This is an opinion paper on the process leading to the initiation of a model multisectoral accountability framework (MAF) project in the coastal district of Sindh. Dopasi Foundation in collaboration with Stop TB Partnership Pakistan conducted several meetings with senior policymakers of Sindh province drawing their attention towards the international commitment for establishing a Multisectoral Accountability Framework (MAF) to control TB. Thereafter, operational meetings were held with key government functionaries and district Badin. Subsequently the first sensitization meeting of stakeholders comprising of the district MAF team was convened and a problem analysis encompassing the current case notification, intersectoral challenges were drawn from the discussion these includes; likely benefits, zakat provision, mapping of community services, augmenting the role of drug inspectors, sputum transport and various dimensions related to the control and elimination of TB was conducted. This problem analysis, MAF implemented in the district and found effective in case detection likewise; during 2020, 2,519 TB cases were notified as compared to 2,464 in 2019, depicting a nominal increase, despite an overall decline of 17% in TB notifications owing to COVID-19 nationwide, while promoting self-reliance, pooling of resources and comparative advantages of each partner. This extremely cost-effective exercise based on WHO principles showed promising results, although the COVID-19 related disruption rendered a proper program evaluation impracticable. It is recommended that the government leaders need to work effectively with ministerial officials, civil society and affected communities, parliamentarians, private sector and academia, involved in diverse sectors including health and social protection, justice, labor, among others through this effective MAF.

Background: The National TB Control Program and its partners advocated for a caucus of parliamentarians to galvanize political support for tuberculosis control. The process urged political representatives from all parties to join the call to action for a TB-free Pakistan by supporting timely decisions and adequate resource allocation for TB prevention and cure. Methods: National TB Control Program Pakistan and Stop TB Partnership ensured an effective advocacy stream of activities leading to formulating a parliamentary caucus. The forum has held several meetings to support political decisions for TB control and cure in the country. Results: A total of 13 Parliamentarians initially agreed to be a caucus member, attended its launch and two follow-up meetings, and supported decisions. The parliamentarians signed a declaration to address the barriers in providing TB diagnostic and treatment care across the country, irrespective of any discrimination.

This paper reviews the overarching strategies, implementation rigour, achievements, strengths and weaknesses, and challenges and opportunities faced by Pakistan’s National Tuberculosis Control Program (NTP) during the period 2011-2020. NTP’s annual reports, Global Tuberculosis (TB) Report (2019 & 2020), peer-reviewed journal articles, NTP and NSP plans, along with voluminous programmatic data reviewed. Pakistan’s national and provincial tuberculosis control program has treated around four million people and gained more than 90% treatment success. Iterative planning, partnership with the private sector, strategic advocacy, communication, social mobilization, operational research, and increasing domestic funding are essential to improving case notification and treatment success. Lack of adequate political commitment, over-and under-reporting, lack of a systematic mechanism for sputum transport, and inefficient coverage from the private sector are the main areas for improvement. Local and national strategic planning in funding, program development, and implementation is imperative from a multisectoral perspective for ending TB. Ensuring universal health coverage, treating drug-resistant cases, maintaining and strengthening the national health information system, and upgrading the vital registration system is the cornerstone for ending TB.

Background: The paper presents the salient features of a comprehensive treatment package for drug resistant tuberculosis (DR-TB), its adaptation and implementation in two indoor care hospital settings in Pakistan, and lessons learned from this implementation.  Methods: A pilot study was undertaken on a group of 100 patients at two Programmatic Management of Drug-Resistant TB (PMDT) sites. Fifty patients each were selected from the Samli Sanatorium Murree and the Lady Reading Hospital, Peshawar by the National Tuberculosis Control authorities, and delivered a comprehensive package of services, including psychosocial and food support. Data were collected using standard TB tools and surveillance indicators. The results were compared between intervention and a historical cohort of DR-TB patients.  Results: Among the total 100 patients, the treatment success rate was 88%, the failure rate was 4%, while there were 7% deaths. A patient was transferred out while none were lost to follow-up, indicating much improvement over the historical cohort. Patients ranked the economic support, free medicines and nutritional support as most helpful, while majority of providers found the intervention sustainable.  Conclusion: A comprehensive package including the psychosocial support can be crucial in enhancing DR-TB outcomes. Regular interaction with patients and improved nutrition leads to improved treatment adherence, while capacity building of psychologists and home visits can further benefit the DR-TB patients leading to their cure.

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