Introduction:

Provincial TB Control Program Punjab is a vertical program, under administrative control of Primary & Secondary Healthcare Department and directly supervised by the Director General Health Services Punjab. The program was started in 2004 as a project and PC-1 was developed. The Program has been regularized and shifted from development to non-development mode w.e.f. July 2021. 

The estimated incidence of all types of TB cases is 259/100,000 population. The Program works to achieve the commitments made through Sustainable development Goals (SDGs) and the End TB strategy.

Organogram:

Diagnostic Facilities
	Microscopy	Gene Xpert	BSL-II Labs	BSL-III Labs
Total	757	171	7	3
Public	560	164	4	3
Private	197	04	1	0

Key Achievements:

1. TB case detection much improved. Even better than pre-COVID era. 

• Identification of more than 11000 TB patients through pharmacies which were previously un-notified (finding missing TB cases)
• Screening of a total of 816,148 people for TB in 2021
• Registration of 209,477 TB patients in 2021 and provision of free of cost treatment
• TB Treatment success rate maintained above 94%
• Registration of 1376 patients with Drug Resistant TB in 2021 and provision of free of cost treatment
• Drug Resistant TB Treatment success rate (TSR) maintained above 72% (Global TSR 54%).

1. First inter-sectoral coordination meeting including all vertical programs held in December to develop mechanism for integration and bi-directional patient screening.
2. Multi-Sectoral Accountability Framework implementation in Hafizabad for engagement of sectors, other than health for Tuberculosis – First time done in Pakistan
3. Establishment of specialized center in DHQ Gujranwala in 2021 for treatment of Drug Resistant TB
4. Decentralization of DR-TB Care – initiation at DHQ Khanewal & Vehari in March 2022
5. Distribution of Insaaf Medicine Cards to TB patients. 
6. Launching of e-TB mobile application for TB Case notification from pharmacies. 
7. Development of Provincial Strategic Plan 2020-23
8. PHC Strengthening workshop for Primary Health facility Doctors, Lady Health Supervisors and School Nutrition Health Supervisors
9. Introduction of Monthly Meeting with District TB Coordinators through video Link.
10. Introduction of district Score Care system to gauge district performance. 
11. Capacity Building of Program Directors DHDC and District TB Coordinators on updated National TB Guidelines
12. Capacity Building of District Statistical Officers and Data Entry Operators on DHIS-2.
13. Capacity Building of M&E Officers from districts and Private partners from all over Punjab. 
14. Training of around 3500 district health professionals (doctors / paramedics / Lab staff) on TB guidelines and Lab diagnostics 
15. Upgradation of TB Provincial Reference Labs (Lahore & Multan) for COVID-19 testing. 
16. 06 Biosafety cabinets received from WHO for COVID-19 and TB culture testing. 
17. Un-interrupted treatment of TB and DR-TB patients in COVID-19 lockdown by doorstep delivery of medicine through TTAs.  
18. Integration with Vertical Programs i.e. IRMNCH, HCP, PACP – Roadmap for developing Multi Sectoral Accountability Framework.
19. Collaboration with Pakistan Medical Association, Pakistan academy of Family Physicians etc.

Activities for 2023:

Key Achievements:

1. TB case detection much improved. Even better than pre-COVID era.

Indicators	Target 2021	Achievements 2021	Target 2022  (3 Quarters)	Achievements 2022 (3 Quarters)
Screening of people for TB		816,148		730,254
Registration & treatment of DS-TB patients	236,864	209,477	180,846	194,747
DS-TB Treatment Success rate	92%	93%	93%	93%
Registration & Treatment of DR-TB patients	2520	1376	2598	1442
DR-TB Treatment Success rate	90%	72%	90%	78%

 

2.   First inter-sectoral coordination meeting including all vertical programs held in December to develop mechanism for integration and bi-directional patient screening.

3.      Multi-Sectoral Accountability Framework implementation in Hafizabad for engagement of sectors, other than health for Tuberculosis – First time done in Pakistan

4.      Establishment of specialized center in DHQ Gujranwala in 2021 for treatment of Drug Resistant TB

5.      Decentralization of DR-TB Care – initiation at DHQ Sheikhupura, Khanewal, Vehari & Chakwal in March 2022

6.      Distribution of Insaaf Medicine Cards to TB patients.

7.      Launching of e-TB mobile application for TB Case notification from pharmacies.

8.      Development of Provincial Strategic Plan 2020-23

9.      PHC Strengthening workshop for Primary Health facility Doctors, Lady Health Supervisors and School Nutrition Health Supervisors

10.   Introduction of Monthly Meeting with District TB Coordinators through video Link.

11.   Introduction of district Score Care system to gauge district performance.

12.   Capacity Building of Program Directors DHDC and District TB Coordinators on updated National TB Guidelines

13.   Capacity Building of District Statistical Officers and Data Entry Operators on DHIS-2.

14.   Capacity Building of M&E Officers from districts and Private partners from all over Punjab.

15.   Capacity Building of BHU Doctors, Paramedics, LHS & LHW on presumptive identification and sputum collection in 12 Districts.

16.   02 days Training of Trainers on TB management at Provincial Level (TOT)-DHDC Managers

17.   01 day training on DHIS and EMR

18.   01 days trickle down training on EMR

19.   Training of around 3500 district health professionals (doctors / paramedics / Lab staff) on TB guidelines and Lab diagnostics.

20.   Rider model for transportation from BHUs to RHCs and THQs.

21.   Upgradation of TB Provincial Reference Labs (Lahore & Multan) for COVID-19 testing.

22.   06 Biosafety cabinets received from WHO for COVID-19 and TB culture testing.

23.   Renovation of BSL-III Lab Lahore.

24.   Un-interrupted treatment of TB and DR-TB patients in COVID-19 lockdown by doorstep delivery of medicine through TTAs.  

25.   Integration with Vertical Programs i.e. IRMNCH, HCP, PACP – Roadmap for developing Multi Sectoral Accountability Framework.

26.   Collaboration with Pakistan Medical Association, Pakistan academy of Family Physicians etc.

IEC Material:

Activities in Pipeline:

1.    Initiation of Preventive Therapy in close contacts of TB patients.

2.    Orientation session in collaboration with WHO in District Rawalpindi & Lahore on Preventive Therapy.

3.    Expansion of Decentralized DR-TB Clinics in 4 more Districts.

4.    Case based real time entries of patients on EMR developed in collaboration of HISDU.

5.    Active Case finding through Mobile X-ray vans in Lahore Division.

6.    LHW engagements for TB presumptive identification in 12 Districts of Punjab.

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