Pakistan: Bigger Dose of Action Needed Against TB

According to government figures, four out of five cases of tuberculosis in Pakistan are not detected or treated. Pakistan ranks sixth on the World Health Organization's list of high-disease burden countries and accounts for 44 percent of all TB cases in WHO's Eastern Mediterranean region.

WHO's 2003 World Health Report states that the annual incidence of TB cases in Pakistan is 171 per 100,000 persons. Each year, at least 268,000 new TB cases are added to the existing patient population of around 1.8 million. TB kills 64,000 people in Pakistan each year, accounting for 26 percent of the nation's avoidable deaths. Most patients are ages 15 to 45; 52 percent are males; and 48 percent are females, according to government figures.

Pakistan adopted the WHO-recommended directly observed short course (DOTS) strategy in 1995. In 2000, thanks to a World Bank-funded scheme, the program was expanded to the provinces. Since 2001, the government has been handling TB as a national emergency. DOTS has been extended to 34 of more than 100 districts, covering 25 percent of the population. More provinces will be covered by the end of the year, and Punjab, the most populated province, will be covered by 2005.

However, officials at the federal Ministry of Health acknowledge that the expansion of DOTS in Pakistan faces many challenges, including a weak health infrastructure, lack of staff at the district level and poor integration of TB control with primary care services in urban areas. Pakistan spends 0.8 percent of its GDP on health.

Reports suggest that 96 percent of Pakistan's TB patients get treatment through the private sector. Many health activists hold the private sector responsible for the alarming proportions of TB: They say private practitioners are not trained to diagnose TB early and treat it properly, which can lead to drug-resistant disease.

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