INTRODUCTION:
The Government of Pakistan is committed to providing comprehensive health coverage to its people and embarked upon the efforts to strengthening health services through expanding key national preventive and promotive interventions. Hepatitis has become a major public health issue in recent years. Globally 385 million people infected with Hepatitis B, 200 million people infected with Hepatitis C, 85% gets chronic infection. The Annual Incidence rate of
HCV is 3-4 Million; Disease specific death rate is 1Million. In Pakistan the Current prevalence rate of Hepatitis B is 3-4% (6 Million infection) and Hepatitis C is 5-6% (7.5 Million infection). In NWFP/FATA all five distinct types of hepatitis viruses; A-E are prevalent.
Current estimated prevalence of Hepatitis B is (0.7852 Million in NWFP & 0.124 Million infections in FATA) and Hepatitis C is (1.1778 Million in NWFP & 0.19 Million infections in
FATA). Unsafe injection and unhygienic invasive practices (Dentists, Barbers, Beauty Parlors,
Ear and Nose Piercing etc.) apparently appears to be the major causes of the disease in the
NWF Province. The overall social and economic impact of chronic Hepatitis B&C are devastating. Sporadic epidemics of Hepatitis E are being encountered in all geographical areas of the NWF Province. The Prime Minister Program for Prevention and Control of Hepatitis in
Pakistan was launched on August 29, 2005 to substantially decrease the prevalence, morbidity and mortality due to viral hepatitis in the general population by utilizing the existing health infrastructure. The total cost of the program is Rs.2.59 billion for financial years 2005 till 2010.
GENERAL OBJECTIVES
The program aims to achieve 50 percent reduction in Hepatitis prevalence by year 2010.
SPECIFIC OBJECTIVES
1.
Establishment of Hepatitis Surveillance System.
2.
Provision of drugs for Hepatitis B & C patients.
3.
Provision of Hepatitis B vaccination for high-risk population.
4.
Ensuring safe blood transfusion.
5.
Proper disposal of medical devices including syringes.
6.
Proper disposal of Hospital waste.
7.
Prevention and control of Hepatitis A & E and actualizing the strategy for safe drinking water supply and sanitation.
1

STRATEGIES
1.
Establishment of Screening / diagnosis centers at Teaching & DHQ level Hospitals.
2.
Counseling and treatment facilities of chronic liver diseases at Provincial, District and
Tehsil level hospitals in a phased manner.
3.
Establishment of Reference water quality control laboratories at NIH and at Provincial level.
4.
Improvement of health care provider’s knowledge for prevention of Hepatitis through focus on injection safety.
5.
Safe blood transfusion practices.
6.
Hospital Waste Management System.
7.
Introduction of lab based surveillance system for evidence based policy decisions and creating opportunity for epidemiological research studies mainly community based and establishment of provincial satellite offices of the Provincial Coordinator.
8.
Advocacy and Behavior Change Communication (BCC) Strategy development and execution on persistent basis for prevention of Hepatitis by creating awareness among general masses for adoption of healthy practices.
9.
Strengthening of routine immunization services of Hepatitis B vaccine for infants through provision of immunization against Hepatitis B in children below one year of age by using Expanded Program of immunization infrastructure.
10.
Reduction of vulnerability to Hepatitis in medical staff of public sector and other High
Risk Group.
ACHIEVEMENTS
 In Financial Year 2007-08, 150 Hepatitis C & 150 Hepatitis B Patients have been provided full treatment in the Province & FATA under the Program.
 In Financial Year 2007-08, the Program is extended to 7 Districts & 3 Agencies of the
Province & FATA.

Logistics are being provided to these 10 sentinel sites.

These sentinel sites are established in Teaching, DHQ and AHQ Hospitals of the
Province. These Sentinel sites are Hayat Shaheed Teaching Hospital Peshawar, City
Hospital Peshawar, DHQ Hospital Batagram, DHQ Hospital Hangu, DHQ Hospital
Haripur, DHQ Hospital Shangla, DHQ Hospital Nowshera, AHQ Hospital Wana South
2

Waziristan Agency, Aurakzai & Mohmand Agency. With this expansion 25 Districts and 07 Agencies are covered under the program in the Province & FATA.

In Financial Year 2006-07 the Program was delivering its services to 18 Districts & 4
Agencies of the Province & FATA. These sentinel sites were providing free medical and diagnostics services to Hepatitis patients.

These sentinel sites have notified District viral Hepatitis Management committees and District focal persons.

These centers are equipped with requisite laboratory equipment, reagents and other consumables across the Province & FATA for free diagnostic services to all deserving Hepatitis “B” & “C” patients.

Training to concerned laboratory staff has been conducted to fully operationalze the diagnostic services at all sentinel sites.

9270 Prisoners inmates have been vaccinated against Hepatitis B in all jails in
NWFP.

45405 General public vaccinated against Hepatitis B in different free camps in
Mardan, Swabi, Swat, Kohat, Khyber Agency, Orakzai & Kurram Agencies.

28700 persons of High Risk Group (Health Care Workers, Prison inmates, Patients on long term chronic renal failure, Dialysis, Thalassaemic, Hemophiliac children,
Hepatitis C Patients negative for Hepatitis B) have been vaccinated against
Hepatitis B under the Program.

In Financial Year 2006-07, 3025 Hepatitis C & 332 Hepatitis B patients have been provided full treatment in Province & FATA under the Program.

The Hospital Waste Management System has been established in 9 DHQ/AHQ
Hospitals of the Province. These include DHQ Hospital Mardan, Swat, Upper Dir,
Abbottabad, Kohat, Bannu, DIKhan, AHQ Hospital Landikotal & Parachinar.

To prevent Hepatitis A & E, water filtration plants have been installed in 9
DHQ/AHQ Hospitals with the recommendation of Provincial Government. These
Hospital includes; DHQ Hospital Mardan, Swat, Dir Upper, Abbottabad, Kohat,
Bannu, DIKhan, AHQ Hospital Landikotal & Parachinar.

Behavior Change Communication (BCC) Strategy developed and Campaign going on regularly through Mix Media Approach. Formally started from free medical camp Mardan. Regular Press briefings are conducted regarding program activities
3

on monthly bases through Information Department. The Provincial Govt. has notified a team of experts for awareness campaign properly augmented by advertisements in Newspapers. 14 Advocacy meetings with District Governments,
26 Advocacy meeting with media people, 22 awareness seminars and 15 awareness walks have been conducted under the Program for mass awareness against Hepatitis in the Province.
MAJOR CONSTRAINTS
1.
Capacity building of the office of the Provincial Coordinator in term of
Human Resource and Financial allocation.
2.
Decentralization of Power for effective implementation of Program interventions in the Province.
3.
Direct Supply of the logistic from Federal Govt. to districts (sentinel sites) without intimation to the office of Director General Health Service NWFP.
4.
Poor HMIS and repeated changes in its Data collection tools makes unnecessary delay in reporting progress of various activities to all stakeholders.
5.
Improper provision of Vehicle and non availability of Driver for program vehicle make the Monitoring and Supervision very difficult
6.
Prolong berucratic procedure and no reimbursement of POL, Stationary,
TA/DA, Advertisement bills, M&R bills delay the progress of the program intervention at tactical level.
4