Comment by Riaz Haq on March 4, 2012 at 10:16pm

Here are excerpts of a report on Pakistan's mobile hospitals serving tribal areas:

PESHAWAR, Mar 4 2012 (IPS) - With no money to see a doctor, Gul Lakhta,50, had resigned himself to blindness when a ‘mobile hospital’ drove into his village in the Bajaur Agency of the Federally Administered Tribal Areas (FATA), on Pakistan’s rugged border with Afghanistan.

“They operated on me the same day. Now, my eyesight is excellent,” says Lakhta, a beneficiary of the Mobile Hospital Programme (MHP) started by the government in 2003 to provide healthcare to people in the war-torn areas of northern Pakistan.

After the United States-led coalition forces toppled the Taliban government in Afghanistan in 2001 its leaders fled across the border to the FATA and adjacent areas, bringing with them their fundamentalist ideology and culture of violence.

Before long, the Taliban had unleashed a campaign of bombings against their hosts, targeting schools, health facilities, markets, government buildings and forces, bringing life to a virtual standstill in the seven agencies that make up the FATA.

“In the process, Taliban militants also destroyed 60 health facilities, forcing patients to travel to Peshawar and beyond to seek treatment for even minor ailments,” said Dr Niaz Afridi, head of the MHP in the FATA.

The government allocates Pakistani rupees 60 million (660,000 dollars) per year for the programme and there are plans to expand it, Afridi said.

These clinics-on-wheels have proved a blessing for the patients because they are well-equipped and manned by dedicated teams. Currently they provide treatment to 90,000 patients annually.

“We also organise medical camps in areas which are inaccessible by the regular medical workers and our medical teams visit the remotest areas to reach the patients and provide diagnosis and treatment free,” Afridi said.

Dr Nauman Mujahid, development officer for health services in the FATA, said the MHP is manned by a staff of 150, including physicians, surgeons, gynaecologists and other specialists like ophthalmologists and dentists.

Each vehicle is equipped with a generator that powers a mobile operation theatre, a dental unit, x-ray and ultrasound machines and laboratories that allow for quick diagnostics.

“Critically-ill patients who require hospitalisation are referred to tertiary care centres in Peshawar,” said Mujahid.

The programme started with the South Korean government donating 14 mobile clinic units in 2003 to help the people in the insurgency-hit areas of the FATA.

Although the process of the rebuilding damaged health outlets is in progress, the MHP will, because of its popularity, continue to operate in the FATA with a fleet that was augmented in 2010 by the government.

Mobile hospitals are particularly effective in ensuring that patients who need to be on drug regimens lasting several months get their doses. This is especially so in the case of tuberculosis (TB) patients who, if improperly treated, can develop drug resistant strains that can endanger a community.

Waqar Ali, 46, who was diagnosed with TB at a free medical camp in North Waziristan three months ago, is now on medication he must take for eight months. “I am feeling better and do my farming like normal people,” he told IPS.

Authorities take care to notify people in areas where the camps are going to be held about a week in advance. Often announcements are made from the mosques.

Talking to IPS, Dr Bilqees Qayyum, a gynaecologist on the rolls of the MHP, says that people often come to the medical camps in droves with a variety of complaints.....

http://ipsnews.net/2012/03/pakistans-hospitals-that-come-home/

Comment by Riaz Haq on May 17, 2012 at 7:17pm

Here's a Businessweek story on fake medicines in Pakistan: In Pakistan’s biggest market for wholesale medicines, it pays to be observant.

More than 2,500 stalls wedged along dirt lanes in Karachi’s busiest trading district offer everything from Pfizer Inc. (PFE) (PFE)’s cholesterol pill Lipitor to GlaxoSmithKline Plc (GSK)’s painkiller Panadol. Closer study of the remedies lining rickety shelves reveals the source of an unfolding medical crisis: Lipitor sold in obsolete packaging, Panadol packets missing tell-tale ribbing, and allergy medicine Zyrtec mislabeled as Zytrec.

