Lecture on Vertical Programs of Health in Punjab, Pakistan.

2. Dr. Muhammad Imran Butt
Senior Demonstrator
Department of Community Medicine
Gujranwala Medical College, Gujranwala.

3. Vertical Health Programs

4. Lecture Objective
 To know about various on-going vertical health programs and their goals and
objectives at national and provincial level.

5. Health
According to WHO Health is defined as
“A state of complete physical, mental, social and spiritual wellbeing and not merely an
absence of disease or infirmity”.

6. Health System
 A Health System consists of all organizations, people and actions whose primary
intent is to promote, restore or maintain health.

7. Vertical Health Program
A “vertical health program” is a component of the health system which:
• has specific, defined objectives, usually quantitative, and relating to a single
condition or small group of health problems
• it has centralized management and discrete means (staff, vehicles, funds)

8. Vertical v/s Horizontal Programs
Vertical
 Often disease specific
 Cure-focused
 Generally driven by donors/outsiders
 Not sustainable without continued
funding
Horizontal
 Focus on a range of issues, not a
single disease
 Prevention-focused
 Driven by affected community
 Integrated into the health system,
which helps with sustainability

9. Advantages of Vertical Program
 Clear Objectives and Targets motivate staff
 Operational Planning is focused and easy to deliver
 Efficient and effective delivery
 Better ability to monitor the restricted output

10. Disadvantages
 No capacity to accommodate extra work in disaster
 Resources used for specific activities only
 No focus on overall development
 Dependent on donors for funding
 Placement of workers after completion-challenging
 Long term public motivation not sustained
 May not be cost effective in long run

12. National TB Control Program
 NTP strives for TB free Pakistan by reducing 50% prevalence of TB in general
population by 2025 in comparison to 2012 through universal access to quality TB
care and achieving Zero TB death. Pakistan ranks 5th amongst the high burden
countries in the world
 National TB Control Program (NTP), revived under Ministry of Health subsequent
to declaration of TB as national emergency in Pakistan in 2001
The Key Objective of NTP are
 To increase the number of notified TB cases from 298,981 in 2013 to at least
420,000 while maintaining the treatment success rate at 91%.
 To reduce, by at least 5% per year the prevalence of MDR-TB among TB patients
who have never received any TB treatment.
 To strengthen programmatic and operational management capacity of the TB
Control Program

14. National AIDS Control Program
 National AIDS Control Program was established in 1986-87 with a focus on
diagnosis of cases that came to hospitals, but progressively began to shift towards
a community focus.
 Pakistan is the second largest country in South Asia in terms of infectivity
associated HIV epidemic.
 Despite many efforts, the HIV infection rate has increased significantly over the
past few years and in fact, the country has moved from a low prevalence to
concentrated epidemic with HIV prevalence of more than 5% among injection
drug users.

15. Main objectives of National AIDS Control
program are
 Prevention of HIV transmission
 Safe Blood Transfusion
 Reduction of Sexually Transmitted Diseases transmission
 Establishment of surveillance
 Reduce Stigma attached with disease
 Training of Health Staff
 Research and Behavioral studies
 Build the right capacity
 Strengthen the institutional framework

16.  Malaria Control activities are on ground in Pakistan since 1950s through succession
of different approaches
Main objective of Malaria Control Program
 To achieve <5 API in high endemic areas of the province of Balochistan, Sindh, KP
and FATA region.
 To achieve <1 API within moderate endemic districts of Balochistan, Sindh, KP
and Punjab.
 To achieve Zero API within low endemic districts of Sindh, KP and Punjab.
 To ensure and sustain the provision of quality assured early diagnosis and prompt
treatment services to >80% at risk population
 To ensure and sustain coverage of multiple prevention interventions to 100% in
the target high risk population as per national guidelines and coverage of foci in
moderate and low risk districts
National Malaria Control Program

17.  To increase community awareness up to 80% on the benefits of early diagnosis
and prompt treatment and malaria prevention measures using health promotion,
advocacy and Behavioral Change Communication (BCC) intervention
 To enhance technical and managerial capacity in planning, implementation,
management and MEAL (Monitoring, Evaluation, Accountability and Learning) of
malaria prevention and control intervention.
 To ensure provision of malaria prevention, treatment and control services in
humanitarian crises, emergencies and cross-border situation

