LAHORE: The Punjab TB Control Programme seems to have hit a snag due to apathy of the successive provincial governments and health authorities.

A disturbing official report made revelations about indifference towards this highly critical programme, putting health and lives of hundreds of millions of TB patients at grave risk.

It states that the Punjab government missed its prime targets primarily by slashing a major chunk of the budget of the largest programme of the country.

Highlighting significance and perspective of the disease burden, the report stated that tuberculosis (TB) is a communicable disease that is a major cause of ill health and one of the top 10 causes of deaths worldwide.

“Pakistan ranks 5th among 22 countries with the highest burden of TB and 27th among high Multidrug Resistant (MDR) TB countries of the world,” the report reads. It contributes about 60% of the total TB burden in the Eastern Mediterranean Region, and overall eight countries accounted for two thirds of the global total TB burden including: India (27%), China (9%), Indonesia (8%), the Philippines (6%), Pakistan (6%), Nigeria (4%), Bangladesh (4%) and South Africa (3%).

These and 22 other countries in the list of the World Health Organization of 30 high TB burden countries accounted for 87% of the world’s total TB cases.

In Pakistan, more than 500,000 new cases of TB occur every year while Punjab shares over 60 per cent of such cases.

“The data analysis showed that the government had released only Rs1,062.3 million (33.67% of the total budget allocations) to the program during 2015- May 2020 against the programme’s total cost of Rs3,154.5 million,” reads the report, declaring it one of the prime factors behind the sorry state of affairs.

It clearly stated that the programme could not achieve its one of the main objectives ‘End of TB remains high on political agenda by increasing the financial support from public sector to 100% by 2020’.

This shows that of the total programme cost of Rs3,154.5 million, only 33.6 per cent (Rs1,062.3 million) were released from 2016 to May 2020, against which Rs776.4 million were utilized under the programme.

“The TB Case notification target for 2020 (from 76% in 2015 to 90pc by 2020) was not achieved as component “LHW / Community Volunteers incentive (Rs.500/Positive case & Rs500/ treatment completion), District Management Incentive (CEO Rs20,000/month & DTC Rs10,000/month), Sputum transportation through courier / LHS (600 LHS 12 months) were not materialized due to funding constrains and funding disbursement issues,” reveals the official report.

Similarly, target for increase in MDR-TB Treatment success rate from 72pc in 2015 to 75pc by 2020 was also not achieved.

Strengthening the institutional collaboration on the TB research priorities in Punjab was one of the main objectives of the Punjab TB Control Programme.

“However, Programme did not involve in any research activity (i.e. Research Publications, Grants for research to scholars & students, representing the country in international conferences and conducting Operational Research) during the past five years (2015-20),” says the report.

It stated that the Punjab TB Control Programme did not have dedicated post of the ‘District TB Coordinator’ that has affected the implementation, management and monitoring of the programme at the district level across the province.

“Therefore, for smooth functioning of the program, the post of ‘District TB Coordinator’ may be created across all 36 districts of Punjab,” it said.

This analysis concludes that the sustainability of this intervention is vitally important to control TB epidemic in Punjab/Pakistan.

“The End TB Strategy milestones for 2030 can only be achieved, if TB diagnosis, treatment and prevention services are provided under the realm of the universal health coverage,” according to the report.

Moreover, multisectoral collaborations and actions are needed to address the broader determinants that influence the TB epidemic and its socioeconomic impacts, the report said.

Published in Dawn, October 9th, 2020