Now, the free flow of fake medications channeled through the market for decades may soon be slowed. Lawmakers are poised to pass legislation in June creating an agency to quash the trade after 107 heart patients were killed this year by pills tainted with lethal amounts of an anti-malarial agent. That may help break the ring of counterfeiters in Pakistan, part of a wider network supplying what the World Health Organization estimates is a $431 billion global market for spurious drugs.

“The issue is serious, demanding serious steps,” said Salman Burney, chief executive of GlaxoSmithKline Pakistan Ltd. (GLAXO) in Karachi. “Better regulation will generate more investment in the pharmaceutical industry, which will mean better quality medicines.”

The problem spans national borders. Pakistan was one of the 10 largest sources of counterfeit goods seized in the U.S. last year, U.S. Customs and Border Protection said in January. Medicines accounted for 85 percent of the value of the Pakistani items obtained.

At least 30 percent of medicines bought in the country are either counterfeits or substandard, said Kulsoom Parveen, a lawmaker who chairs a Senate health committee. Pharmacies nationwide sell drugs without a doctor’s prescription, enabling the treatments to be taken without medical supervision.
’Exploiting Weaknesses’

Pakistan has 4,000 registered pharmacists and 25 times more merchants dispensing medicines illegally, the Pakistan Pharmacists Association said.

It’s no coincidence that fake and substandard drugs are flourishing in Pakistan, said Laurie Garrett, senior fellow for global health at the Council on Foreign Relations. The New York- based think-tank prepared six recommendations to fight the drug- safety crisis for consideration by the Group of Eight summit at Camp David, Maryland, today and tomorrow.

“Individuals that are exploiting weaknesses in global drug safety and regulation will base themselves in places where they know the system is fragile or nonexistent,” Garrett said in a telephone interview. “Pakistan is really struggling to keep its entire public health infrastructure alive.”
Damaging Brands

Protecting product integrity would also benefit makers of brand-name medicines. Pharmaceutical sales in Pakistan, with a population of 196 million, total $2 billion annually, compared with $12.4 billion in neighboring India, with 1.2 billion people.

GlaxoSmithKline Pakistan, based in Karachi, made 1.14 billion Pakistani rupees ($12 million) in profit on sales of 21.75 billion rupees last year. In India, Mumbai-based GlaxoSmithKline Pharmaceuticals Ltd. (GLXO) had net income of 6.3 billion Indian rupees ($118 million) and revenue of 23.9 billion rupees.

Prime Minister Syed Yousuf Raza Gilani’s government hasn’t had a federal health minister or a central drug regulatory agency since powers were handed to the country’s four provinces last year. A new bill, to be voted on by Pakistan’s senate next month, will strive to fill the void....

http://www.businessweek.com/news/2012-05-17/stopping-fake-drugs-fro...

Comment by Riaz Haq on May 26, 2012 at 4:40pm

Pakistan's private health care spending rises to $7.3 billion, reports Express Tribune:

Pakistanis are increasingly spending more on health, with spending rising to a total of Rs665 billion in 2011, up 14.5% over the previous year, according a to research report released by Business Monitor International (BMI), a UK-based research and consulting firm.

Within the overall sector, the largest in terms of total spending was that of hospitals and other healthcare facilities, which saw their total revenues rise to Rs456 billion in 2011, up 14.1% from the year before. The fastest growing segment was medical devices, which saw sales rise 18.1% to Rs35.5 billion. Pharmaceuticals grew a little slower, at 13.1%, to reach Rs173 billion in gross sales in Pakistan.

There are also several developments taking place within the sector that are likely to allow for even further expansion, according to BMI analysts.

In August 2011, the Drug Registration Board (DRB) approved the registration of 30 medical devices and 210 medicines after a meeting was held at the request of the Prime Minister Yousaf Raza Gilani, who called for the uninterrupted provision of medicines to patients. Products approved for registration included vaccines, biologicals, cancer therapeutics, drugs for the treatment of blood disorders such as thalassaemia, and devices used in cardiac procedures.

BMI points out that there are many reasons why investors, particularly those outside the country may want to consider investing in this sector. “Pakistan has one of the most liberal foreign investment regimes in South Asia, with a commitment to low tariffs and 100% foreign equity permitted,” said BMI analysts in the report.

