ISLAMABAD: The Government of Pakistan has recently launched another landmark initiative, the Essential Package of Health Services—its national version of universal health coverage. Universal health coverage is a globally promoted initiative and is in line with Pakistan’s commitment to achieving the Sustainable Development Goals, particularly target 3 on health for all and leaving no one behind.
Prime Minister Imran Khan said: “Pakistan has adopted an essential list of health services, which, once implemented, will put into action a set of preventive and curative interventions without stigma, delivered at the primary and secondary levels, that directly impact upon the health of vulnerable populations and marginalized communities; will help to achieve our human development goals; and will reduce the burden of many diseases and conditions, including HIV and AIDS.”
The Essential Package of Health Services will benefit everyone, including the furthest marginalized populations in geographically far-flung areas, and will improve access to lifesaving and life-prolonging services.
Pakistan has also recognized pro-poor health strategies for responding to the HIV epidemic and the need to significantly increase public-sector investment at the federal and provincial levels to enhance primary health-care services.
This comprehensive package, which includes HIV prevention and treatment services, is a compelling vision of a future in which everyone, including people at the grassroots level, has access to health services that are responsive to their needs and are provided in a timely manner.
Dr Faisal Sultan, Special Assistant to the Prime Minister on Health, emphasized: “The provision of many health-promotive, preventive and curative services is effectively possible only if woven into the normal delivery of care at the primary level. HIV is not an exception, and its quality of care will benefit greatly once it is part of a universal package.”
The Essential Package of Health Services includes specific services for people living with or affected by HIV, including:
- Community-based HIV testing and counselling, with appropriate referral and linkages to care and immediate antiretroviral therapy initiation.
- Provision of condoms to key populations, including female sex workers, men who have sex with men, people who inject drugs, transgender people, and people in prison.
- Provision of disposable syringes to people who inject drugs.
- Partner notification and expedited treatment for common sexually transmitted infections, including HIV.
- Provider-initiated testing and counselling for HIV, sexually transmitted infections and hepatitis for all people in contact with the health system in high-prevalence settings, including prenatal care, with appropriate referral and linkages to care, including immediate antiretroviral therapy initiation for people who test positive for HIV.
- Screening of HIV in all people with a diagnosis of active TB.
- Immediate antiretroviral therapy initiation for all people living with HIV, with regular monitoring of viral load.
- Use of mass media to encourage the use of comprehensive prevention methods.
- Post-gender-based violence care, including counselling, provision of emergency contraception, and rape-response referral.
The 90,000 community-based Lady Health Workers (LHW) all over the country mandated to provide primary, preventive, promotive and curative care services mainly in remote rural and urban slum communities will now play a stronger role in providing HIV education and referral services at the community level. Comprehensive HIV prevention, treatment, care, and support services will now be an integral part of LHW Programme, thus normalizing HIV and reducing HIV related stigma. In the long run, it is expected to increase the uptake of HIV services and improve the quality of lives of people living with and affected by HIV.
Highlighting equitable access to health services, Dr Zafar Mirza, former Special Assistant to the Prime Minister on Health and now WHO Advisor on Universal Health Coverage, said: “Pakistan is well on its way in advancing universal health coverage. Steady expansion of social health insurance for poor people and vulnerable groups and launching of the national essential services package are major milestones. Universal health coverage promotes equity and promotes affirmative action for marginalized and vulnerable people, including people living with HIV, people who use drugs, transgender people and other vulnerable populations.
Aware of the limited resources available, the Government of Pakistan is carefully calibrating decisions to ensure it can bring the greatest impact for people in need. Its success depends on the delivery of all interventions that are critical for good health, including prevention and other non-medical interventions, such as awareness-raising, advocacy, treatment adherence support, and linking key populations to friendly health services.
“I am so glad this is happening now, and I am excited not only for myself but for my brothers and sisters living with HIV, to benefit from this government program. This programme will help normalize the HIV response in the country along with addressing stigma and discrimination and capacity strengthening of health care providers”, said Asghar Satti, National Coordinator, Association of People Living with HIV and AIDS
UNAIDS strongly believes that ensuring access to good-quality services for all, at the time and place where they are needed, is critical to the success of universal health coverage. Dr Maria Elena Filio Borromeo, UNAIDS Country Director for Pakistan, reiterated: “The inclusion of HIV prevention and treatment services in the Essential Package of Health Services is a positive step towards improving access to comprehensive HIV services—not for some but for all. With its effective implementation, Pakistan could sustain its HIV response and potentially end AIDS as a public health threat by 2030.”