Is Ministry of Health fully prepared to implement an Effective DOTS Program in Pakistan? An Operations Research on TB Control Program in the Public Health Sector in Sindh

Purpose of the study: Pakistan is among the high-burden countries for tuberculosis. One of the fundamental problems in TB control is a high defaulter rate among the registered TB cases in the public sector. In 1999, a cross-sectional study was designed to identify the determinants of low compliance for the TB treatment in two rural districts in Sindh. Methods: Before the actual data collection, a pilot testing was planned in a secondary level care hospital. Fourteen defaulters for TB treatment were identified but none could be contacted due to incomplete addresses. Other alternatives were explored with the health facility team to reach them including a field-based search through Lady Health Workers of the National Health Program but all endeavors went into vain. The pilot testing propelled us to postpone the cross-sectional study but we continued scrutinizing the follow up problem for TB patients in other health facilities. Not surprisingly, more or less a similar picture was found in those health facili-ties. Principal conclusions: The study concludes that the public health care system in Pakistan lacks even the basic requirements for an effective TB control program, that is, a viable information system and the functional integra-tion of program with rest of the health care delivery system. A DOTS strategy to control TB was initiated in the public sector in Pakistan just one year prior to this study. The Ministry of Health requires re-visiting the program to ensure that the lacunae identified in this study are being taken care of in the current DOTS strategy (JPM