Scaling-up innovative approaches, mobile health technology, and a strong network of community health workers (CHW), GHD’s service delivery in the community and at the primary care level of services has strong linkages with local, secondary and tertiary facilities within the Indus Health Network. GHD successfully implemented interventions at hospitals and community settings across Pakistan and has impacted over 1 million people.

IHN in partnership with IRD has been a major stakeholder in carrying out the “Aao TB Mitao” initiatives in Pakistan with public and private sector partners. In addition to two Zero TB City projects in Karachi and Peshawar, the program has also laid the foundations for establishing comprehensive programs that work towards the elimination of TB by initiating active case finding programs in Quetta, Bhong, Hyderabad, Sukkur, Lahore, Skardu, and Khaplu. Aside from providing mass screening at a population level, the emphasis has been laid on effective screening of at-risk groups such as prisoners, HIV patients, diabetics, factory workers, coal miners, and other high-risk groups. The teams screened 552,587 adults and 161,886 children for TB during 2019-20 and started 3,856 adults and 2,387 children on treatment for drug-sensitive TB across different parts of the country. Through this initiative, the team has enrolled 937 patients on treatment for drug-resistant TB across 11 sites in Sindh and Baluchistan. Of the patients found, 10,882 contacts of TB patients have been evaluated for the presence of disease of which 7,657 patients were offered preventive therapy for TB. In an effort to expand its reach and provide widespread coverage the program has mobilized almost 55 mobile X-Ray vans across the country aiming to help work towards the decline of TB in the country.

13,522 prisoners across Sindh, Khyber Pakhtunkhwa, and Baluchistan jails were also started on preventive treatment.

As part of an integrated primary care model, IRD Pakistan’s Pursukoon Zindagi has integrated all patients registered at the primary care clinics – as well as their attendants – and creened them for depression and anxiety by trained lay-counselors. 53,829 individuals were screened, from which 2,527 were found to be symptomatic of depression and anxiety. 1,462 of these were enrolled in counseling by the mental health lay-counselors.

PCP’s more than 60 % of patients are mothers and children. The Maternal, Neonatal, Child Health (MNCH) Program has been an integral part of the PCP. The MNCH component is running the following projects:

• Expanded Programme on Immunization
• Zindagi Mehfooz – Electronic Immunization
• Registry (Child Level Data) implemented in Sindh and now expanding to Islamabad and
  Baluchistan
• Deworming Program
• Family Planning
• Lactation Management Program
• Integrated Management of Childhood Illness (IMNCI)
• Nutrition Program
• Safe Delivery Program
• Midwifery Program
• Helping Babies Breathe (HBB)

During July 2019- June 2020, the program immunized 168,563 children; 27,206 women of reproductive age were immunized with tetanus toxoid; 1,553,236 children and 528,885 women were enrolled into the Zindagi Mehfooz digital immunization registry from 29 districts of Sindh; dewormed 6,673 children; provided family planning services to 11,553 women; lactation management services to 23,405 women; Integrated Management of Childhood Illness (IMNCI) service was provided to 28,441 children; nutrition screening of 83,673 patients; 12,831 children enrolled in the nutrition program out of which 12,134 were treated for severe acute malnutrition and moderate acute malnutrition in outpatient therapeutic program and 697 children with complications were treated in a stabilization center.

Surveillance for Surgical Site Infections (SSI) Program

The program aims to assess the burden of SSIs in addition to evaluating the ability of patients to identify an SSIs and to take immediate action. The operational research was initiated in RTEH in March 2018 and was completed in March 2019. However, passive surveillance is still being conducted in RTEH.

Pehla Qadam (PQ) Program

The program is part of a global commitment to eliminate untreated clubfoot; the PQ program provides free of cost treatment using the Ponseti method, the gold standard approach to managing uncomplicated club foot. Since its inception in 2011, more than 1,000 children have been enrolled in the program and 250 patients have completed treatment. This program is jointly funded by the Amer Haider Charitable Foundation and IHN.

