"" "" # *Detailed SUMMARY of the article "TB after Global Fund" by Naseem Salahuddin, Published in Dawn on June 19th, 2025:* The article examines *Pakistan*'s critical *tuberculosis (TB)* crisis, ranking *fifth globally* after *India*, *China*, *Indonesia*, and the *Philippines*. *Pakistan* faces a severe *infectious disease* burden including *hepatitis*, *HIV/AIDS*, *malaria*, *dengue*, and various preventable diseases, with *TB* being the deadliest. At *Indus Hospital Karachi*'s TB clinic, patient numbers have *tripled over 12 years*, with *100+ daily visits* and complications including *meningitis*, *perforated intestines*, and *adrenal crisis*. *One in four* outpatients has *TB* affecting multiple organs. Random screening revealed *10%* of minimally symptomatic patients had *TB*, including *drug-resistant cases*. The *health ministry* reported a massive increase from *11,050 cases in 2002* to *608,000 in 2024*, with *1,500 drug-resistant cases*. The *National TB Programme (NTP)*, supported by the *Global Fund (GF)*, provides free treatment through *1,500 facilities* nationwide. *Eighty-two percent* of *NTP*'s budget comes from *GF*, primarily funded by *USAID*. *India* supplies *sensitive TB drugs*, while *resistant TB medications* and *diagnostics* from *Japan/Europe* are *prohibitively expensive*. Experts like *Dr. G.N. Kazi* and *Dr. Shifa Habib* warn of *America*'s potential foreign aid cuts threatening *TB*, *AIDS*, and *malaria programs*. The article emphasizes *Pakistan*'s overdependence on *donor funding*, noting that *three local pharmaceutical companies* ceased *TB drug production* due to *GF competition*. It advocates for *domestic financing*, *local manufacturing* of *first-line drugs*, and warns that without access to *diagnostics* and *medicines*, *drug-resistant TB* will become *untreatable*, affecting both *rich and poor*. # *Easy/Short SUMMARY*: *Pakistan* ranks *5th globally* in *TB cases* with *608,000 new cases in 2024*. *Indus Hospital* sees *100+ daily TB patients* with severe complications. *82%* of *National TB Programme* budget depends on *Global Fund* (*USAID*-funded). Experts warn of *foreign aid cuts* threatening *TB control*. *Pakistan* needs *domestic financing* and *local drug manufacturing* to reduce *donor dependency* and prevent *untreatable drug-resistant TB*. # *SOLUTIONS of The Problem*: ## *1. Increase Domestic Financing* Reduce *82%* dependency on *Global Fund* by increasing *government healthcare budget* allocation. ## *2. Develop Local Manufacturing* Establish *domestic pharmaceutical production* of *first-line TB drugs* to reduce import dependency. ## *3. Strengthen Healthcare Infrastructure* Expand *TB treatment facilities* beyond current *1,500 centers* to improve access. ## *4. Improve Living Conditions* Address *overcrowding*, *poor ventilation*, and *malnutrition* that fuel *TB transmission*. ## *5. Enhanced Screening Programs* Implement *mass screening* in *schools*, *factories*, *restaurants*, and *healthcare facilities*. ## *6. Combat Drug Resistance* Invest in *second-line TB drugs* and *advanced diagnostics* for *drug-resistant cases*. ## *7. Nutrition Programs* Launch *malnutrition prevention* initiatives to strengthen *immune systems* against *TB*. ## *8. Healthcare Worker Protection* Provide *proper ventilation* and *protective equipment* for *healthcare workers*. ## *9. Public Awareness Campaigns* Educate communities about *TB symptoms*, *transmission*, and *treatment compliance*. ## *10. International Partnerships* Diversify *funding sources* beyond *USAID* to ensure *sustainable TB control*. # *IMPORTANT Facts and Figures Given in the article*: - *Pakistan* ranks *5th globally* in *TB cases* after *India*, *China*, *Indonesia*, *Philippines*. - *TB patients* at *Indus Hospital* have *tripled over 12 years*. - *100+* new and follow-up *TB patients* visit daily at *TB clinic*. - *One in four* outpatients has *TB* affecting multiple organs. - *10%* of randomly screened patients diagnosed with *TB*. - *TB cases* increased