off record
Shaukat Ali Jawaid


Strategic Plan for
control of Hepatitis


Hepatitis-C has become endemic in the country and its prevalence is quite alarming in certain districts of Punjab, Sindh as well as Baluchistan according to the National Health Survey conducted a few years ago. The topic of eliminating Hepatitis was also given due importance and discussed in detail from discovery to preventive strategies as well as treatment modalities at the recently concluded  11th Annual Conference of Pakistan Society for Study of Liver Diseases  (PSSLD) held at Islamabad from December 8-10th 2017. 

Dr. Asad Hafeez DG Health was invited to be the chief guest at the session devoted to elimination of Hepatitis while Federal Secretary in Ministry of Health Regulations was invited to be the chief guest in the inaugural session. However, perhaps due to some other engagements none of them could attend the meeting and one is not sure whether they sent any of their representative to listen to the speakers and brief them about the conference deliberations.

An interesting situation also arose during the session when while speaking on Hepatitis-C Discovery-Elimination Myth or a Reality Prof. Wasim Jafri an eminent Gastroenterologist and founder President of PSSLD also referred to the reported Strategic Plan for control of Hepaitis prepared by the Government of Pakistan and then hastened to add that they do not know anything about it. Later speaking in the same session Dr. Human Qureshi whose presentation was on “Overview of National Hepatitis Strategic Framework (2017-2021) remarked that Aga Khan University was on board while they prepared this plan. She also highlighted the salient feature of this plan including the composition of the working group. I wanted to ask a question to both the speakers to find out who was Right and who was Wrong but the Chairpersons of the session did not allow any discussion and after the session, one of the speakers also left early. Hence, one could not find out the Truth. However, this does indicate some missing link between the Professionals who matter a lot and the Planners in the Government. Hence, the success of any such plan becomes a question mark?

We are living in an era of Professionalism and while preparing any plan, it is extremely important to have meaningful input by the experts, professionals in that particular field to guarantee success of any plan. After devolution of Health, it has become a provincial subject and implementation of health services has become the responsibility of the provincial governments. As such their adequate representation in such working groups is essential and needed but they cannot replace the professional experts whose input while planning any such strategy is crucial. The provincial health departments can be included in these groups as observers but not as decision makers. Once a plan is prepared after thorough discussion among all the stake holders, the implementation could be entrusted to the provincial health departments which is their duty. Many of our health plans have failed to achieve the desired objectives simply because of this missing link, lack of proper communication and interaction between the professional experts and the health planners which is very much evident in the case of National Hepatitis Strategic Framework. It is still time and all those concerned must sit together and try to sort out their differences if any for the sake of national interest.

It must also be remembered that since Pakistan has the second largest number of Hepatitis-C positive population in the world after Egypt, we need to work on war footing. Concentrating on provision of curative services alone was not enough and not affordable as well. We need to put emphasis on preventive strategies. Government of Punjab has taken certain steps in this direction. Punjab Hepatitis Ordinance 2017 stipulates enforcement of preventive measures including ensuring safe blood transfusion and dialysis services, provision of safe blood products etc.  The provincial government has also provided disposable syringes in healthcare facilities besides taking other important steps like proper disposal of medical waste. Other provinces should also follow these initiatives.  Health education and awareness campaign to enlighten the public about the risk factors must be intensified and accelerated. Otsuka, a multinational pharmaceutical concern is running a constant campaign in this regard for the last many years. A number of NGOs are also doing a commendable job not only providing curative services treatment for Hepatitis-C but also organizing awareness campaigns. The Government should also instruct the electronic media to devote some time for health education and creating awareness about risk factors for hepatitis spread.

Members of the medical profession must also realize their responsibilities. It is essential that Hepatitis-C is appropriately diagnosed in time, as early as possible by experienced well trained physicians and then treatment started. Now availability of oral medications has made the task of treatment quite easy and affordable but great care is needed to ensure rational prescribing in proper dosage for appropriate duration with proper follow up so as to avoid relapses and check the development of resistance to these medications. Let us hope the conscious healthcare professionals will discharge their responsibilities by upholding the professional ethics.

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