Pakistan

Pakistan has a large, mostly rural population with a high rate of growth. The government estimates the population at 163.9 million (2007), not including 1.2 million refugees from Afghanistan.

The DOTS strategy had been adopted in 1995 but major progress has only been achieved since the revival of the NTP in 2001 after TB had been declared a national emergency ("Declaration of Islamabad"). The NTP consists of a well functioning central unit, provincial TB coordinators and coordinators at district level (DTO). TB services are integrated into the primary health care system. They are delivered by chest clinics in tertiary hospitals (currently 23 public and private hospitals connected to the national and/or provincial TB programs), district hospitals and basic health units (BHU). The private sector has been increasingly involved in TB diagnosis and care (PPM see below), but TB services in prisons, the police forces and the military are not yet linked with the NTP.

TB CAP Project Period (2005-2010)

TB CAP support was requested by the USAID country mission and the NTP because of the increasing complexity of the program with increased funding and new demands for collaboration of technical assistance (TA) provided by multiple partners.

The TB CAP project will complement program components included in and financed through the Global Fund and the government Project Cycle 1 (PC-1). The planned prevalence and drug resistance surveys, challenges in developing the national laboratory network for sputum smear microscopy, culture and drug susceptibility testing (DST), drug management of first and second line drugs (FLD and SLD), diagnosis and treatment of multi drug resistant TB (MDRTB), engagement of all care providers including the private sector will need better coordinated TA and well developed strategies.

This TB CAP project intends to contribute to the adaptation of the current National Strategic Plan 2005-2010, to the development of the new Strategic Plan for 2010-2015 including a comprehensive strategy for the laboratory network for culture and DST, diagnosis and treatment of drug resistant TB, infection control, drug management, strengthened M&E.

Further activities will include the continuation and expansion of the NPO package implemented through WHO, strengthening drug management through continuation of the work previously done by MSH and JATA (development of drug management guidelines), through the development of training modules and training at district and facility level, and improvement of the laboratory network with support of IUALTD. The technical capacity of KNCV as a new partner in TB control in Pakistan will support the planned prevalence survey in collaboration with all partners, development of an HRD strategy for TB control and overall coordination. KNCV will open a country office within the premises of the NTP central unit in Islamabad for management and administration of the TBCAP project.