patients do respond to this course of treatment. However, the erratic consumption of medicines or leaving off midway during therapy has seen bacteria mutate to the point where it can become resistant to multiple drugs — which means a new therapy has to be considered for MDR-TB patients. Even among those that are undergoing first-line therapy, consisting of fixed-dose combination drugs, there are some who do not respond well and have to be given medicine in which the ingredients have been separated — such single-ingredient drugs are not always available in the country. Because the endgoal is eradication, policymakers must monitor the momentum of the national programme and its response to transmission trends and especially ensure that the most marginalised are not left out.

Published in Dawn, October 23rd, 2017