In Pakistan: The Other Fight
April 2, 2008
While it’s easy for the dramatic events of the last year in Pakistan to overshadow other issues, the stories that do not get told often tend to have the largest, daily impact on people’s lives. Pakistan’s very recent history has been full of tremendous highs and lows ” Benazir Bhutto’s assassination, the ongoing struggle over the judiciary, and elections, while imperfect, were widely recognized as democratic ” just to name a few. While all of this has been going on, so has constant work to campaign against a well-known and predictable foe: tuberculosis.
Tuberculosis is a curable disease that killed an estimated 1.5 million people worldwide in 2006. The World Health Organization’s recently released report, Global Tuberculosis Control 2008, finds that while progress in the rate of identification of new TB cases is being made worldwide, growth has slowed to 3% in 2005-2006, down from 6% per year between 2001 and 2005. The WHO cites as reasons a lack of growth by national programs in Africa and the fact that many patients are served by private organizations rather than public — therefore their identification is not recorded. The report notes progress in Pakistan (which is classified as one of the world’s 22 “high-burden” countries with respect to TB), citing increased case identification rates and decreased default rates, resulting in cure rates near their target of 85%. Yet, the scope of the problem remains a challenge: WHO estimates that in Pakistan the incidence of TB (including TB/HIV cases) is 181 cases per 100,000 people per year.
Four years ago, The Asia Foundation (TAF) joined the fight against TB in Pakistan. With a grant from The Global Fund to Fight Aids, Tuberculosis, and Malaria, and in partnership with Pakistan’s National TB Control Program, Provincial, District and Sub-District-level government, nonprofit organizations, and the communities they serve, TAF is working in 20 districts in all four provinces to increase rates of detection and help cure TB.
The work is very grassroots: trainers conduct interactive video sessions to raise awareness and explain treatment in all the affected communities. One crucial outcome of these sessions is identification and referral of suspected cases of TB; another is that people in these communities often become volunteers themselves to help their own neighborhoods fight TB. They assist in identifying and referring possible TB cases and visit homes to ascertain whether treatment is being followed. New aspects of the TAF program that are currently being piloted include offering social services in addition to medical services, and introducing food incentives.
Because no issue exists in a vacuum, the program seeks to directly involve political leaders and government official in the fight against TB. This is key, as it is these national systems that ultimately will be in place long term. Many problems can be addressed in the way citizens access public services. Now, once TB patients are identified, TAF refers them to Pakistan’s health system and provides forums for people to discuss any difficulties in accessing health services from the government. This information is then relayed to government authorities so they can act. By working this way, the hope is that health programs will be more responsive to broader governance concerns in ways that can positively impact the delivery of services.
Pakistan has borne witness to events in the last year which undoubtedly impact its national consciousness and future. However, it should not be forgotten that the unseen day-to-day work of people like those that volunteer to fight tuberculosis in their communities has an important impact on the lives of people. This is a story worth telling.
Jon Summers is The Asia Foundation’s Country Representative in Pakistan, and can be reached at email@example.com; Dr. Shabir Chandio is a Senior Program Officer at the Foundation in Pakistan.
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