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By
Mazhar Arif

Islamabad - Last month, on March 24, World TB Day was commemorated all over the world including Pakistan to invite people to actively participate in the fight against the killer disease -- Tuberculosis. The force behind the commemoration of this annual occasion is, within the Stop TB Partnership, The International Union Against Tuberculosis and Lung Disease, known as The Union, an international organisation established in 1920. The union is the only international voluntary scientific organisation with partners in all regions providing a neutral platform to fight TB, TB-HIV, Asthma, tobacco and lung disease.

The Stop TB Partnership is a global campaign to fight TB launched in the year 2000 with the collaboration of over 500 organisations and the World Health Organisation (WHO). This global action was initiated because, despite a deep commitment, numerous actions and strong ongoing medical progress surrounding TB, the disease is still an alarming global public health problem. This year the campaign is dedicated not only to the men and women who have contributed in the fight against TB but also celebrates those who have been successfully treated for the disease.

For centuries, tuberculosis has been a major health issue with over a third of the world’s population exposed to or suffering from the consequences of this disease. As a reminder, tuberculosis is still a common, communicable but potentially deadly infectious illness, caused by the tubercle bacillus discovered by Dr Robert Koch on March 24, 1882. Medicine has come a long way and cures have been found since then, but unfortunately, tuberculosis is still responsible for over a million and a half deaths and nine million new cases are declared each year worldwide.

According to the World Health Organisation (WHO) Global TB Report 2006, Pakistan ranks seventh among the 22 high-burden tuberculosis countries worldwide, every year, approximately 280,000 people in Pakistan (primarily adults in their productive years) develop TB. The emergence of multidrug-resistant TB and TB-HIV co-infection are growing concerns in the country.

The Ministry of Health began implementing Directly Observed Therapy Short (Dots) course in 1995, with Balochistan as a pilot province. Between the years 2000 and 2004, Dots coverage increased in Pakistan from 9 to 79 per cent. As the Dots programme expand, the quality of treatment must also improve. Treatment success was just 75 per cent in the 2003 cohort, but a high proportion of patients were not subject to follow-up. The steep rise in the number of TB cases reported each year since 2000 represents improved case registration under Dots. Despite progress over the past five years, the case detection rate for Pakistan was estimated to be only 27 per cent in 2004, well below the target of 70 per cent. In 2001, the government declared TB a national emergency, which led to a TB budget increase from $1.65 million in 2001 to $26 million in 2006. Despite improvements, the NTP still faces challenges. As TB planning shifts from the national to the district level, technical and managerial capacity at the provincial and district levels required to be strengthened.

Tuberculosis remains Pakistan’s leading cause of death among infectious diseases. It carries a social stigma because of its link with poverty and overcrowded living conditions. TB, a bacterial infection that spreads through inhalation and primarily affects the lungs, if left untreated, eats away at bones and organs. Hobbled by poverty, shame or a lack of awareness, three-fourths of sufferers in Pakistan are never diagnosed by a doctor. Poverty and poor nutrition are major factors fuelling the spread of tuberculosis in the country, health experts say.

Smoking is another cause of the lung disease, which is spreading like an epidemic particularly among the youth. Pakistan has ratified the FCTC and promulgated the ‘Prohibition of Smoking and Protection of Non-Smokers Health Ordinance 2002’, which was enforced in July 2003, however its effective implementation is needed. Pakistan has also incorporated tobacco control in the National Action Plan for Non-Communicable Diseases Prevention. Efforts have also been made for public awareness by establishing Tobacco Control Cell in the Ministry of Health. Though the statutes ban smoking at public places and enclosed areas, the methods for implementation are not defined. No significant changes have been seen due to gaps in legislation and absence of implementation structures. No effort is currently visible for specific structural reforms required to undertake this work.

Coalition for Tobacco Control – Pakistan (CTC-Pak), an alliance of more than 20 organisations, has been advocating for stronger measures for tobacco control by the translation and adaptation of FCTC provisions into national tobacco control laws. Despite the introduction of some legislative measures, a comprehensive approach towards effective tobacco control is still lacking. These loopholes allow the tobacco industry to exploit an under regulated market. CTC-Pak feels that efforts are now required to initiate an advocacy campaign so that a holistic legislative environment can be created for tobacco control.

Last week, the Tobacco Control Cell, Ministry of Health, recognising the harmful effects of smoking on public health, formed the Technical Advisory Group (TAG) on Tobacco Control, which proposed a series of strategies including enhancement of taxation on cigarettes, introduction of pictorial warnings on cigarette packs, abolition of designated smoking areas and creation of 100 per cent smoke-free public places. Meanwhile, ‘The Bloomberg Initiative Forum-Pakistan’ which is committed to the scaling up of tobacco control has endorsed all the proposals forwarded by the TAG at the close of a meeting held at the World Health Organisation (WHO) here last Friday to review the progress and strengthen coordination among the Bloomberg Initiative grants projects. Bloomberg Initiative grants are for tobacco control, and its partners are the WHO, the Ministry of Health, Coalition for Tobacco Control-Pakistan, The Network for Consumer Protection, Society for Alternative Media and Research, John Hopkins and others.

The ‘Bloomberg initiative for Tobacco control’ is playing an important leadership and coordination role in assisting for effective tobacco control interventions in line with best evidence and policies.

Mazhar Arif is a senior journalist, now working as the Executive Director of Society for Alternative Media And Research (SAMAR), a civil society organisation, based in Islamabad, Pakistan.

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