A hepatitis epidemic simmers in Sindh

Health authorities neither have the data nor a plan on how to deal with the crisis

KARACHI: With the province still reeling from the outbreak of the Human Immunodeficiency Virus (HIV) in Ratodero, Larkana, there are ominous signs of another epidemic just around the corner.

This time, it is Hepatitis B and C - two chronic diseases that are reportedly affecting over 5,000 patients every month. What is even more troubling is the fact that over 6,600 registered patients of Hepatitis C are stuck in limbo because the funds for their medication have yet to be released by the provincial government. The health authorities, for their part, have no idea when the funds for the procurement of medicines will come through.

Budget constraints

The Hepatitis Prevention and Control Programme, also known as the Hepatitis Free Sindh Programme, has been facing an acute shortage of funds since the start of the last fiscal year. This year, the programme is set to receive Rs900 million, according to health officials. The funds are yet to be released, a health official told The Express Tribune.



The programme’s in-charge, Dr Zulfiqar Ali Dharejo, confirmed to The Express Tribune that there are a total of 7,915 patients of Hepatitis C under treatment across the province, besides another 12,321 patients of Hepatitis B virus. At least 280,000 patients infected by both viruses have been treated through the programme since 2009, he added.

Despite 10 years of the programme’s existence, health officials remain clueless about the total number of patients in the province. “It is not possible to conduct the screening of the entire population,” said Dr Dharejo. He claimed, however, that the situation was under control and the health department will abide by its commitment made with the World Health Organisation to eliminate hepatitis from Sindh by 2030.

Govt’s efforts

Over the last decade, 61 sentinel sites have been set up in different hospitals across the province for the detection of infected persons. Meanwhile, there are only four molecular laboratories to confirm the presence of the virus - one each in Larkana, Sukkur, Hyderabad and Mirpurkhas - functioning under the programme. The fifth such laboratory is located in the Dr Ruth Pfau Civil Hospital Karachi.

Speaking to The Express Tribune, Dr Dharejo said that 6,600 patients of Hepatitis C have recently been registered. “We will have to provide them with the medicines,” he said, adding that they were still waiting for the funds to be released.

“The process is underway and the medicines will be made available to the all registered patients,” he pledged

Meanwhile, the secretary of the Pakistan Medical Association, Karachi, Dr Abdul Ghafoor Shoro said that the number of Hepatitis patients was far higher than those affected by HIV. “The situation in far-flung areas is alarming. The government needs to take appropriate measures.”

Lack of data

According to Dr Shoro, there is no accurate data regarding the number of Hepatitis patients. “I fear the number of patients will be higher than all communicable diseases.” He said that the provincial government has failed to devise a strategy to mitigate the crisis. “There is no proper screening of any disease. There is no scientific method of collecting accurate data,” he lamented.

“Young persons are dying daily due to HIV and Hepatitis,” said the PMA secretary. “People in Sindh live in fear of diseases. It is the prime responsibility of the government to reform the healthcare system,” he urged.

Dr Shoro was of the view that the health department must focus on the infected patients. “These infected patients directly proliferate the number. The free movement of untreated and unidentified patients is the biggest challenge for the health system.”

Govt denies incompetence

Asked about these inadequacies, Dr Dharejo said, “The number of patients surfacing regularly confirms the effectiveness of our programme.” He added that the health minister, Dr Azra Fazal Pechuho, was taking a personal interest in the programme.

With regards to their strategy, Dr Dharejo admitted that his department did not have an action plan yet, but they were hoping to launch the first one, with the help of the WHO, by July 28.



Dr Dharejo also did not know which areas of the province were most affected. He quoted the Pakistan Research Council’s data, saying there were around three million patients of Hepatitis in Sindh in 2008. “But we need to verify that data.”

Moreover, various non-governmental organisations also provide treatment to Hepatitis patients. According to Dr Shoro, most patients prefer going to these private establishments due to lack of trust in public facilities.

But the health authorities don’t even have the data for the number of patients being treated in private facilities. “They do not share their data with the provincial government,” said Dr Dharejo.

Published in The Express Tribune, July 25^th, 2019.