RESUMEN
Substantive progress has been achieved in advancing emergency response interventions during disasters including assistance of internally displaced persons [IDPs]. Explicit operational technical guidelines and management strategies have been successfully applied through the [cluster approach]. In 2008-09 armed conflict in several districts of the Khyber Pakhtunkhwa [KP] province and the Federally Administered Tribal Areas [FATA] of Pakistan resulted in over 2.7 million IDPs. This report describes the response by the Pakistan government, assisted by the hosting populations and humanitarian partners, to deal with the crisis using the cluster approach to ensure the health protection of the IDPs, particularly mothers and children
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Protección a la Infancia , Desastres , Urgencias Médicas , Atención a la Salud , Promoción de la Salud , Refugio de Emergencia , Salud MaternaRESUMEN
Malaria is endemic in Pakistan and constitutes a national health priority However the parasite and vectors are showing resistance to common antimalarial drugs and insecticides. The provinces of Balochistan, Sindh and Khyber Pakhtunkhwa and the Federally Administered Tribal Areas have the highest malaria burden. Districts and agencies bordering Afghanistan and Islamic Republic of Iran account for 37% of the malaria burden with an annual parasite incidence [API] exceeding 4.5/1000 population per year. Moreover, there has been a growing risk of Ptasmodiumfatdparum malaria incidencein areas where previously P. vivax was predominant New and effective control tools have been introduced such as rapid diagnostic tests, artemisinin-based combination therapy and long-lasting insecticide-treated nets. This paper reports the progress achieved in the implementation of a malaria control strategy in Pakistan, shares major outstanding challenges and unearths the potential of performance-based implementation for advancing resource mobilization and collaborative partnerships
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Malaria , Incidencia , Prioridades en SaludRESUMEN
Of the 10 million annual deaths of children below five years of age, four million are neonates. Pakistan's neonatal mortality rate of 54/1000 live births, which accounts for 57% of the under-five mortality, the contraceptive prevalence rate stagnating at 30%, the meagre number of deliveries assisted by skilled birth attendants [39%] and the low coverage of cost-effective child survival interventions hamper the achievement of Millennium Development Goals [MDGs] 4 and 5. The Government launched the national maternal, neonatal and child health programme in 2007 to promote access to evidence-based cost-effective interventions; strengthen district health system capacities; empower communities; expand the community midwives' cadre; and promote utilization of essential services. This paper reviews the implementation of the programme and the likelihood of attaining the MDG4 and 5 targets by 2015, and provides strategic directions for scaling-up programme implementation
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Servicios de Salud del Niño , Atención Prenatal , Promoción de la Salud , Mortalidad Perinatal , Servicios de Salud MentalRESUMEN
Pakistan's Expanded Programme on Immunization [EPI] performance has a significant impact on global and regional immunization indicators such as poliomyelitis eradication, maternal and neonatal tetanus and measles elimination. Despite significant efforts by the Government and partners, Pakistan's immunization indicators have not met the expected benchmarks. Barriers to achieving immunization goals are related to limited access to immunization services, lack of parent awareness and weak management. With sustained Government commitment, predictable partner support and by adopting effective strategies, Pakistan can achieve the immunization targets set at the regional and global level and make strong progress towards achieving Millennium Development Goal 4. This paper reviews EPI coverage targets, constraints, costs and resource allocation, and financial impact of suboptimal performance, and indicates the way forward to overcome these challenges
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Accesibilidad a los Servicios de Salud , Servicios Preventivos de Salud , Concienciación , Programas de InmunizaciónRESUMEN
Maternal and childhood morbidity and mortality are high in Pakistan and health disparities exist. Multivariate logistic regression analysis of the Pakistan Demographic and Health Survey database 2006-07 was performed. There was an excess of 25 neonatal, 34 infant and 41 under-five deaths per 1000 live births in the poorest quintile of wealth index compared with the richest. Women in the richest quintile had a 35%, 38% and 20% higher probability of getting prenatal care, delivery by skilled provider and emergency obstetric care, respectively. Pakistan needs to enhance social equity so development benefits can accrue to the underprivileged by introducing social protection interventions so that those in the informal sector are not excluded from accessing health care, scaling-up poverty reduction strategies and promoting intersectoral action. This study assesses the independent impact of wealth status, as determined by a validated index, on health outcomes in Pakistan
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Factores Socioeconómicos , Mortalidad Materna , Mortalidad del Niño , Accesibilidad a los Servicios de Salud , Evaluación de Procesos y Resultados en Atención de SaludRESUMEN
