CONFUSION AND DENIAL: NEED FOR SYSTEMS THINKING TO UNDERSTAND THE HIV EPIDEMIC IN PAKISTAN

Authors

  • Muhammad Ahmed Abdullah
  • Babar Tasneem Shaikh

Abstract

The first case of HIV appeared in Pakistan more than 25 years ago, and since then the prevalence of the disease is creeping up apparently at a dawdling pace, with only 3,983, cases registered till November 2010, of which 1,725 are undergoing treatment. The National AIDS Control Program is responsible for managing the epidemic. Pakistan has moved from a ‘low prevalence-high risk’ to a ‘concentrated epidemic’ state, yet the forcefulness required for managing this silent escalation of HIV infected numbers is not being highlighted, as it should be. A more holistic focus is the need of the hour, and for this purpose the WHO’s HealthSystemsBuildingblocks have been used to discuss the state of affairs in Pakistan, with reference to the HIV/AIDS concentrated epidemic. This paper attempts to present a narrative, based on extensive literature review, with a focus on the six building blocks of health systems strengthening. No doubt, the service delivery has to be responsive; but skilled human resources, a robust information system, an uninterrupted supplies and use of latest technology, adequate financing, and above all good governance at operational level are essential ingredients, which call for re-orienting the national programme today. Lack of coordination, capacity and interventions with questionable sustainability pave a perilous path. Hitherto the issue can be addressed by involving stakeholders from all levels of the society and managing the void between policy and implementation. Furthermore, interventions that focus on the long term future are imperative to combat the menace threatening the human lives.Keywords: HIV/AIDS; Pakistan; Health system; Building blocks

References

National AIDS Control Programme. HIV second generation surveillance in Pakistan, National Report Round 2, 2006-7. Ministry of Health and Canada- Pakistan HIV/AIDS Surveillance Project, Islamabad: NIH; 2007.

UNAIDS. Global AIDS response progress report 2014: Country progress reoprt Pakistan. Islamabad: 2014.

Miller AC, Arquilla B. Disasters, women's health, and conservative society: working in Pakistan with the Turkish Red Crescent following the South Asian Earthquake. Prehosp Disaster Med 2007;22:269–73.

Emmanuel F, Fatima M. Coverage to curb the emerging HIV epidemic among injecting drug users in Pakistan: delivering prevention services where most needed. Int J Drug Policy 2008;19:S59–64.

Mayhew S, Collumbien M, Qureshi A, Platt L, Rafiq N, Faisel A, et al. Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan’s fight against HIV/AIDS. Sex Transm Infect 2009;85(Suppl 2):ii31–6.

Kassi M, Afghan AK, Khanani MR, Khan IA, Ali SH. Safe blood transfusion practices in blood banks of Karachi, Pakistan. Transfus Med 2011;21(1):57–62.

Altaf A, Shah SA, Shaikh K, Constable FM, Khamassi S. Lessons learned from a community based intervention to improve injection safety in Pakistan. BMC Res Notes 2013;6:159.

Nasir A, Todd CS, Stanekzai MR, Bautista CT, Botros BA, Scott PT, et al. Prevalence of HIV, hepatitis B and hepatitis C and associated risk behaviours amongst injecting drug users in three Afghan cities. Int J Drug Policy 2011;22:145–52.

National AIDS Control Programme. The HIV/AIDS surveillance project (HASP): Summary Report – Integrated Biological and Behavioral Surveillance Study. Islamabad: Pakistan Ministry of Health; 2007.

Kianni W. 250 HIV/AIDS cases detected in Gujrat .The Daily Nation. 14 Nov 2008. Islamabad.Availabel at: http://www.nation.com.pk/politics/14-Nov-2008/250-HIVAids-cases-detected-in-Gujrat [accessed 2 June 2014]

Achakzai J. 31 Adiala Jail inmates test positive for HIV in two years. The News International. 16 June 2011. Islamabad. Available at: http://www.thenews.com.pk/Todays-News-6-52779-31-Adiala-Jail-inmates-test-positive-for-HIV-in-two-years [accessed 2 June 2014]

Wazir MS, Mehmood S, Ahmed A, Jadoon HR. Awareness among barbers about health hazards associated with their profession. J Ayub Med Coll Abbottabad 2008;20(2):35–8.

