Owing to the alarming rate of TB in the province, with the highest rate in the most productive age group of 30-34 years, Asif Mohmand, Accountability Lab fellow in Pakistan, visits the TB control center in Mardan and collects evidences of deplorable service delivery regarding the awareness, prevention and treatment of TB.
Envisioning universal access to TB care, the National TB Control Program aims to reduce the prevalence of TB in the general population by half, in comparison to 2012, by the year 2025.
The Khyber Pakhtunkhwa Tuberculosis Notification Bill 2016 declares TB as a ‘notified disease’ and ensures that patients are provided free diagnosis and treatment.
With 400,000 new cases reported every year, Pakistan is the 6th high burden TB country in the world. Out of these, 55,000 new TB cases occur in Khyber Pakhtunkhwa (KP) alone. The District Health Information System (DHIS) reported Peshawar district with the highest number of cases (2,007) in the province followed by Mardan district (1,582), during April-June 2016.
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Tuberculosis (TB) awareness and prevention centers are operational throughout KP province with the support of World Health Organization (WHO) TB control program. In Mardan, the center is established four years ago in a public Sarai (Inn) of the District hospital.
The center, since its inception, is facing severe shortage of facilities, equipments and staff. It consist of four rooms – one for doctor, a medicine store and the only waiting room for patients visiting the facility for treatment on daily basis.
According to official record of the TB Control program center Mardan, on average, 30 to 40 patients visit the Centre on daily basis for Diagnosis and treatment purposes.
Asif Mohmand, during his visit, met with Maryam, an 11-year-old girl suffering of TB for the last three months. She was accompanied by her mother. Her mother was carrying a small baby in her lap along trying to cover her face in her Burqa (veil). She was not aware of the fact that TB could be evenly inflicted from one person to another the moment there is a contact with the person coughing near to you. She gets medicine from the center without paying any charges. However, the other required supplements, she shared, she purchase from the market when she can afford. For the last two visits, she could not arrange for such supplements. The patients visiting the center are provided free diagnosis facility and free medicine for the last four years as per the official’s statement.
Doctor Sartaj Malik, a senior Chest Physician in the center, revealed to Asif Mohmand that the X-Ray machine was out of order for the last one year, adding that District Health Officer (DHO) is aware of the fact and has taken no action till now. The space required to cater the patients properly is the main issue, he added, explaining that there is only one room in the center shared by the patients and normal visitors and this has the high potential to cause spread of the disease to the visitors.
According to a rough estimate, Doctor Sartaj claimed, there are around 6000 patients inflicted of TB at Mardan district out of the total population of 2 million. The number of patients is even more than those registered, he added, owing to the fact that the TB cases relatively do not come into notice and remain undiagnosed. On average, a TB patient inflicts around 15 people before he or she reaches the center for the purpose of diagnosis or initiating the treatment process, Doctor Sartaj further revealed.
There are eleven TB control centers in the District of Mardan, however, the condition of the main Center postulates the real picture of the situation on ground.
Sabaz Ali, Lab Assistant at the Center fetches tap water from outside of the center as there was no clean water in the laboratory for sample investigation and diagnosis purposes.
The record of TB centers said that in the two months, January and February 2017, around 121 cases of TB emerged and were added to record of the patients. Tuberculosis has been persistent among the population for long and it still a predominant disease in the region.
The increasing ratio of the TB patients across the world compelled the World Health Organization (WHO) to combat the disease by initiating the Directly Observed Treatment Strategy (DOTS) program. DOTS was initiated in 1994 with the aim to eradicate TB from the world and recommends TB diagnosis and its treatment through proper observation of the patients. The program assists the Governments of the developing countries including India, Pakistan, Bangladesh, China, and Thailand. DOTS program adopted the strategy to keep the TB patients in observation for at least three months. It is the mandate of each TB diagnosis and control center to provide required diagnosis facility, quality consultation and free of cost medicine to such patients.
Pakistan National TB control Program was started for eradication and prevention of TB under the banner of DOTS program. TB control program Khyber Pakhtunkhwa provides medicines, equipment’s and all other related services to 192 centers functional in the province.
Though, the purpose of the DOTS program is to providing technical support, medicines, equipments, and awareness regarding the TB disease, the way the program is administered in the region indicates serious lapses and malpractices.
Abdul Khaliq, Project Director of the National TB Control Program in Khyber Pakhtunkhwa said that he has not coordinated with DHO on the issues prevailing in the TB centers in Mardan. All the current issues of the Center, he added, including of clean water, X-Ray machine and proper space for the patient have not been brought to his notice thus far. The provincial government of KP is responsible for the proper implementation of the DOTS program in the province and it’s mandatory for it to ensure the provision of required facilities to the TB patients.
Shahab Saqib Mohmand, a PhD scholar who collected data of the TB patients in Mardan for his research, criticized the country for failing to implement the DOTS program. While talking to Asif Mohmand, he claimed that the Health Department could not manage the program as per its requirements and has remained unsuccessful in eradication of TB from the region. Other countries and specially developed countries, he added, have reduced the TB from their countries by successfully implementing the DOTS program. The situation demands determination from both the Government as well as the citizenry to free the society from TB, he suggested. While commenting on the prevailing situation of TB, he added that in Pakistan TB mostly affects adults, between 15 and 64 years of age, and that includes the alarming ratio of patients in their most productive age from 30 to 34 years, in Khyber Pakhtunkhwa. Lack of accountability, Shahab Mohmand concluded, is making the situation worse for TB patients in KP province.
The increasing number of patients on daily basis poses greater threat to the spread of the disease in the region and if TB patient are not properly diagnosed and treated on time, the lack of awareness in general public regarding the disease will further multiply the danger, Doctor Sartaj Malik warned.
Noor Ul Islam and Asif Mohmand are partners at PROGNAT DEVELOPMENT INITIATIVE (PDI).Asif Mohmand is fellow of Accountibility Lab