The UN Secretary-General constituted a high-level panel on system-wide coherence in 2005 within the areas of development, humanitarian assistance and the environment. The panel adopted [Delivering as One] as a slogan for its coherence initiative. Pakistan was among eight pilot countries implementing this reform initiative. Five joint programmes were developed, on health and population; agriculture, rural development and poverty reduction; disaster risk management; education; arid environment. Fourteen UN agencies supported the health and population joint programme and participated in its implementation. Although confronted by many challenges, the positive results of the joint programmes confirmed the advantage of Delivering as One over the past scenarios of fragmentation, duplication and incoherent government and UN strategic operations. The paper shares the accomplishments of the health and population sector including its ability to harness the power of intersectoral collaboration and prospectively concentrate human and financial resources around the strategic national priorities
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Naciones Unidas , Población , Prioridades en Salud , Reforma de la Atención de Salud , Implementación de Plan de Salud , Medio Ambiente y Salud PúblicaRESUMEN
The October 2005 earthquake in Pakistan created a new generation of [persons with disabilities] [PWDs] in the affected districts. A total of 741 people suffered spinal injuries while 713 underwent amputations. A comprehensive response was launched jointly by the Ministry of Health, Earthquake Reconstruction and Rehabilitation Authority and the World Health Organization involving rescue and recovery, hospitalization, surgical interventions, building of infrastructure, development of technical guidelines to improve quality of care, human resource deployment and training. The first national megaproject for institutional and community-based rehabilitation [CBR] services was launched in the earthquake-affected areas. The institutional management of PWDs is now carried out alongside the CBR programme. This intervention also led to the concept of a national CBR programme. The study aims to identify the post-earthquake situation regarding the magnitude and type of physical disabilities and to highlight the rehabilitative interventions undertaken
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Terremotos , Rehabilitación , Organización Mundial de la Salud , Programas Nacionales de Salud , Personas con DiscapacidadRESUMEN
The bacteriological quality of drinking-water supply of five major urban centres affected by the October 2005 earthquake in Pakistan were assessed in three phases: onset of emergency, during emergency response and post-emergency. A total of 1850 samples were randomly collected from the study area during each phase, and faecal coliforms were detected in 100%, 28% and 91% inBattagram, 81%, 22% and 77% in Mansehra, 100%, 27% and 92% in Rawalakot, 100%, 23% and 65% in Bagh and in 30%, 14% and 5% in Muzaffarabad respectively. Faecal contamination was high during the onset of emergency and post-emergency phases in four out of the five surveyed towns. The organization of a timely emergency response intervention depends on the level of preparedness of local water-supply service providers as well as on their institutional capacities. Bacteriological water-quality improvements in emergencies may not be sustained unless complemented by a proper exit strategy
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Urgencias Médicas , Terremotos , Microbiología del Agua , Abastecimiento de AguaRESUMEN
Blindness and visual impairment are major causes of noncommunicable diseases in Pakistan. Two national population-based blindness surveys conducted in 1988 and 2002-04 demonstrated a reduction in prevalence of blindness from 1.78% to 0.9% with a significant drop in cataract blindness as a result of accelerated nationwide interventions and eye care integration in primary health care. In addition, between 2006 and 2008r 88 facilities were upgraded as a result of the national eye health programme. These measures resulted in a 279% increase in eye outpatient attendances and a 375% increase in eye surgeries performed. Investment in human resources development and policy change contributed significantly to the sustainability of the programme. Key challenges facing the programme include aligning national eye health strategies with health system strengthening informed through health systems research. This gaper attempts to document this extraordinary success
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Planes de Sistemas de Salud , Ceguera , Baja Visión , Atención Primaria de Salud , Programas Nacionales de Salud , Prestación Integrada de Atención de SaludRESUMEN
Pakistan has shown drastic expansion oftuberculosis [TBTcareduring the past 10 years, increasing case notifications from 11 050 in 2000 to 248115 in 2008. Over 1 million TB patients have been cared for since 2000, with a treatment success rate of 91% in 2007. This paper examines the strategic decisions and infrastructure improvements underlying this achievement, such as the implementation of universal DOTS coverage, expansion of the laboratory network, effective drug management systems, improved communication strategies, and inclusion of private practitioners, laboratories and hospitals in the TB control programme through the public-private mix strategy. The paper also outlines challenges faced in further expanding TB control within the private sector and parastatal health care institutions; strengthening the laboratory network for diagnosis of drug-resistant TB; and ensuring uninterrupted supply of quality anti-TB drugs, ail requiring continued and coordinated technical and donor support