from *11,050 in 2002* to *608,000 in 2024*. - *1,500 drug-resistant TB cases* reported in *2024*. - *National TB Programme* operates through *1,500 facilities*. - *82%* of *NTP budget* funded by *Global Fund*. # *IMPORTANT Facts and Figures out of the article*: - *WHO* estimates *Pakistan* has *610,000 TB cases* annually (*WHO Global TB Report*, 2024). - *TB* causes *70,000 deaths* annually in *Pakistan* (*WHO*, 2024). - *Drug-resistant TB* treatment costs *$10,000-15,000* per patient (*MSF*, 2024). - *Pakistan*'s *TB mortality rate* is *40 per 100,000* population (*WHO*, 2024). - *Global Fund* provided *$180 million* to *Pakistan* for *TB* (2020-2023). - *USAID* contributes *33%* of *Global Fund* total budget (*Global Fund*, 2024). # *MCQs from the Article*: ### 1. *What is Pakistan's global ranking in TB cases?* A. Third B. Fourth *C. Fifth* D. Sixth ### 2. *How much of NTP's budget is funded by Global Fund?* A. 75% B. 80% *C. 82%* D. 85% ### 3. *How many TB cases were reported in Pakistan in 2024?* A. 500,000 *B. 608,000* C. 650,000 D. 700,000 ### 4. *Which country primarily supplies TB drugs to Pakistan?* *A. India* B. China C. Japan D. USA ### 5. *How many facilities does the National TB Programme operate through?* A. 1,200 B. 1,300 *C. 1,500* D. 1,800 # *VOCABULARY*: 1. *Cauldron* (کڑاہی) – A large container; metaphorically, a place of intense activity 2. *Zoonotic* (حیوانی) – Diseases transmitted from animals to humans 3. *Corroborates* (تصدیق کرتا ہے) – Confirms or supports with evidence 4. *Abject* (انتہائی) – Extremely bad or severe 5. *Paucity* (کمی) – Scarcity or lack of something 6. *Procurement* (خریداری) – The process of obtaining goods or services 7. *Prohibitively* (ممنوع حد تک) – So expensive as to prevent purchase 8. *Seismic* (زلزلہ خیز) – Having a very great effect; earthquake-related 9. *Impending* (آنے والا) – About to happen; approaching 10. *Depletion* (ختم ہونا) – Reduction in the quantity of something 11. *Dire* (خطرناک) – Extremely serious or urgent 12. *Inevitable* (ناگزیر) – Certain to happen; unavoidable 13. *Prudent* (دانشمندانہ) – Acting with care and thought for the future 14. *Transmissible* (منتقل کرنے والا) – Capable of being transmitted 15. *Wracked* (تباہ) – Severely damaged or affected 16. *Frail* (کمزور) – Weak and delicate 17. *Vulnerability* (کمزوری) – The state of being exposed to harm 18. *Mitigating* (کم کرنا) – Making less severe or serious 19. *Incidence* (واقعات) – The occurrence or rate of occurrence 20. *Diagnostics* (تشخیص) – The practice of identifying diseases 📢 *Attention Please!* We appreciate your commitment to acquiring knowledge through our summaries. 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Click the link below to join now 🔗 [Dawn Article Summaries](https://cssmcqs.com/dawn-editorials-articles-summary-for-students-pdf-download/) *WhatsApp Channel Link*: [https://whatsapp.com/channel/0029Va7tT3o35fLnJeFbpS2y](https://whatsapp.com/channel/0029Va7tT3o35fLnJeFbpS2y) --- *www.dawn.com* *TB after Global Fund* *Naseem Salahuddin* *5–6 minutes* PAKISTAN is a cauldron of infectious diseases, including a wide range of hepatitis, HIV/AIDS, malaria, dengue, chikungunya, diarrhoea and dysentery, as well as older diseases like rabies and various zoo­notic illnesses, all of which could be prevented with effective local governance. No disease inflicts more suffering and death than tuberculosis (TB). We rank fifth globally, trailing only India, China, Indonesia and the Philippines, primarily due to poverty, overcrowding and malnutrition. At the daily TB clinic in Indus Hospital, Karachi, the number of patients diagnosed with TB has tripled over the past 12 years. Patients of all ages arrive with severe complications of TB, including meningitis, perforated intestines, adrenal crisis and sho­ck. One in four patients in a routine medical outpatient clinic has TB affecting the lungs and glands of the neck, breast, skin, bones, joints, kidneys, ovaries and uterus. At the purpose-built TB clinic, over 100 new patients and those