KARACHI, March 26: The WHO and other international agencies working for elimination of tuberculosis have registered their concern regarding lack of standardisation of pharmaceuticals used under national tuberculosis programme.

The officials from WHO/ EMRO, WHO Headquarters and other international agencies following their visit to different TB centres in the country, observed that there existed no clear guidelines on ensuring quality of fixed dose combination tablets supplied by the programme.

The sputum smears in many of the health services were also found to be of substandard technical quality and the microscope in many of the sites visited were neither of good quality nor in good working order. Monitoring and supervision in some of the districts visited were also found not to be taken systematically due to lack of resources.

Though appreciating that substantial progress had been made in the expansion of DOTS strategy in Pakistan, the experts observed that delivery of services to the community in large urban areas remains a challenge due to the fact that community level health services are substantially less well defined and less extensive in the large cities.

In spite of the substantial success in engaging the most peripheral services in delivery of tuberculosis services in many areas, their engagement was found to remain a challenge particularly in the period of changes in the organisational structure of these services associated with devolution.

The experts recommended that the provincial tuberculosis coordinators, in collaboration with the Manager of the National TB Programme, develop a clear plan for full engagement of all primary health services and strengthening those already engaged as an essential first step in engagement of other partners in the DOTS strategy.

The federal ministry of health was also suggested to monitor the investment of development partners and ensure that such investment be coordinated through the inter-agency coordinating committee and follow the national plan and investment needs outlined in it.

The Manager National TB Programme, in collaboration with the National Drug Authority, was expected to review, revise and amend the policy on selection of drugs for the programme.—APP