Health for All is a biding for all nations under the Alma Ata Declaration, the provision of quality healthcare services to the people of Pakistan, Pakistan is struggling with a double burden of disease, which means that the country is facing a significant burden of infectious diseases alongside an increasing epidemic of non-communicable diseases. Hepatitis C is a significant public health concern in Pakistan, with the prevalence rate currently standing at 7.5% with 10 million infected cases, out of 60 million hepatitis C cases globally. The impact of the disease on the population is significant, and it poses a serious challenge to the nation's healthcare system. Viral Hepatitis, though infectious, can also transition into chronic illness. i.e. liver cancers, increasing the financial burden on both our public and health systems. However, the Government of Pakistan, with the highest political will has launched an ambitious initiative to eliminate Hepatitis C infection in the country. This initiative aims to screen, test, and treat at least 50% of the eligible population, a step towards significantly reducing the burden of Hepatitis C in Pakistan.

Pakistan has the highest prevalence of Hepatitis-C in the world, surpassing Egypt, which successfully eliminated the disease through a concerted national effort. "Our goal is to replicate Egypt's success by ensuring mass screening, awareness, and access to effective three-month oral treatments."

Government of Pakistan has taken a crucial step by investing in the hepatitis C program which will help avert significant morbidity and mortality due to complications as well as financial burden on the health systems Hepatitis C Elimination Program as Public Sector Development Programme (PSDP) project in collaboration with all four provinces. Timely screening and treatment are essential in preventing liver failure and liver cancer among affected individuals.

This initiative aims to ensure early detection through widespread screening, PCR testing, and treatment - all provided free of cost.

The project is set to run from July 2024 to June 2027 with domestic funding as a PSDP project covering all four provinces, ICT and federating regions. The initiative targets a substantial portion of Pakistan’s population, focusing on individuals aged 12 years and above, with a goal to screen and treat 50% of the eligible population (approximately 82.5 million people).

The success of this initiative hinges on a well-coordinated effort between the federal and provincial governments. The federal government will play a pivotal role by providing essential commodities for the program. This includes 100% of the Rapid Diagnostic Test (RDT) kits for screening, 30% of the testing (PCR), and 50% of the medicines required for treatment. Additionally, the federal government will establish a Project Management Unit (PMU) to oversee the implementation of the program, ensuring that key performance indicators (KPIs) are met and providing the necessary support to the provinces.

The provincial governments will strengthen health facilities to enable effective screening, testing, and treatment. They will be responsible for training the necessary healthcare workforce, including doctors, nurses, laboratory technicians, and data entry officers. Provinces will also take the lead in raising public awareness about Hepatitis C, ensuring that communication strategies are in place to promote prevention, control, and treatment. The provinces will be tasked with deploying human resources where needed and covering the treatment costs for 50% of positive cases.

Since the devolution of health services in 2011, provincial governments have been managing hepatitis control programs. These programs are already operational and have made strides in addressing Hepatitis C and B. Key initiatives include:

• Free screening, testing, and treatment services for the general population
• Hepatitis B vaccination (except for infants and children under five years of age)
• Awareness campaigns aimed at the prevention and control of viral hepatitis

The provinces, including Punjab, Sindh, Khyber Pakhtunkhwa (KP), and Balochistan, have established hepatitis clinics across various healthcare facilities, such as district and teaching hospitals, rural health centers, and dispensaries. These clinics offer screening, PCR testing, and treatment. For example, Punjab alone has 243 hepatitis clinics in place. Additionally, waste management systems have been set up at hospitals, and vaccination and treatment camps are organized to reach underserved areas, including prisons and refugee camps.

Federal and Provincial Collaboration for Success

A crucial aspect of this program is the coordination between federal and provincial authorities. The Prime Minister will chair a National Task Force (NTF) to ensure that the Hepatitis C elimination initiative stays on track. The Technical Committee, led by experts Prof. Saeed Akhtar and the highest level leadership from MONHSRC, will provide strategic oversight and guidance on program implementation. A well-defined procurement and implementation plan will ensure that the program is executed effectively, with ongoing monitoring and evaluation to track progress.

The development of a National Electronic Medical Records (EMR) system for Hepatitis C is a significant innovation that will facilitate better management and reporting of patient data, ensuring that the program is not only comprehensive but also efficient and transparent.

Challenges and Solutions

One of the primary challenges in addressing Hepatitis C in Pakistan is the need to expand screening, testing, and treatment services, especially in remote areas. Additionally, tackling stigma and misinformation about Hepatitis C is a key component of the public health strategy. The collaboration between federal and provincial governments, supported by robust funding, training, and awareness efforts, will be crucial in overcoming these challenges.

The provision of free screening and treatment, combined with a strong communication campaign, will help to ensure that a larger portion of the population is reached. Further, engaging the private sector and ensuring that healthcare workers are well-trained and equipped with the necessary resources will contribute to the program's overall success.

Recently program has been successfully piloted in two districts of Gilgit Baltistan District Shigar - UC Markunja District Diamer - UC MC ChilasThe Hepatitis C elimination initiative in Pakistan marks a significant step forward in the country’s battle against viral hepatitis. With a well-coordinated effort, sufficient funding, and the active involvement of both federal and provincial governments, the goal of eliminating Hepatitis C in the country by 2027 is achievable. By reaching out to vulnerable populations, improving healthcare infrastructure, and promoting awareness, this initiative has the potential to reduce the prevalence of Hepatitis C and improve the health outcomes of millions of Pakistanis.

Early detection can save lives.

Acknowledgement:

Director General Health (PD) and DD program I MONHSRC.

By ISID Emerging Leader, Dr. Nadia Noreen