Bossert TJ, Mitchell AD. Health sector decentralization and local decision-making: Decision space, institutional capacities and accountability in Pakistan. Soc Sci Med 2011;72:39–48.

deSavigny D, Adam T, editors. Systems thinking for health systems strengthening. Geneva: World Health Organization; 2009.

Nishtar S. hoked pipes: reforming Pakistan's mixed health system. Islamabad: Oxford University Press; 2010.

Shaikh BT. Marching toward the Millennium Development Goals: What about health systems, health-seeking behaviours and health service utilization in Pakistan? World Health Popul 2008;10(2):16–24.

Hafeez A, Khan Z, Bile KM, Jooma R, Sheikh M. Pakistan human resources for health assessment. East Mediterr Health J 2010;16(Suppl):S145–51.

Ahmed J, Shaikh BT. An all-time low budget for healthcare in Pakistan. J Coll Physicians Surg Pak 2008;18:388–91.

Shaikh BT. Health care system in Pakistan. In: Rout HS, editor. Health care systems: A global survey, New Delhi: New Century Publications; 2011.p. 434–54.

National AIDS Control Programme. Available at: http: //www. nacp.gov.pk/treatment_centres /List%20of%20Treatment%20Centres.pdf [accessed on 21 August 2014]

Altaf A, Khamassi S, Shah SA. Preventing transmission of hepatitis C due to unsafe injections should be a priority for Pakistan. J Pak Med Assoc 2014;64:239–41.

Astor A, Akhtar T, Matallana MA, Muthuswamy V, Olowu FA, Tallo V, et al. Physician migration: views from professionals in Colombia, Nigeria, India, Pakistan and the Philippines. Soc Sci Med 2005;61:2492–500.

Khandwalla HE, Luby S, Rahman S. Knowledge, attitudes, and practices regarding sexually transmitted infections among general practitioners and medical specialists in Karachi, Pakistan. Sex Transm Infect 2000;76:383–5.

Shaikh FD, Khan SA, Ross MW, Grimes RM. Knowledge and attitudes of Pakistani medical students towards HIV-positive and/or AIDS patients. Psychol Health Med 2007; 12(1):7–17.

Kumar R, Shaikh BT, Chandio AK, Ahmed J. Role of Health Management Information System in disease reporting at a rural district of Sindh. Pak J Public Health 2012;2(2):10–12.

National AIDS Control Programme. Enhancing Government of Pakistan capacity in secong generation surveillance of HIV. Available at: http://www.nacp.gov.pk/surveillance_and_research/ [accessed on 12 July 2014]

Shah SA, Altaf A, Khanani R, Vermund SH. Antiretroviral drugs obtained without prescription for treatment of HIV/AIDS in Pakistan: patient mismanagement as a serious threat for drug resistance. J Coll Physicians Surg Pak 2005;15:378.

Abbasi W. Thousands of AIDS patients face doom as billions misappropriated. Available at: http://www.thenews.com.pk/Todays-News-2-221757-Thousands-of-Aids-patients-face-doom-as-billions-misappropriated [accessed on 28 July 2014]

Shaikh BT, Ejaz I, Achakzai DK, Shafiq Y. Political and economic unfairness in health system of Pakistan: a hope with the recent reforms. J Ayub Med Coll Abbottabad 2013;25(1-2):198–203.

Schwartländer B, Stover J, Hallett T, Atun R, Avila C, Gouws E, et al. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet 2011;377:2031–41.

World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach-2010 revision. Geneva: WHO; 2010

Published

2014-09-01

Most read articles by the same author(s)

1 2 > >>