Despite notable progress in the fight against hepatitis C (HCV), it remains a significant global health challenge, affecting approximately 71 million people and causing 400,000 deaths annually. The international community has made strides in addressing HCV through initiatives like the Global Health Sector Strategy (2016–2021), the Global Hepatitis Action Plan (2011), and the United Nations Sustainable Development Goals (UN-SDGs) for 2030. However, achieving the World Health Assembly’s goal of eliminating HCV by 2030, which involves treating 90% of infected individuals, presents substantial challenges, particularly in Pakistan. This study explores the perspectives of key stakeholders involved in the hepatitis elimination policy in Pakistan, identifying barriers to effective policy implementation and highlighting motivating factors.
Understanding the Global Context of Hepatitis C
Hepatitis C continues to be a leading cause of mortality and morbidity worldwide. Despite global efforts, only 12 countries are on track to eliminate hepatitis C by 2030, with Italy, the United Kingdom, and Spain among them. Egypt has notably reduced its HCV burden from one of the highest in the world to the lowest, achieving the “gold tier” status for hepatitis C elimination as per WHO criteria.
In 2016, the World Health Assembly committed to eliminating hepatitis C by 2030 through high-impact interventions, aiming to treat 90% of all people with HCV. The WHO has urged countries to invest in hepatitis elimination through sustained financial support within their universal health coverage plans. However, challenges such as stigmatization and lack of high-quality epidemiological data remain significant obstacles.
The Hepatitis C Challenge in Pakistan
Pakistan ranks second globally in HCV infection rates, with nearly one in 20 people infected. The epidemic is widespread across all provinces, with Punjab and Sindh reporting the highest prevalence. Persistent risk factors, such as unsafe injections, unscreened blood transfusions, and poor sterilization practices, contribute to the ongoing transmission. Without stronger interventions, cases could exceed 11 million by 2035, resulting in high rates of liver disease and over 130,000 deaths annually.
Genotype 3a is the most common genotype in Pakistan, accounting for 63% of cases. Current government funding for hepatitis treatment and control is insufficient to meet the WHO’s elimination targets. Pakistan needs to screen an average of 18.9 million people, treat 1.1 million, and prevent 470,000 new infections annually to reach these goals.
Stakeholder Perspectives on Policy Implementation
This study involved interviews with ten key informants, including policymakers, clinicians, and provincial hepatitis program personnel. Thematic analysis revealed several critical themes: perceptions of hepatitis and elimination policies, feasibility of achieving elimination goals, international collaborations, policy development, gaps in epidemiological data, and the influence of political contexts.
Participants expressed concerns over the recent surge in hepatitis cases and related fatalities. Some rejected the notion of significant progress since the adoption of hepatitis prevention and control policies in Pakistan. There was a consensus that intervention strategies and resources have not adequately transitioned from control to elimination efforts.
Barriers to Effective Policy Implementation
Several barriers hinder the effective implementation of hepatitis elimination policies in Pakistan. These include inadequate funding, lack of reliable epidemiological data, insufficient awareness, a fragile healthcare system, and weak political will. The absence of a national database registry complicates comprehensive data analysis and tracking of hepatitis prevalence.
Collaboration among government entities, provinces, NGOs, and healthcare companies is crucial for effective policy implementation. Participants highlighted the lack of coordination among provinces as a significant obstacle. International collaboration, particularly learning from successful models like Egypt, emerged as a key influencer in shaping hepatitis elimination policy.
Political and Financial Challenges
Political dimensions play a significant role in hepatitis elimination efforts. Participants identified a lack of political will, inadequate funding, and misuse of resources as major challenges. The fragmented healthcare system further limits access to hepatitis diagnosis and treatment, particularly in rural areas.
Despite the government’s ambitious plans, the allocated funds are often misused, and there is a lack of accountability. The national hepatitis framework strategy has not been updated, indicating a lack of political commitment to eliminating hepatitis.
Recommendations for Moving Forward
To advance hepatitis elimination efforts, Pakistan must conduct a national assessment to understand the current situation comprehensively. Reducing dependency on donors, enhancing awareness campaigns, setting realistic goals, and strengthening the surveillance system are crucial steps. A centralized national database registry is essential for effective data management and evidence-based decision-making.
Strong political commitment and sustained financial support are imperative to address resource and administrative challenges. Adopting integrated, patient-centered care models and promoting collaboration between government, private sector, and NGOs will be critical to the success of Pakistan’s hepatitis elimination strategy.
Conclusion
The study highlights the significant challenges Pakistan faces in achieving hepatitis C elimination by 2030. Despite the adoption of a national elimination strategy, barriers such as insufficient resources, governance issues, corruption, and a fragmented healthcare system persist. Urgent policy action is required to meet the WHO 2030 elimination goals. By addressing these barriers and learning from successful models, Pakistan can make significant strides toward achieving its hepatitis elimination objectives.
🔗 **Fuente:** https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1540689/full