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Pakistan became a sovereign state in 1947 and
its present projected population is estimated at 151 million, spreads over
an area of 852392 sq km. The population growth rate is 2.5 % life expectancy
is about 63 yrs and the average literacy rate is 50 %. Per capita income is
US $ 492. Health expenditure (public sector) is 0.08 % while total health
sector investment is 3.9 % of GDP.
Administratively Pakistan comprises of four
provinces besides some Federally Administered Areas and the state of Azad
Jammu and Kashmir. The country has a mixed society, which is predominantly
Muslims. Urdu is the National language while multiple regional languages are
spoken in the country; however, English is used for most official purposes.
Each province/area is divided into districts, which are the basic
administrative units.
WHO declared TB a global emergency in 1993.
Since then efforts have been made to expand partnerships and bring all
stakeholders on board in order to control this disease more effectively. The
economic conditions correlate with new cases of TB. The highest incidence is
seen in those countries of Africa, Asia, and Latin America with the lowest
gross national products. WHO estimates that eight million people are
infected with TB every year, out of those 95% live in developing countries.
An estimated 3 million people die due to TB every year.
TB has been prevalent in Pakistan and
unfortunately it has been one of the neglected health areas in the past.
Pakistan ranks 6th amongst the countries with a highest burden of TB in the
world. Pakistan contributes about 44% of tuberculosis burden in the Eastern
Mediterranean Region. According to WHO, the incidence of sputum positive TB
cases in Pakistan is 80/100,000 per year and for all types it is
177/100,000.TB is responsible for 5.1 percent of the total national disease
burden in Pakistan. The impact of TB on socio economic status is
substantial.
Government of Pakistan endorsed the DOTS
strategy, following WHO’s declaration of TB as a global emergency in 1993,
The National TB Control Programme (NTP) Pakistan adopted DOTS (Directly
Observed Treatment, Short course) strategy in 1995. The national guidelines
were developed and few pilot projects were also started. However, the
program became dormant due to abolition of the Federal Directorate for
Tuberculosis Control in 1996. therefore the progress during the first three
years (i.e. 1995 – 1998) remained slow, because of its vertical approach,
lack of consensus between federal and provincial units, and non-availability
of funds from regular health budget. In 1998 the roles and relationship
between the federal and provincial tuberculosis control program were
re-defined and agreed.
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