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TuberculosisRESUMEN
Pakistan faces a human resources for health [HRH] crisis. A cross-sectional survey was conducted to overview frontline health workers. A total of 750 health facilities were surveyed across Pakistan. The median estimate of public sector health care workers in the district health system in Pakistan is 417 288, including 46 153 doctors and 41 032 nurses. Another estimated 20 000 doctors work in public sector tertiary care hospitals across the country. A total of 3549 health care workers were interviewed regarding job satisfaction and work environment. The private sector had better work environment scores compared with the public sector. Policy dimensions showed an absence of robust policies in practice. The public sector is inadequately staffed and job satisfaction and work environment need improvement. HRH crisis countries should share experiences, and developmental partners should support them in overcoming the HRH crisis
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Personal de Salud , Sector Privado , Sector Público , Estudios Transversales , Satisfacción en el Trabajo , Recursos en SaludRESUMEN
There is growing renewed trust in primary health care as the best approach for ensuring equity in the delivery of essential health services. However, Pakistan with one of the most widely spread district health system networks in the region, has not delivered at the expected capacity. A series of health system reform agendas are now stipulated which include the promulgation of an essential health service package, public private partnerships and a people-centred focus. Nevertheless, success of these reforms will hinge on the ability of the three tiers of the government and other stakeholders to work togetherto improve the overall performance of the district health system. This paper provides an overview of thedistrict health system infrastructure and organization of primary health care services in Pakistan, the evolving governance pattern and the operational significance and merit of health system pillars for effective service implementation
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Planes de Sistemas de Salud , Planificación en Salud Comunitaria , Atención a la Salud , Atención Primaria de SaludRESUMEN
The disease early warning system [DEWS] was introduced in the immediate aftermath of the 2005 earthquake in Pakistan, with the objective to undertake prompt investigation and mitigation of disease outbreaks. The DEWS network was replicated successfully during subsequent flood and earthquake disasters as well as during the2008-09 internally displaced persons'crisis. DEWS-generated alerts, prompt investigations and timely responses had an effective contribution to the control of epidemics. Through DEWS, 1360 reported alerts during 2005-09 averted the risk of disease outbreaks through pre-emptive necessary measures, while the 187 confirmed outbreaks were effectively controlled. In the aftermath of the disasters, DEWS technology also facilitated the development of a disease-surveillance system that became an integral part of the district health system. This study aims to report the DEWS success and substantiate its lead role as a priority emergency health response intervention
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Brotes de Enfermedades , Terremotos , Medición de Riesgo , EpidemiasRESUMEN
Five major disasters in Pakistan affected close to 8 million people from 2005 to 2009. The 2008-09 humanitarian crisis in Khyber Pakhtunkhwa and the Federally Administered Tribal Areas [FATA] of Pakistan resulted in 2.76 million internally displaced persons [IDPs], of whom 88% were off-camp IDPs hosted by the local population. The service delivery challenges posed by the IDPs, their sparse geographical distribution and phased displacement were managed through a successful health response strategy, which focused on 13 major interventions supplemented by a set of standard guidelines for field implementation. This study evaluates the process and results attained by this coordinated health cluster strategy that has guided the mobilization and implementation of a colossal humanitarian response to an unprecedented crisis in Pakistan's history
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Atención a la Salud , Altruismo , Sistemas de Socorro , DesastresRESUMEN
The Health Services Academy has launched a 12-month postgraduate diploma course in medical entomology and disease vector control. The objective is to create a core of experts trained to prevent and control vector-borne diseases. The course is a response to the serious health and socioeconomic burden caused by a number of vector-borne diseases in Pakistan. The persistence, emergence and re-emergence of these diseases is mainly attributed to the scarcity of trained vector-control experts. The training course attempts to fill the gap in trained manpower and thus reduce the morbidity and mortality due to these diseases, resulting in incremental gains to public health. This paper aims to outline the steps taken to establish the course and the perceived challenges to be addressed in order to sustain its future implementation
