National Hepatits Strategic Framework (NHSF) for Pakistan 2017-21
Globally, approximately 257 million persons are chronically infected with Hepatitis B Virus (HBV) and 71 million with Hepatitis C Virus (HCV). If the number of people living with hepatitis remains at the current high levels for the next 40-50 years, it is estimated that a cumulative 20 million deaths will occur between 2015 and 2030; therefore a stepped-up global, regional and national response can no longer be delayed.
World Health Organization (WHO) has developed the Global Health Sector Strategy (GHSS) for Viral Hepatitis (VH) 2016-2021 that contributes to the achievement of the 2030 agenda for Sustainable Development Goals (SDGs). The strategy addresses all five hepatitis viruses (hepatitis A, B, C, D and E), with particular focus on hepatitis B and C. The strategy describes the contribution of the health sector in combating viral hepatitis towards its elimination as a public health threat by 2030. The WHO Eastern Mediterranean Regional Office (EMRO) developed a Regional Action Plan 2017-2021 for the implementation of the GHSS for Viral Hepatitis (VH). The regional action plan is intended to guide the Member States and the WHO secretariat on a roadmap towards the achievement of national, regional and global targets.
Pakistan has a high disease burden of hepatitis A to E, with maximum morbidity in hepatitis A & E and maximum morbidity and mortality in hepatitis B, C and D. HBV and HCV are major public health threats in Pakistan.
Recognizing the enormity of the problem and working towards achieving the WHO global elimination targets by 2030, Pakistan has also developed its National Hepatitis Strategic Framework (NHSF) for Hepatitis response 2017-2021 through a participatory process with the involvement of Provincial hepatitis programmes, Federal and Provincial partners, including private sector and NGOs.
The vision of NHSF is "In Pakistan; viral hepatitis transmission is halted and everyone living with viral hepatitis has access to safe, affordable and effective prevention, care and treatment services". The NHSF goals and targets have been aligned with the SDGs for 2030 and the WHO global goals and targets. This takes into account the country context, including the nature and dynamics of the country viral hepatitis epidemics, populations affected, structure and capacity of the health care and community systems, and the resources that can be mobilized.
Five strategic objectives have been set up to implement the priority areas that have emerged from the epidemiological situation of viral hepatitis and its current National response. These include;
- Strategic objective I: To strengthen leadership, governance and advocacy for a coordinated and integrated hepatitis response
- Strategic objective 2: To increase the availability and use of strategic information that will enable the development and monitoring of the implementation of evidence-based strategies
- Strategic objective 3: To improve the quality, and scale up coverage of the hepatitis B and C prevention
- Strategic objective 4: To strengthen the viral hepatitis B and C testing and diagnosis services
- Strategic objective 5: To improve the quality, and scale up coverage and utilization of comprehensive treatment, care and support for hepatitis B and C patients
Effective implementation of the NHSF depends on concerted Federal and Provincial actions from all stakeholders in the health and other sectors to respond to viral hepatitis. Success requires strong partnerships to ensure policy and programme coherence. Within the health sector, linkages across different disease-specific and cross-cutting programmes need to be established and strengthened. Implementation of the strategic framework needs the development of the Provincial action plan and a strong monitoring and evaluation system to generate the best possible data on the viral hepatitis situation, including trends and responses, and to monitor the hepatitis response through a set of standard and measurable indicators.