The analysts also note that Pakistan’s rapidly growing population – currently closing in on 190 million – should also be considered an asset. “A growing population is feeding increased demand for pharmaceuticals.”
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Pakistan’s overall business environment gets a poor rating from BMI, which ranks the economy 16th out of the 18 economies that it tracks in the Asia-Pacific region. The only two economies behind Pakistan are Sri Lanka and Cambodia. “The business environment still suffers from poor infrastructure and, most problematically, an uncertain security situation that has declined considerably since March 2007,” said BMI analysts.

In addition, there are several structural challenges to the Pakistani healthcare industry itself that have little to do with the external environment of Pakistan that they operate in. “Procurement processes are bureaucratic and often lack transparency, raising the risks of corruption,” said BMI in its report.

http://tribune.com.pk/story/384773/money-and-doctors-private-health...

Comment by Riaz Haq on July 5, 2012 at 9:07pm

Here's an ET story on Pakistan's chances of meeting MDG 5:

Pakistan will not be able to achieve the Millennium Development Goal (MDG) 5, that relate to bringing about an improvement in maternal health, by the targeted year of 2015. This was stated by Special Adviser to the Prime Minister and Chairperson National Assembly Special Committee on MDGs Shahnaz Wazir Ali on Thursday.

She was addressing participants at a National Policy Dialogue on Monitoring Implementation of MDG 5 in Pakistan at a local hotel.

Ali said dictatorship, slow pace of work, lack of integrated coordination and planning between the federal and provincial ministries after the 18th amendment and unavailability of credible data on health and family planning are major factors behind the failure to achieve the set targets on time.

She expressed concern over low prevalence of safe family planning measures which is one of the major reasons behind high maternal mortality rate in Balochistan despite heavy funding. Ali revealed that allocations under the NFC Award for Population Welfare were need-based rather than determined by population size and hoped that these would be used to promote maternal health. “Now the provinces have to come up with strategies to enable the country to achieve the targets. The federal government will, however continue to offer financial support,” she said.

Presenting the findings of the research on progress achieved so far under the MDG 5, Khawar Mumtaz said that the maternal mortality rate (MMR) is 276 per 100,000 live births in the country which needs to be reduced to 140 by 2015. Similarly, contraceptive prevalence rate (CPR) is 30% which needs to be increased to 55% by 2015, while total fertility rate (TFR) is 4.1 live births per woman which need to be reduced to 2.1.

In Balochistan, MMR is 785 per 100,000, CPR is 14%, while TFR is 4.1. Discussing the appalling situation in his province, Balochistan Health Minister Haji Ainullah Shams said the term family planning is taken as a plan for not having children in the province, which needs to change.

Similarly the province is deprived of all basic health facilities and health officials who are deputed in the BHUs they are not given any incentives or facilities, he added.

Moreover, the report presented by Mumtaz stated that widespread unmet need for family planning among women and no safe abortion or post-abortion care is available across the country. In rural areas, basic health units have inadequate staff while some are inaccessible due to inconvenient location. A whole range of unregulated informal and formal health services result in widespread quackery, negligence and malpractice....
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Meanwhile, Secretary Federal Bureau of Statistics Sohail Ahmed emphasised on the need for federal government to re-invent its role post-18th amendment for coordination of international commitments and to serve as a bridge between provinces and donors for achievement of MDGs. He suggested the federal government should offer matching grants to provinces for achievement of MDGs.

http://tribune.com.pk/story/404268/maternal-health-pakistan-cannot-...

Comment by Riaz Haq on November 4, 2012 at 9:30pm

Pakistan to get closer to meeting MDGs, reports News Tribe:

...According to the reports, Pneumonia kills an estimated 1.5 million children under the age of five years every year over the world – more than AIDS, malaria and tuberculosis combined. “Here in Pakistan the lack of awareness among masses has been furthering the rise of chronic diseases, which is alarming,’ he added.

But, he adds, luckily expensive pneumonia control vaccinations are being provided free of cost at EPIcenters in the country, as the government of Pakistan is introducing pneumococcal vaccine in the EPI programme with the help of Global Alliance for Vaccines and Immunization (GAVI).

