Current Situation in Control Strategies and Health Systems in Asia by Prof. Dr. Jovaria Mannan, Professor of Paediatrics, Chairperson of the Medical Advisory Board, Thalassaemia Federation of Pakistan

1. Current Situation in Control Strategies
Current Situation in Control Strategies
and Health Systems in Asia ‐ Pakistan
Prof. Dr. Jovaria
Prof. Dr. Jovaria Mannan
Prof. of Paediatrics,
Chairperson, Medical Advisory Board,
Thalassaemia Federation of Pakistan

2. 24,280,000 1,000,000
4,340,000
9,280,000
2,972,000
98,350,000
43,300,000

3. Healthcare in Pakistan
Healthcare in Pakistan
• Policy making
Federal
•N i
National Programs
lP
Govt.
• Implementation of
Provincial y
Healthcare System
Govt.

4. < 1% GNP spent
< 1% GNP spent Allopathic
All thi Homeopaths
H th
on Health
Private (70%) Non‐allopathic Hakims
Accupuncture &
Traditional Chinese Herbal
Medicine
Healthcare in
Pakistan Tertiary Care
Hospitals (22)
District
Public (30%) Headquarter
Hospitals
Primary Health
Care Basic & Rural
Estimated that a
Estimated that a Health Unit
H l hU i
person visits this
center once a year

5. Healthcare Infrastructure in Pakistan
Healthcare Infrastructure in Pakistan
Type of Healthcare No. (according to Health No. No. of beds
professional 2009 statistics) Facilities
Doctors 139,555 Total 13,937 103,708
Dentists 9,822
9 822 Healthcare
Facilites
Nurses 69,313
Hospitals 968 84,257
Midwifes 26,225
Dispensaries
Di i 4,813
4 813 2,845
2 845
Health visitors 10,731
Rural Health 572 9,612
Centers
Tuberculosis 293 184
Clinics
Basic Health
Basic Health 5,345
5 345 6,555
6 555
Units
M. C. H. 906 256

6. Thalassaemia in Pakistan
Thalassaemia in Pakistan
• Beta Thalassaemia is the commonest inherited
disorder in Pakistan
• 5 ‐ 8% Pakistanis are
5 ‐ 8% Pakistanis are
carriers of
Thalassaemia Gene
h l i
5000 new thalassaemics
born every day
born every day

7. Thalassaemia Care in Pakistan
Thalassaemia Care in Pakistan
• Private sector
– 95% care based on outpatient diagnostic, clinical,
p g , ,
transfusional, BMT and preventative services.
• Public sector
Public sector
– 5% care based on diagnostic, critical care and
transfusional services.
f i l i
• Privately 36 NGO’s knitted together by the
y g y
Thalassaemia Federation of Pakistan.

8. Thalassaemia Federation of Pakistan:
Federation of Pakistan:
• Provides support in government policy making
– sets standards of care of thalassaemia patients in
p
Pakistan
– Training of healthcare providers
Training of healthcare providers
– Conducts awareness Programmes across the
country
– Publishes books, pamphlets and handouts for
healthcare providers and the general population.
h lh id d h l l i

9. There are no current programs in the
following provinces
• Azad Jammu and Kashmir
• Balochistan
• Federally Administered Tribal Areas
• Gilgit & Baltistan

10. KhyberPakhtunkhwa (2006 –
KhyberPakhtunkhwa (2006 2007)
– Ph
Phase‐II:
II
• Public awareness campaign through media and community
institutions.
• Screening of the family members of the Index Cases at
Peshawar.
• Screening of the family members of the index cases in the
districts of high prevalence of Thalassaemia major.
• Screening of the family members of the index cases in the
Screening of the family members of the index cases in the
districts of high prevalence of Thalassaemia major.
• Compilation of Thalassaemia trait directory in the settled
area of KP.
f KP
• Establishment of genetic counseling services.

11. Punjab Thalassaemia Prevention Program
(PTPP)
( )
ADP Scheme No 531 Grant No 36 Development
ADP Scheme No. 531 Grant No. 36 Development
Launched July 2009
July 2009
Revised Sept 2010
Duration
Duration 04 years
04 years
Budget Rs. 162.358 m
Lady Willingdon Hospital, Lahore

12. PROJECT NETWORK
DHQ Hospitals
Southern Punjab
Regional Center 1
Children Hospital, Multan Mobile Teams
Southern Punjab DHQ Hospitals
Regional Center 2
Victoria Hospital, Bahawalpur
Mobile Teams
Mobile Teams
PIMU
DHQ Hospitals
Central Punjab
Central Punjab
Regional Center
Sir Ganga Ram Hospital, Lahore Mobile Teams
DHQ Hospitals
Northern Punjab
Regional Center
Regional Center
Holy Family Hospital, Rawalpindi
Mobile Teams

13. Punjab Thalassaemia Prevention Program
(PTPP)
•Genetic Counselling
•Blood collection
•Carrier Testing
•CVS
•DNA Lab
•Result Feedback
•Awareness
Awareness
•Trainings •Genetic Counselling
•Blood collection
District •Result Feedback
DHQ
DHQ •Awareness
Hosp.
•Genetic Counselling
•Blood collection
•Carrier Testing Regional
•CVS Office
•Result Feedback
•Awareness
74 Field Officers

14. Sindh
• NGO based prevention programmes are
g
running in Sindh
• a resolution was approved in 2010 for
mandatory thalassaemia screening prior to
mandatory thalassaemia screening prior to
marriage in 2010
• A formal bill has yet to be presented in the
Sindh Assembly
Sindh Assembly

15. 2. Screening
2 Screening
• Target screening
Most cost effective method advised by WHO in countries with gene
frequency less than 10 % in general population
f l th 10 % i l l ti
• CBC
• Hb Electrophoresis
p
• DNA Analysis

16. Conclusion
• The health budget of Pakistan needs revision
pp p
for appropiate health care delivery y
•
• Th l
Thalassaemia Federation has done a lot of
i F d i h d l f
awareness in Pakistan but a prevention
programme cannot run effectively without
the political will and financial support of the
the political will and financial support of the
government.