HEPATITIS CONTROL PROGRAMMEARFA TALIA

What is Hepatitis?

Hepatitis is an inflammation of the liver. The condition can be

self-limiting or can progress to fibrosis (scarring), cirrhosis or

liver cancer.

There are 5 main hepatitis viruses, referred to as types A, B,

C, D and E. All these 5 types are of greatest concern because

of the burden of illness and death they cause and the

potential for outbreaks and epidemic spread.

But in Pakistan, Hepatitis B and C is more common and lead

to chronic disease in millions of people and, together, are the

most common cause of liver cirrhosis and cancer.

PAKISTAN : a cirrhotic state?

World Health Organization (WHO) has rated Pakistan as 2nd country in the world having highest rates of chronic infections like Hepatitis.

It is estimated that 18 million Pakistani population is infected with the hepatitis. Every 10th Pakistani is believed to be suffering from viral hepatitis.

Thousands of Pakistani die each year from Hepatitis & its complications prematurely. Approximately 1 million new people are infected with hepatitis B each year.

As a result Pakistan has been declared a “Cirrhotic state” in international health circles.

Steps Taken by Prime Minister

It is evident from above burden of disease that the situation

of Hepatitis B and C in Pakistan is highly alarming and is

beyond the acceptable level as recommended by WHO. So the

directions recently given by the Prime Minister that an

“Emergency Action plan against Hepatitis”

may be undertaken by the Ministry of Health to avert the

impending epidemics of Hepatitis B and C knocking at the door

of Pakistan.

Prime minister’s programme for prevention and control of hepatitis.(prime minister’s emergency action plan)

Goal :

The overall goal of the project is a

“HEPATITIS FREE PAKISTAN”.

Objectives :

To prevent new transmission of hepatitis B and C infection in the country thereby reducing the incidence and prevalence of hepatitis B and C.

To reduce morbidity and mortality due to Hepatitis B and C by appropriate steps towards hepatitis B vaccination, injection safety, infection control and safe blood transfusion.

To organize diagnostic services for hepatitis B and C throughout the country.

To strengthen the existing support system at National Provincial & District level for effective implementation of preventive programme.

Components of Project:

1. Hepatitis B vaccination to high risk groups.

2. Improvement in the infection control and sterilization practices.

3. Safe injection delivery with development of legal framework.

4. Diagnostic laboratory services.

5. Treatment interventions for hepatitis B & C.

6. Community mobilization.

7. Behavior change communication through media.

8. Safety of blood and blood products

Component 1: Hepatitis B vaccination

To immunize women in reproductive age in high endemic

areas.

Vaccination of all public sector health care provider.

Vaccination of all students of medical , nursing and

paramedical staff in the public sector.

Promote Hepatitis B vaccination to all high risk groups

including Hepatitis C patients, chronic dialyses,

Thallasemics, Hemophiliacs, convicted jail inmates,

injection drug users etc.

Component 2: Infection Control

Strengthening of infection control practices.

Develop monitoring and evaluation tools for the infection

control.

Seminar on infection control in each district.

Promote good sterilization practices using disinfectants at all health care facilities.

Component 3: Injection Safety

Develop guidelines for safe and rational use of

injection.

Ensure the use of disposable syringes in all

health care facilities and facilities their easy

accessibility to all areas.

13 injection/person/year will brought down at

midpoint to 7 syringes/person/year.

Component 4 and 5: Hepatitis B and C diagnosis and Treatment interventions.

Development of guidelines for the diagnosis and interpretation of Hepatitis B and C Tests.

Training and standardization of diagnosis of Hepatitis B and C infection in the participating laboratories and enhance the skills of participating laboratories.

Development of Hepatitis B and C selection criteria for their inclusion in the treatment protocol that is cost effective and with the potential of high compliance and treatment success.

Component 6 and 7: Community mobilization and Behavior change.

1. Recruitment of 300 community mobilizers and 50 supervisors for community mobilizers

2. They will work for the program and will report for duty to their respective executive district officers

3. Development of behavioral change communication guidelines and messages to promote safe and rational use of injections in country.

4. Develop guidelines and tools for counseling chronic Hepatitis B and C patients and train all health care workers in managing and counseling skills of these patients.

Component 8: Blood Transfusion

1. Reviewing and updating national guidelines on safe blood transfusion practices in conformity with WHO norms and quality standards.

2. Developing national guidelines on rational use of blood and blood products as an integral component of quality of care.

Provincial Programs

All provinces have their own Hepatitis control programs

under the Chief Ministers’ initiative for control of this

disease. The main focus is on providing treatment but other aspects of prevention and control are neglected.

WHO support

WHO has been working with the national program and assisting in the areas outlined below:

Constitution of a Technical Advisory Group on Hepatitis in Pakistan

Development of national guidelines for infection control

Normative guidance on prevention, testing and treatment of Hepatitis B and C

Technical assistance in developing national guidelines on treatment and surveillance

Provision of blood screening kits to blood banks

WHO Support

Injection safety equipment to all health facilities in 25 targeted districts of Pakistan.

Training of health care providers on treatment, prevention, infection control, hospital waste management and surveillance.

Working to increase the awareness of masses on Hepatitis transmission and prevention in 25 targeted districts of Pakistan.

Procured conventional Interferon worth 4.5 million $ to be given to selected treatment sites in the country.

Key Area needing development

Need major policy shift to focus more on prevention than

treatment.

Development of national and provincial surveillance systems

for Hepatitis.

Resource mobilization for provision of baseline testing and

treatment for Hepatitis B and C.

Intensive awareness campaigns for the general population.

Injection safety including infection control and hospital

waste management.

Issues

More focus on treatment and less on prevention by the

provincial programs

No surveillance system existing that could give information on

burden of disease in the country

Uncontrolled private sector and quackery causing rapid spread

and mismanagement of cases

Very high injection use in the population

Injection safety system is quite weak

Lack of awareness of masses on Hepatitis B and C transmission

and prevention

Achievements in Hepatitis Control

Medicine for treatment of 16,000 Hepatitis patients purchased and

distributed among 38 sentinel sites in the Punjab.

Computers purchased and distributed to develop data bank.

Ongoing media compagnie.

Two fold folders on different aspects of hepatitis produced.

07 posters on different topics distributed in Punjab.

Regular health education compagnie through Radio, TV, Press.

38 sentinel sites for diagnosis, screening & treatment are established.

A network of PCR labs has been established to facilitate PCR testing.

THANK YOU