Moreover, Dr. Tariq Bhutta added that reducing child mortality rate is one of the eight MDGs, which are the world’s time bound targets for reducing poverty in its various dimensions by 2015. Pakistan is heading towards achieving that targets, while the MDG on child mortality will require urgent action to control childhood deaths by pneumonia, which is 19 percent of the all the deaths of under-five children in the country.

Dr. Bhutta said that Pneumonia kills more children than any other illness – more than Aids, Malaria and Measles combined. ‘Yet, little attention is paid to this disease. After free availability of pneumonia vaccine at all government hospitals public awareness regarding the availability of vaccine needs to be increased for the EPI program to have its full time impact.

It is worth adding that Pneumonia is a severe form of acute lower respiratory infection that specifically affects the lungs. ‘Chest X-rays and laboratory tests are done to confirm the extent and location of the Pneumonia infection and its cause,’ he said, adding that but here in Pakistan suspected cases of pneumonia are diagnosed by their clinical symptoms due to non-availability of latest technologies. This becomes severe when transformed to other organs through the bloodstream causing meningitis, bacterimia and sepsis.

Dr Bhutta further said that during or shortly after birth babies are at higher risk of developing pneumonia. The statistics of World Health Organization (WHO) show that more than 150 million episodes of pneumonia occur every year among children under five in developing countries, accounting for more than 90 per cent of all new cases worldwide. Between 11 million and 20 million children with pneumonia will require hospitalization, and almost 1.8 million will die from the disease.

But, he adds, luckily Pakistan is fortunate in the sense that pneumonia prevention vaccine has been provided free of cost by GAVI Alliance, a global NGO, to vaccinate all 5 million babies that are born every year in Pakistan. ‘A course of three injections to newborns was previously costing approximately Rs 14000, but with the funding of GAVI this treatment is available free of cost across the country for the masses. Three vaccines include the measles, Hib and pneumococcal conjugate vaccines have the potential to significantly reduce child deaths from pneumonia,’ he added.

It is to be noted that immunizations help reduce childhood deaths from pneumonia in two ways: first, vaccinations help prevent children from developing infections that directly cause pneumonia such as Haemophilus influenzae type b (Hib); secondly, immunizations may prevent infections that can lead to pneumonia as a complication (e.g., measles and pertussis).

Dr Tariq Bhutta encouraged all parents to take their infants at 6, 10 and 14 weeks of ages to the government EPI center and hospitals in their vicinity for vaccination.

http://www.thenewstribe.com/2012/11/04/pakistan-to-get-closer-to-mi...

Comment by Riaz Haq on November 7, 2012 at 8:38pm

Here's Kantawala in Friday Times on India's Dengue outbreak killing Yash Chopra:

I'm still not over Yash Chopra dying from Dengue disease. I just thought I'd throw that out there. Of course it's sad that the Rom Com Don passed away and I do hope he is running through heavenly wheat fields while singing love songs to clouds and backup singers, like the many dream sequences he inspired in us all. But I would never have thought of Dengue and Bollywood in the same sentence until now (or Dengue and anything, really. It's still not so much a reality as a morbid punch-line). It just reminded me of how good India is at PR. During last year's Succubus Summer Solstice, when Dengue Mosquitoes hit the Punjab like a wife beater with Daddy Issues, we lost over 2,000 people to the disease. Judges, trainers, workers, rich, poor, women, men. We covered it (forgive me) to death in newspapers, and the news of the world was gripped with yet another Pakistan catastrophe. For six months it really was like the end of a disaster movie called Infection or Gestation Period or something clinically unimaginative.
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Last year, around this time, a water-based brain disease killed 500 children in a town in Northern India in one week. One week! It comes every year, it's just that that year was particularly bad. Now, how does a deadly, brain-eating, child specialist disease that may or may not have "come from Japan" not make it to the world's news? How? PR people. That's how. Get on that.

Here's NY Times on dengue fever in India:

NEW DELHI - An epidemic of dengue fever in India is fostering a growing sense of alarm even as government officials here have publicly refused to acknowledge the scope of a problem that experts say is threatening hundreds of millions of people, not just in India but around the world.