seeking follow-up care visit daily. Apparently healthy individuals in the outpatient waiting area were randomly screened for symptoms such as fever, persistent cough or weight loss. Ten per cent of those with minimal sy­­­m­ptoms were diagnosed with TB, incl­uding one with drug-resistant TB. Among those randomly tested, three girls from a government school were found to have TB, and we are now conducting contact screening for all students and teachers. Many of our patients with TB who work in factories, restaurants, banks or schools, or are children studying in schools or madressahs, breathe the same air for hours in unventilated spaces. One infected person coughing up TB bacteria will transmit it to many. More alarmingly, several healthcare workers have contracted TB. Indi­viduals with few or mixed symptoms who remain undiagnosed and hence untreated spread the disease in communities. On World TB Day in March 2024, the he­­alth ministry announced grim statistics: newly notified cases increased from 11,050 in 2002 to 608,000 in 2024, with 1,500 being resistant to conventional drugs. This escalation corroborates our experience. Are we prepared for the challenge? As Pakistan's population explodes, living space diminishes, forcing large families to crowd into poorly ventilated spaces. Nutritious meals are out of reach for most. TB does not spare children — the frail bodies of infants and adolescents are wracked by it. Rising diabetes, malnutrition and HIV/AIDS weaken immunity, rendering them more vulnerable to TB; abject poverty and paucity of funds present enormous challenges to TB control. The National TB Programme, supported by the Global Fund, provides free treatment services through 1,500 facilities across Pakistan via provincial TB programmes, guaranteeing access to trained personnel, diagnostics and treatment. GF is primarily funded by USAID, while contributions from other countries and private donors are relatively small. Eighty-two per cent of the NTP's budget is funded by GF, with the remainder expected to come from Pakistan. GF procures anti-TB drugs and diagnostics from countries that comply with good manufacturing practices and meet global standards. India is the world's third largest pharmaceutical producer, primarily supplying drugs for sensitive TB. Drugs for resistant TB are prohibitively expensive, as diagnostic machines and cartridges are made in Japan or Europe. Despite considerable global investment, the results from Pakistan fall short of expectations. We are far from achieving global milestones in mitigating deaths and incidence. Dr G.N. Kazi, aglobal health and public policy specialist and the editor-in-chief of Public Health Act­ion, voices concerns about America's ab-rupt de­­cision to halt foreign aid, which has delivered a seismic shock to prog­r­ammes combating TB, AIDS and mal­aria. Dr Shifa Ha­­bib, a public health scholar at Johns Hop­kins University, also expresses worry ab-o­­­ut the impending depletion of resources for GFATM (Global Fund for AIDS, TB and Malaria). Given the dire situation of TB in Pak­istan, we must prepare for the inevitable: the support for diagnostics, drugs and man­­power will soon face severe disruption. Our reliance on donor funds must be lessened and domestic financing increa­sed. At least three pharmaceuticals in Pakistan that marketed TB drugs in previous years wound up because of dwindling returns due to GF support. Today, there is no local provider. It would be prudent for the government to explore options for the local manufacture of first-line drugs. Dia­gnostics and costly second-line medicines could be procured through grant resources. Without access to diagnostics and medicines, TB will affect tens of thousands more with drug-resistant bacteria, which will become untreatable. If these challenges are not addressed soon, it could be too late to control this highly transmissible and dangerous disease that will impact both rich and poor. The writer is an infectious disease specialist. Published in Dawn, June 19th, 2025