The program is functional at:
• The Indus Hospital, Korangi, since August 2011
• Recep Tayyip Erdogan Hospital, Muzaffargarh, since December 2017
• Manawan General Hospital, Lahore, since October 2017
• Civil Hospital, Badin, since February 2019

Certification Program in Emergency Medicine (CPEM)

This one-year program aims to train Emergency Department (ED) doctors in key Emergency Medicine (EM) knowledge and skills through a standardized and locally relevant training curriculum. The initial course commenced at TIH in July 2018. The second year of the course began in July 2019. CPEM is a collaboration between IHN and emergency medicine specialists based at Harvard Medical School. It is funded by the Habib Bank Limited Foundation; during the first year of the program, additional funding support was provided by the Harvard Medical School’s Centre of Global Health Delivery, Dubai.

In June 2019, CPEM graduated its first batch of 25 students. 25 students enrolled for the second batch.

Decentralizing HCV screening through integration in routine patient process flow of family medicine clinics (at Primary Care Program sites), “Aao TB Mitao” initiative, community-based activities run by CEC and Emergency Department services has helped us to identify up to 6,461 confirmed cases, who could have gone undetected and possibly presented at a later untreatable stage of illness. Up to 2,535 participants have been engaged through community-based health awareness sessions at two rural sites.

The program model has also been very instrumental to ensure linkage of suspected cases, identified incidentally during blood donation drives in Karachi. It has been able to actively link up to 246 blood donors to PCR testing and 64 of these to treatment.

The program continues to expand its scope of prevention, screening, and treatment activities to create awareness and actively identify suspected cases to slow down community-based transmission, hence contributing to curb this silent epidemic, a public health emergency in Pakistan.

Lung Health Program

The Lung Health program was established in response to the serious morbidity and mortality associated with chronic respiratory disease, recognized by WHO as a serious non-communicable disease. The Lung Health program specifically focuses on non-TB associated respiratory disorders. The program runs the following projects:

Tobacco Control

Tobacco use is a leading cause of poor lung health. During 2019-2020 the program sensitized over a 1,000 adolescent school-going girls at the She Leads conference about tobacco hazards.

Obstructive Lung Disease (OLD)

Obstructive Lung Disease such as asthma and chronic obstructive pulmonary diseases (COPD) is one of the commonest forms of complaints in the primary care sector. In 2019-2020, the service offered 1,130+ spirometry services at The Indus Hospital, Korangi, of which 800+ patients were diagnosed with asthma or COPD in Family Medicine.

Pulmonary Rehabilitation (PuRe)

PuRe provides multidisciplinary treatment for breathless patients with chronic respiratory disease. It was designed to improve health-related quality of life and reduces the burden of exacerbations of respiratory disease. In 2019-2020, 18 patients completed PuRe and 27 are currently enrolled.

Air Quality

The impact of air quality on lung health requires highlighting in Pakistan and locally. In 2019-2020, the programliaised with Pakistan Air Quality Initiative and World Bank for strategy and monitoring the level of carbon monoxide (CO) in 350+ outpatients.

Malaria

The Indus Health Network secured The Global Fund Malaria Grant in 2016 as a private sector principal recipient. IHN in collaboration with the Directorate of Malaria Control Program Pakistan, provincial malaria programs, and the Department of Health is providing Malaria preventive and curative services in Pakistan. IHN’s Malaria interventions are implemented to reach out to around 13.2 million beneficiaries in 7 districts of Khyber Pakhtunkhwa and 12 districts of Baluchistan. The goal is to, by 2020, reduce the Malaria burden by 60% in 72 high endemic districts/agencies of Pakistan.

IHN closely worked with its partners to provide Malaria preventive, promotive, curative, and health systems strengthening activities in its grant which supported multiple districts of Pakistan.

TIH is implementing its diagnosis and treatment services in 984 public hospitals and private clinics, out of which 496 are in Khyber Pakhtunkhwa and 488 in Baluchistan. During the year 2019-20, a total of 1,228,934 Malaria suspects were identified and all of them were screened for the Malaria parasite with a rapid diagnostic test or Malaria microscope. A total of 85,744 suspects were confirmed as Malaria patients with all of them treated as per the national treatment guidelines.

Despite the challenges due to COVID-19, the performance of the Malaria team and its partners remained exceptional. When compared with the preceding year 2018-19 there is an increase of 26% in the screening of Malaria suspects. Similarly, there is a drop of about 3% in the confirmed cases during 2019-20 when compared with 2018-19.