India has become the focal point for a mosquito-borne plague that is sweeping the globe. Reported in just a handful of countries in the 1950s, dengue (pronounced DEN-gay) is now endemic in half the world's nations.

"The global dengue problem is far worse than most people know, and it keeps getting worse," said Dr. Raman Velayudhan, the World Health Organization's lead dengue coordinator.

The tropical disease, though life-threatening for a tiny fraction of those infected, can be extremely painful. Growing numbers of Western tourists are returning from warm-weather vacations with the disease, which has reached the shores of the United States and Europe. Last month, health officials in Miami announced a case of locally acquired dengue infection.

Here in India's capital, where areas of standing water contribute to the epidemic's growth, hospitals are overrun and feverish patients are sharing beds and languishing in hallways. At Kalawati Saran Hospital, a pediatric facility, a large crowd of relatives lay on mats and blankets under the shade of a huge banyan tree outside the hospital entrance recently.

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"I'd conservatively estimate that there are 37 million dengue infections occurring every year in India, and maybe 227,500 hospitalizations," said Dr. Scott Halstead, a tropical disease expert focused on dengue research...

http://mobile.nytimes.com/2012/11/07/world/asia/alarm-over-indias-d...

Comment by Riaz Haq on December 6, 2012 at 10:16pm

Here's a Nation report on 30th anniversary of rural support network in Pakistan:

ISLAMABAD - The Rural Support Programme (RSPs), the largest development network in Pakistan, mark their 30th anniversary on Thursday across Pakistan.

On 7th December 1982, the Nobel Peace Prize nominated development guru Shoaib Sultan Khan initiated the Aga Khan Rural Support Programme (AKRSP) in northern Pakistan as a project of the Aga Khan Foundation. Since then, the RSP movement has grown across Pakistan, touching the lives of 32 million people.

This model has been replicated in development programmes of India, Afghanistan and Tajikistan.

The RSPs will kick off their 30th anniversary celebration in January 2013 with renewed commitments and organizing series of events of which the most significant will be a large community convention and Book launch event of Shoaib Sultan Khan.

In Pakistan, there are now 12 RSPs nationwide, which have fostered almost 300,000 community organisations. These have demonstrated that poor Pakistanis are willing and able to improve their own lives. These 12 RSPs come together at the RSP Network (RSPN), a national level network of which they are all members.

The approach of the AKRSP has led successive governments to replicate this approach across Pakistan. The commitment of government and donors has enabled the RSPs to reach so many people who are engaged in the largest self help movement in Pakistan.

http://www.nation.com.pk/pakistan-news-newspaper-daily-english-onli...

Comment by Riaz Haq on January 7, 2013 at 11:19am

Kudos to the brave workers carrying out the vaccination campaign. It's because of their service that polio cases in Pakistan significantly declined from 198 in 2011 to 57 in 2012.

http://www.riazhaq.com/2012/12/why-are-taliban-attacking-women-poli...

Comment by Riaz Haq on January 26, 2013 at 5:00pm

Here's a report on rising use of contraceptives in Pakistan:

ISLAMABAD - In year 2011-12, Pakistanis used 149.278 million condoms, 6.223 million cycles of oral pills, 1.315 million insertions of internal uterine devices (IUDs) and 2.705 million vials of injectables, revealed a report released by the Pakistan Bureau of Statistics (PBS).

The PBS report showed an unprecedented rise in the use of condoms as a contraceptive tool during the year 2011-12 as compared to last year.

The Federally Administrated Tribal Areas (FATA) witnessed a 60 percent increase in the use of condoms while the federal capital stood second with a rise of 27.9 percent.

In Khyber Pakhtunkhwa, the ratio of using condoms as a contraceptive tool remained 24.5 percent while Sindh showed a rise of 20.7 percent. In Punjab, rise in the use condoms was recorded at 18.7 percent.

However, according to the report made available to Pakistan Today, a contradictory trend was witnessed in Balochistan, Gilgit-Baltistan and Azad Jammu and Kashmir where the use of condoms as a contraceptive tool saw a decline in the year 2011-12.

