Tuberculosis (TB) is a major problem of public health in Pakistan. Pakistan ranks 4th among 22 high TB burden countries and 27 high multi-drug resistant (MDR) TB burden countries. It accounts for approximately 64% of the TB burden of the Eastern Mediterranean Region (EMR) of the World Health Organization (WHO).
According to the latest WHO Global TB report published in 2017, the incidence rate of TB in Pakistan is 268/100,000, while the mortality rate is 23 deaths per 100,000 populations in 2016. Pakistan notified 366,061 TB cases of all forms in 2016. The absolute number of cases is likely to increase due to population growth. The case detection rate is increasing and is just below target at 69%, while the treatment success rate for new smear positive cases has reached at 93%.
The Global Fund has been the main financial support for TB control activities in Pakistan and the country succeeded in mobilizing substantial financial support from the Global Fund under Rounds 2, 3 and 6. Recognizing the increasing disease burden, the Round 9 Proposal was designed with the goal of reducing the burden of TB in Pakistan by improving access to quality DOTS and Multi-drug resistant tuberculosis (MDR-TB) care services.
The Rounds 6 and 9 of the Global Fund grants were merged into a Single Stream of Funding (SSF) Program. The SSF Program significantly streamlined the existing national interventions through achieving economies of scale and scope in both programmatic and financial management. With strong synergies and phased progression of SSF Program activities from previous Global Fund grants, the SSF Program has ensured the provision of quality care to TB patients through a network of enabled public and private sector and parastatal hospitals, clinics and laboratories.
Under the Global Fund’s New Funding Model grant started in 2015, Mercy Corps has worked in the private sector by expanding partnerships and engaging healthcare providers and managing the implementation of the grant together with public sector’s Principal Recipient (PR), namely National TB Control Program (NTP). Mercy Corps, being private sector’s PR, was responsible for implementation of public-private mix interventions in 75 districts across the country. The NFM grant will end by December 31, 2017 and the next round of funding will be started from January 01, 2018.
In the province of Khyber Pakhtunkhwa Association for Community Development (ACD) implemented PPM interventions in 14 districts in the capacity of sub-recipient of the Mercy Corps. Focus of the project remained on expanding partnerships and engaging
Health care providers for implementation of public-private mix interventions in the target 14 districts of the KP province.
The purpose of New Funding Model (NFM) grant was to contribute to achieve the goal of the national strategy to control TB in Pakistan, which is to reduce by 50% the prevalence of TB by 2025 in comparison to 2011.
The new funding model (NFM) was implemented to achieve the following four objectives:
Objective 1: To increase the number of notified TB cases from 298,981 in 2013 to at least 420,000 by 2020 while maintaining the treatment success rate at 91% (PR: NTP and MC)
Objective 2: To reduce, by at least 5% per year by 2020, the prevalence of MDR-TB among TB patients who have never received any TB treatment (PR: NTP)
Objective 3: To increase the number of TB patients who are screened for HIV infection from 3% (10,433) in 2013-14 to 10% by 2017 and the proportion of PLHIVs on ARVs who are screened for TB from 60% in 2013 to 90% in 2017 (PR: NTP)
Objective 4: Strengthen programmatic and operational management capacity of the TB Control Program while enhancing public sector support for TB control by 2020. (PR: NTP)
Strategy and Planned Activities:
Mercy Corps with its sub-recipients was responsible for implementation of the following strategies and activities related to the objective 1 of the NFM grant.
- Strengthen and scale-up quality TB diagnosis and treatment through a public-private mix (PPM) approach by engaging general practitioners and private laboratories in 75 districts of Pakistan
- Enhance TB case finding by engaging 2,000 private healthcare providers (general practitioners) and 235 private laboratories
- Mapping and training of selected private healthcare providers (general practitioners and laboratories) and paramedics on TB DOTS as per National Guidelines
- Chest camps to ensure active case finding approaches for diagnosis of TS in high-risk and vulnerable population
- Community events and meetings with area notables for community mobilization, awareness and participati6n in chest camps
- Incentivize the private healthcare providers (private practitioners and laboratories) through voucher scheme to encourage their participation as well as to reduce the out- of-pocket expenses of TB patients