18. Vertical Health Programs in Punjab

19. Punjab Aids Control Program
 The Punjab AIDS Control Program (PACP) was established in 1998 to reverse the spread of
HIV among the most at risk groups and to keep the epidemic from establishing among the
bridging groups and the general population by following the international guidelines of
UNAIDS, WHO and UNICEF. The program is operating under the umbrella of the Primary and
Secondary Healthcare Department, Government of the Punjab.
Goal
 The main goal of the Punjab AIDS Control Program is to prevent and halt new
HIV infections and improve the health and quality of life of people living with
HIV/AIDS in Punjab.
Objectives:
 Provide information to people on the modes of transmission of HIV and ways of preventing
transmissions.
 Provide information about myths related to HIV and educate on stigmas related to HIV.
 Create a conducive environment for HIV testing through pre- and post-test counselling.
 Ensure life-long free treatment and confidentiality of HIV patients.

20. Summary of Program Initiatives:
The PACP started multiple initiatives to reach out to High Risk Groups that are:
 The Program sets up camps at strategic sites and tests bus and truck drivers for
Hep B, Hep C, Syphilis and HIV/AIDS with free vaccination for Hep B and free
treatment for Hep C
 The Program screens Jail inmates in Punjab continuously. The Program is also
providing treatment to those testing positive for Hep C and HIV. The Program has
provided mass vaccination for Hep B
 Punjab’s first ever BSL-3 Lab was established at PACP Complex. The state-of-the-
art BSL-3 Level Advanced Diagnostics Laboratory provides complete package of
services and is equipped with latest flowcytometry machine, gene expert, CD4
Count machine and has the capacity to perform viral genotyping or HIV Resistance
testing for initiating or switching ART.
 The Program tests Transgenders, 300 Female Sex Workers/family members and is
providing free treatment services to Injecting Drug Users
 The PACP has started Pakistan’s first ever exclusive trans genders clinic was at
Fountain House

21.  The Program made coordinated efforts for introduction of Infection Control
measures in Punjab. Coordinated efforts were made to introduce Hospital Waste
Management protocols as per international standards
 The PACP initiated crackdown against quackery in areas having HIV outbreaks in
Chiniot and Sargodha in 2018. A province-wise massive operation against quackery
was initiated and efforts were made to stop the re-use of syringes.
Achievements:
 State of the art Bio-Safety Level 3 laboratory
 25 HIV treatment centers in 36 districts of Punjab
 36 Satellite treatment centers in all prisons of Punjab
 Biometric Registration of all patients for seamless service delivery
 Lost to Follow-up mechanism that ensures no patient is left untreated
 Free provision of Opportunistic infection medication to HIV patients
More than 14000 patients are actively getting free treatment.

22. Communicable Disease and Epidemic
Prevention & Control Program
 The main components of the program are Disease and Vector Surveillance, Health
Education, Communication, Social Mobilization and Advocacy, Institutional &
Capacity Building, Research & Development for all the districts of Punjab.
Objectives
 Make institutionalized and sustainable arrangements to combat Dengue and other
Epidemics
 Protect the population of Punjab from Dengue fever and other infectious diseases.
 Introduce comprehensive health including preventive, promotive, curative and
rehabilitative components.
 Enhance coverage and quality of health care at all levels including districts,
tehsils/towns and union councils.
 Maintain preparedness all the time to combat Dengue and other epidemics.
 Ensure involvement of community, civil society community leaders in controlling
Dengue and other epidemics in the Punjab.

23.  To prevent transmission of communicable diseases in general population of all
age groups
 Surveillance and response to prioritized communicable diseases i.e. Malaria,
Dengue Fever, Rabies, Congo Fever, Influenza H1N1, Pneumonia, Typhoid,
Cholera etc and emerging diseases like COVID-19
 All public health emergencies, including floods and epidemics
 Procurement and provision of insecticides for dengue fever prevention
 Procurement of medicines and other consumables for epidemic control of all
communicable diseases
 Capacity Building of health staff in field

