LAHORE: The Global Fund’s efforts to fight tuberculosis in Pakistan have suffered a blow after it has been reported that 221,000 TB patients including 125,000 in Punjab are ‘missing’.

A majority of them have either gone to quacks or remained untreated, putting a healthy population at risk of the highly infectious disease.

Moreover, there is a very alarming situation in Punjab where it has been warned through an official letter (on July 11) about suspension of global grant to its provincial TB Control Programme for utilisation of pathetically low funds - currently 43pc burn rate.

Faces threat of global grant suspension

The prime goal of the Global Fund is to trace/detect TB patients in Pakistan, put them on medicines and provide data to the organisation to stop its spread in the country, an official told Dawn. He said the Global Fund had released US $3,246,333 grant to the Punjab government in January this year but the programme could spend US $1,409,805 during the last seven months.

The official figures say out of the 940 positions created all over the country under the programme funded by Global Fund, 174 (mostly in Punjab) are vacant since the start of the grant in January 2018. The hiring was to be made against created slots for a three-year contract under the New Funding Request (NFR).

The Ministry of Economic Affairs Division, Islamabad, had signed an agreement with the Global Fund which had promised $142 million grant for Pakistan to dispense the same in three years to fight TB.

The official figures/documents portray a very dismal picture and have irked the international organisation making huge spending to support Pakistan to fight tuberculosis.

The performance of Punjab’s TB Control Programme is said to be pathetic after the controversial appointment of head Dr Aamir Nazir in January last. The appointment was made allegedly in violation of the criteria defined in the PC-I and many experts were removed before termination of the contract.

Out of the 287 positions created for the Punjab TB Control Programme, 140 are vacant since January 2018, say the documents. The documents say 14 slots are vacant in Sindh, 17 in Balochistan, one in Khyber Pakhtunkhwa and one each in the two NGOs operating in Pakistan.

Similarly, the Punjab government had approved PC-I in 2017 creating 60 slots separately for the same programme for three-year period. Forty of the slots are vacant since then making the programme practically dysfunctional.

According to the PC-I, the then Punjab government had approved Rs3,498 million for three years. A sum of Rs1,100 million each was to be provided every year to achieve the targets. For the fiscal year 2018-19, the government released Rs398 million and the programme failed to spend the given funds till July this year.

Out of Rs398 million, Rs10.17 million were also given under the head of the medicines which could not be purchased during that period.

The missing TB patients have been a main area of concern for the international financing and partnership organisation and the issue came under discussion at a meeting in Geneva where the figures of disease burden in Pakistan, especially Punjab, were shared, the official said.

He said the World Health Organization (WHO) guidelines say the bacteria that causes TB spreads through the air when a person with disease coughs, speaks, or spits. A TB patient (if not traced and treated timely) may spread TB to 15 people of immediate contact yearly when they breathe in the bacteria and become infected.

According to the Global Fund, Pakistan with an estimated 510,000 new TB cases emerging each year ranks fifth among high-burden countries worldwide. The country is also estimated to have the fourth-highest prevalence of multidrug-resistant TB globally.

Pakistan is one of the 13 partner countries in a Global Fund TB catalytic investment initiative aimed at finding and treating 1.5 million missing cases of TB by the end of 2019.

The federal ministry’s July 11 official letter has given Aug 15 deadline to Punjab to avoid suspension of Global Fund’s grant for the TB Control Programme for failure to address issues pointed out by the Centre.

It has detected several other “blunders” in the programme and addressed the senior health mangers including health secretary, programme director and the director general health services. It made serious accusations stating that Punjab’s programme was not reporting data of TB patients at the District Health Information Software (DHIS-II) since January 2019.

Currently used in more than 60 countries around the world, the DHIS is an open source software platform for reporting, analysis and dissemination of data for all health programmes, developed by the Health Information Systems Programme (HISP), to curb fake reporting through manual system.

Punjab also faced criticism for not submitting Progress Update and Disbursement Request (PUDR), a mandatory condition of the Global Fund to disburse further grant to the province, states the report.

Punjab TB Control Programme Director Aamir Nazir clarified his position claiming that the provincial government was directly responsible for the 138 vacant positions. He said the programme suffered owing to the ban on recruitments in Punjab.

About the missing TB patients, Dr Aamir said the programme was facing challenges to address this highly significant issue. He said the Global Fund was also responsible to some extent as it was supposed to prepare sites for the programme management of drug resistant tuberculosis (PMDT) without which they are facing issues to hit targets in Punjab.

Similarly, Dr Aamir claimed that he had strong reservations on the authenticity of the provenance of the TB disease that showed the huge number of cases in Punjab. When reminded that the survey was done by the National TB Control Programme with the technical assistance of the global organisations, he said, even then he had some doubts and the authorities must plan a new survey to reach an exact number of TB patients.

Published in Dawn, July 22nd, 2019