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Educación de Postgrado en Medicina , Curriculum , Vectores de Enfermedades , EntomologíaRESUMEN
Pakistan is seriously confronted by many complex and difficult environmental challenges related to air, water, soil, forests and food including issues such as climate change. The close link between environment and health is neither well understood nor appreciated. The annual cost of environmental degradation in Pakistan has been estimated to be around US $ 4.0 billion orat least 6% of the country's GDP. Up to 35% of the burden of disease is attributable to environmental hazards and risk factors and most of this burden is preventable. A systematic process for identifying environmental health needs and issues as well as the efforts made by the government of Pakistan and the World Health Organization in establishing and launching an environmental health protection unit are described. Also presented are the mission, functions, structure [operational and logistical] and technical requirements as well as sustainability aspects of the environmental health protection unit
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Medio Ambiente y Salud Pública , Evaluación de Necesidades , Organización Mundial de la Salud , Cambio Climático , Factores de Riesgo , Salud AmbientalRESUMEN
Smokeless tobacco [ST], wtclefy used in Pakistan, poses a high risk for oral cancer. Our hospital-based data illustrate that oropharyngeal cancer [9.9%] is the second leading malignancy after breast cancer [16.1%], and is significantly higher than in other Member States of the World Health Organization's Eastern Mediterranean Region. Urdu-speaking communities had a proportionately higher rate of oropharyngeal cancer [20.4%], followed by Balochis [19.9%], Sindhis [16.8%], Punjabis [11.7%] and Pashtuns [9.6%]. Association of oropharyngeal cancer with ST use was four times higher relative to no history of tobacco use after adjusting for age, ethnicity and gender. Our findings also show a predominance of this cancer among males relative to females and one-third of the reported cases occurred among individuals under 40 years. These findings have significant social impact, indicating the need for urgent intervention against the use of ST
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Neoplasias Orofaríngeas , Factores de Riesgo , Tabaco sin HumoRESUMEN
A prevalence survey on hepatitis B and C infections was carried out to obtain national estimates and assess epidemiological dynamics and underlying risk factors. Overall prevalence of hepatitis B surface antigen [HBsAg] and anti-hepatitis C virus [HCV] of 2.5% and 4.8%, respectively, reflected a combined infection rate of 7.6% in the general population, consistent with an ongoing high burden of chronic liver disease [CLD]. There was significant association of these viral infections with a range of risk factors led by reuse of syringes. These findings validate currently implemented strategies by the national programme for the control of hepatitis viral infections, including universal vaccination of newborns and high-risk groups, support of auto-disable syringes, promotion of infection control and patient safety, public health education, and majiageprient of needy CLD patients as a poverty-reduction health intervention
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Hepatitis B , Prevalencia , Encuestas Epidemiológicas , Factores de Riesgo , Educación en Salud , VacunaciónRESUMEN
Pakistan, with Nigeria, India and Afghanistan, is one of the four remaining polio endemic countries in the world. Since the start of polio eradication initiative in 1994, the country has succeeded in reducing the number of polio cases from an estimated 20,000 annually to 89 in 2009. Furthermore, persistent transmission is largely localized to three transmission zones in which ten of the fifteen highest risk areas are situated. Insecurity, operational issues, governance lapses, low routine immunization coverage, inadequate trickle-down of the political commitment existing at the national level to subnational level and extensive population movement are the main barriers to the process. A robust strategicplan was developed for 2010-2012 encompassing district-specific plans and focused strategy on securitycompromised areas, performance-based payment, independent monitoring, attention to migratory populations, social mobilization, and strategic cooperation with Afghanistan. This will provide Pakistan a strong and imminent opportunity to interrupt polio virus circulation
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Poliomielitis , Planificación en Salud , Vacunas contra Poliovirus , Emigrantes e InmigrantesRESUMEN
Organ transplantation must be viewed in relation to the prevailing cultural, religious and socio-economic conditions of a nation. Over the past two decades, Pakistan has emerged as one of the largest centres for commercial renal transplantation. Government efforts, supported by professional associations, civil society organizations and the media, along with World Health Organization technical assistance, have led to the development of legislation regulating this practice and curbing organ trade in conformity with international guidelines. Although only two years have passed since the enactment of the law, there is evidence that conditions have significantly improved, raising hopes for ethical and safe organ transplantation in Pakistan. This study reviews the salient features of the legislation and lists the foreseeable evolving challenges and opportunities