24. Services and Initiatives:
 Support to Provincial Command & Control Center for COVID-19 Data Management
 Supervision of District Level Disease Surveillance & Response Units (DDSRUs)
 Development of COVID-19 SOPs with the inputs of all Stakeholders
 Trainings/Capacity building sessions regarding field surveillance, sample collection
and transportation, proper usage of PPEs, Diagnostic techniques, Surveillance for
ILI/SARI, home based care, Infection prevention and control trainings and clinical
case management.
 Procurement of Personal Protective Equipment (PPEs)
 Strengthening and Development of COVID-19 diagnostic Labs with necessary
logistics
 General Public awareness regarding COVID-19 prevention

25. Hepatitis Control Program
Program Goal
The overall goal of the program is to reduce morbidity and mortality due to
Hepatitis B&C
Objectives
 To increase coverage of Hepatitis B immunization services especially of the
target population sub-groups and high endemic regions of the province.
 To improve hospital waste management, infection control and injection safety
practices in public sector health facilities.
 To improve access to quality diagnostic services and effective hepatitis B&C
case management in the public sector health facilities.
 To strengthen the existing infrastructure and support system at Provincial &
District level for efficient and effective implementation of preventive program.

28. Achievement of Hepatitis Control Program:
 The Program has achieved following milestones implementing its four-pronged
strategy of “Educate, Prevent, Test and Treat”
 Macro-elimination through Hepatitis Clinics
 Micro-elimination- door-to-door campaign
 Special Initiatives for universities, colleges, madrassas, and prisons etc. and
collaboration with private stakeholders.
 Establishment of 281 Hepatitis Clinics at DHQ / THQ Hospitals, Teaching Hospitals
and partner organizations for free of cost Registration, Screening, Vaccination,
PCR processing and Medicine delivery to all Hepatitis Patients. All services
recorded and reported through electronic Medical Record (EMR). So far 2,019,179
have been registered, 1,610,858 screened, 1,437,153 vaccinated, 415088 patients
given free of cost medicines for Hepatitis B and C.
 Establishment of state-of-the-art and Center-of-Excellence Hepatitis PCR
lab with advanced and high throughput equipment. Total 3,67,334 PCR tests
conducted till date: 3,24,686 for Hepatitis C, 37,988 for Hepatitis B and 4,660 for
both B and C more than 200000 COVID-19 tests.

29.  Hepatitis Act 2018 promulgated for provision of legal backstopping for prevention
of Hepatitis in the Province. Includes Rules for enforcement mechanisms on
injection safety, blood safety, Organ transplant, dialysis.
 Hepatitis B vaccination of the newborn and Centralized licensing for barbers and
beauty salons and hospital waste management.
 WHO EMRO Region conference 2019 held in Lahore (3-5th December 2019),
as a token of appreciation for achievements for Control & Prevention of
Hepatitis in Punjab.

30. Integrated Reproductive, Maternal,
Neonatal and Child Health (IRMNCH) and
Nutrition Program
The IRMNCH & NP was launched in July 2013 with the
strategy to integrate 03 different programs (LHW Program, MNCH
Program & Nutrition Program). From July 2017, the Chief Minister’s
Stunting Reduction Program (CMSRP) and From June 2021, the
Prime Minister’s Health Initiative (PMHI) Program is also being
executed by IRMNCH & NP.

32. Goal
To improve maternal, new-born and child health in Punjab, especially of the poor
thereby making real progress towards achieving health related MDGs and contribute
to reduction in:
 Maternal mortality ratio from 227/100,000 live births to less than 140/100,000 live
births
 Under-five mortality rate from 104/1000 live births to 52/1000 live births
 Total fertility rate from 3.6 to 3.2
 Prevalence of stunting from 36% to 32

33. Objectives
The Program objective is to improve access to Reproductive health, Child health and
Nutrition services in the province especially for the poor through:
 Improving contraceptive prevalence rate for modern methods from 23% to 35 %
 Increasing skilled birth attendance from 59% to 80%
 Increasing institutional deliveries from 53% to 70%
 Increasing coverage of complete immunization from 35% to 70%
 Increasing percentage of children suffering from diarrhea treated with ORS and Zinc,
up to 40%
 Increase in the proportion of severe acute malnourished (with complications) children
0-59 months successfully treated (for discharge) up to 75%
 Increasing percentage of early initiation of breast feeding from 15% to 40
 Increasing percentage of exclusive breast feeding from 22% (0-5 months) to 35%
 Increased percentage of utilization of adequately Iodized salt at household level from
34% to 50%
 Increase in the distribution of iron & folate tablets among pregnant women from 20%
to 50%
 Increase in proportion of children 6-23 months fed in accordance with all three infant
and young child feeding (IYCF) practices (food diversity, feeding frequency,
consumption of breast milk or milk), up to 40%
 All districts implementing MNCH related MSDS

