Tuberculosis (TB) presents a significant public health challenge in Pakistan, particularly in its Sindh province. The World Health Organization (WHO) estimates that Pakistan faces 230 incidents, 310 prevalent cases, and 39 TB-related deaths per 100,000 people annually. This translates to approximately 410,000 new TB cases and 69,000 deaths each year.
Addressing this crisis, the Integrated Health Systems Strengthening and Service Delivery (IHSS-SD) Activity, specifically its TB Component, is taking decisive action in Sindh. This initiative, backed by the United States Agency for International Development (USAID) and executed by JSI Research and Training Institute, Inc., targets 15 districts in Sindh over a two-year span from 2023 to 2025.
The IHSS-SD Activity collaborates with the Provincial Tuberculosis Control Program (PTP) to bolster both the detection and treatment of drug-resistant (DR-TB) and drug-sensitive TB (DS-TB). A key focus is enhancing the TB case detection rate and ensuring adherence to treatment through community engagement. By employing a social mobilization approach, the project aims to facilitate efficient tracking of index cases and contact tracing. It also supports the referral process from communities to the nearest Basic Management Unit (BMU) and Programmatic Management of Drug-Resistant Tuberculosis (PMDT) sites, thereby strengthening the overall TB management infrastructure in the region.
August 28, 2023 to 30 June 30, 2025 (02-years)
15 districts of Sindh i.e., Karachi (Keamari, Malir, West), Thatta, Sujawal, Tando Allahyar, Thar Parker, Noshehroferoz, Dadu, Kamber Shahdadkot, Khairpur, Ghotki, Kashmore, Jacobabad and Shikarpur.
National Rural Support Programme (NRSP), Thardeep Rural Development Programme (TRDP) and Sindh Rural Support Organization (SRSO)
John Snow, Inc. (JSI) funded by USAID
In this initiative, RSPN will play a crucial role in addressing tuberculosis (TB) in high-risk communities through a comprehensive approach. The project involves deploying specially-equipped mobile vans to these areas, designed to provide essential TB-related services. Each van will be outfitted with advanced diagnostic tools, including a Gen Xpert machine and a portable X-ray device. A dedicated team comprising a doctor, a laboratory technician, and an assistant will staff these vans, ensuring expert medical and diagnostic services are available on-site.
Key activities of the project include conducting pre-TB screenings, raising community awareness about TB, and actively working to reduce the stigma associated with the disease by organizing educational and interactive community sessions. Moreover, the project will focus on tracing and monitoring contacts of individuals who have tested positive for TB. This will be complemented by ensuring strict adherence to standard operating procedures (SOPs) and facilitating timely referrals to specialized health facilities such as BMU (Basic Management Unit) and PMDT (Programmatic Management of Drug-Resistant TB) for further treatment and care.
Additionally, these mobile units will play a pivotal role in active case finding (ACF), which is crucial for early detection and treatment of TB cases, thereby helping to curb the spread of the disease within these high-risk communities.
Our primary goal is to maximize service usage. To achieve this, Contech Int. and RSPN, along with the Rural Support Programs (RSPs), will engage in close coordination with key stakeholders including the district health department, Basic Management Units (BMUs), and the Provincial TB Control Program (PTP). This collaboration will be under the expert technical guidance and assistance of JSI.
Leveraging RSPN’s existing community networks, including Community Institutions and their Representatives (CIRs), we aim to streamline the testing process for individuals suspected of having TB. These suspected TB cases will be referred to BMUs or nearby testing centers for diagnosis and treatment. The same methodology will apply for contact tracing and tracking.
In targeted districts, we plan to create micro plans to identify TB hotspots. However, cases arising outside these hotspots will also receive full support and facilitation by the Social Mobilization Teams (SMTs) and CIRs. We will adopt a flexible approach, combining direct outreach for community-level testing where feasible, in consultation with BMU or static center staff.
The SMTs, aided by CIRs, will ensure consistent support for TB patients, overseeing treatment and follow-up care until medication completion. This includes regular follow-up visits and engagement with both CIRs and Key Community Influencers (KCIs). Additionally, RSPs will provide necessary transportation for contact cases, facilitating their access to screening and medication. This comprehensive approach is aimed at enhancing the reach and effectiveness of TB treatment and prevention efforts within the community.