Balochistan recorded a decrease of 11.8 percent in the trend of using condoms as a contraceptive tool whereas the popularity graph of condoms fell down in Gilgit-Baltistan where a decrease of 5.4 percent was recorded.

In Azad jammu and Kashmir, there was a decrease of 1.3 percent in the use of condoms.

For oral pills, the report showed that FATA remained at the top with an increase of 46.2 percent in their use followed by Gilgit-Baltistan with a rise of 20.8 percent and the third place was occupied by Khyber Pakhtunkhwa with 12.0 percent.

In federal capital, the use of oral pills as a means of contraception showed a rise by 4.5 percent, Punjab 3.2 percent and Sindh showed a rise of 2.1 percent.

Again in the case of Balochistan, the use of oral pills was discouraged by locals. The report showed that the use of oral contraceptive pills had decreased by 21.3 percent.

The province/sector-wise comparison of contraceptive performance during the financial year 2011 -12 in terms of Couple Year of Protection (CYP) – an international indicator for data collection – has been made with the previous year 2010-11 which showed that at the national level, an increase of 0.7 percent had been observed for all programme and non-programme outlets during 2011-12 as compared with 2010 -11.

As far as the district Islamabad and FATA are concerned, the contraceptive performance for the financial year 2011-12 compared with 2010-11 depicted an increase of 19.5 percent and 37.4 percent respectively, whereas a decrease of 2.9 percent and 12.0 percent had been recorded in AJK and Gilgit-Baltistan.

http://www.pakistantoday.com.pk/2013/01/27/news/national/pakistanis...

Comment by Riaz Haq on January 27, 2013 at 10:53am

Here's a Dawn story on polio eradication in Pakistan:

LAHORE, Jan 26: A World Health Organization (WHO) official says this is for the first time in the public health history of Pakistan that the country is on the track to get rid of poliovirus type 3 (P3), one of the two globally continuing strains of the wild poliovirus, in April.

Last time, a P3 case was reported on April 14, 2012 and it would be a great breakthrough in the fight against polio if the virus is not found in any part of the country till April 14 this year.

India is gearing up to be declared polio free by 2014. The WHO has already removed India from the list of polio endemic countries.

“We believe that Pakistan is on the right track to become free of poliovirus type P3, as the last P3 case was reported in the Bara Tehsil in Khyber Agency in the second week of April 2012, whereas all recent sewage samples show no active transmission of the P3 strain across the country,” Dr Elias Durry, head of the Polio Eradication Initiative at WHO Pakistan, told Dawn.

According to the WHO, type 2 strain of the poliovirus (P2) has been eradicated globally since 1999.

About eradication of the P3 strain throughout the world, Dr Durry says Nigeria reported 19 cases of the P3 strain and the most recent case was reported in November. He says that recent security-related incidents disrupted national polio campaigns. “Though there is more than 70 per cent decrease in polio cases in Pakistan, no corner of the country can be considered polio free until the poliovirus is eradicated throughout the country,” says the WHO official.

“Pakistan successfully brought down the number of cases by 71 per cent in 2012 compared to 2011. All provinces except Khyber Pakhtunkhwa have brought down the number of cases from 66 per cent to 95 per cent,” says the official.

Dr Durry says last year Balochistan brought down the number of polio cases by 95 per cent, Sindh by 88 per cent, Punjab by 78 per cent and the Federally Administered Tribal Areas (Fata) by 66 per cent. “The most promising sign for Pakistan during the last year was a massive decrease in the number of polio cases during the high transmission season,” he said.

He said the last polio case of 2012 was reported on Nov 30 and a small number of samples from last year was still pending with the polio virology lab for evaluation. “Most likely, Pakistan is going to close its tally of 2012 polio cases at 58,” Dr Durry said.

The official says that all sewage samples collected from cities of Punjab in recent weeks were found negative. He says: “Most samples collected from Peshawar, Gadap Town in Karachi and Hyderabad produced positive results in the past, but they showed negative results now.”

http://dawn.com/2013/01/27/pakistan-close-to-getting-rid-of-a-polio...

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