35. Prevention and Control of Non-Communicable
Diseases (NCDs) Program
Goal
 To reduce burden of morbidity and premature mortality related to NCDs.
Objectives
 To prevent NCDs by risk factor modifications through health promotion and multi-
sectoral action following a life-course approach.
 To provide access to the population for NCDs care through early detection and
management by strengthening existing health systems.
 To assess and monitor NCDs and risk factor situation in Punjab through Case
Registries, Operational Research and Surveys.

36. Expanded Program on Immunization (EPI)
 The Expanded Program on Immunization (EPI) started, as a pilot project in
1978 and was included as one of the component of Accelerated Health
Program in 1983. After wards it was integrated into regular Health Services in
1985
 Program aims to immunize 3.39 million target children of 0-23 Months
annually against 12 vaccine preventable diseases

37. Goal:
 The goal of the EPI is to reduce the infant and childhood mortality and morbidity
linked with vaccine preventable diseases, as per EPI’s schedule, and to limit other
infectious diseases (epidemics and pandemics) through emergency vaccination drives.
Objectives:
 Achieving routine coverage of Penta 3 more than 98% at provincial and at least
90% in all districts.
 Interrupting indigenous circulation of measles virus by 2024.
 Interrupting polio circulation by 2023.
 Decreasing deaths caused by tetanus from 0.03 to 0.01 per 10,000 newborn by
2024.
 To introduce the new available vaccines based on evidence and epidemiological
data complying to vaccine regulatory system of the country.
 To strengthen the VPDs surveillance in order to provide complete and timely
information backed with strong monitoring system for continuous improvement
 To integrate EPI with Primary Health Care within a more comprehensive service
delivery program

38.  To institute robust vaccine supply chain system ensuring availability of potent
vaccines
 To enable the communities in enhancing their understanding and ownership of the
value of vaccination, and demand vaccination as their right and responsibility.
 To enhance facility-based vaccination with timely and effective AEFI management
and improve immunization waste management system.
 To achieve sustainability in financing and resource mobilization for various
immunization interventions in a timely and efficient manner.

39. Achievements:
 Punjab achieved Fully immunized coverage of children 12-23 Months 90% highest
in all provinces
 Program shifted from PC-I mode to regular Non development budget in 2019-20
 Punjab introduced TCV, Hepatitis Birth dose and MR vaccines in Routine
Immunization
 Punjab achieved COVID-19 vaccination target, Fully immunized-76%, among
eligible population (Above 12 years) and at least one dose to 91% of eligible
population.
 EPI Punjab conducted its history’s largest mass vaccination campaign, the Measles
Rubella Catch-up Campaign from 15-27 Nov 2021 in all 36 districts. Target was
46.6 million children aged 9 months to 15 years (~39% of population) Coverage:
49.18m (105%)

40. Punjab TB Control Program
 The program was started in 2004

41. Key Achievements:
 Screening of a total of 816,148 people for TB in 2021
 Registration of 209,477 TB patients in 2021 and provision of free of cost treatment
 TB Treatment success rate maintained above 94%
 Registration of 1376 patients with Drug Resistant TB in 2021 and provision of free
of cost treatment
 Drug Resistant TB Treatment Success Rate (TSR) maintained above 72% (Global
TSR 54%).
 Establishment of specialized center in DHQ Gujranwala in 2021 for treatment of
Drug Resistant TB
 Development of Provincial Strategic Plan 2020-23
 Introduction of Monthly Meeting with District TB Coordinators through video Link.
 Capacity Building of Program Directors DHDC and District TB Coordinators on
updated National TB Guidelines
 Training of around 3500 district health professionals (doctors / paramedics / Lab
staff) on TB guidelines and Lab diagnostics
 Collaboration with Pakistan Medical Association, Pakistan academy of Family
Physicians etc.

43. Thank You