Picture a young woman in rural Sindh in Pakistan, fatigued from years of battling an undiagnosed illness, unable to care for her children or fulfill her potential. 

But a simple diagnostic test and a 12-week treatment for hepatitis C could transform and save her life. 

This story is no longer a distant dream. With the government’s recent pledge of $250 million to eliminate hepatitis, Pakistan is poised to turn its staggering hepatitis burden into a model of success. 

However, for this vision to materialize, there is an urgent need to tackle systemic barriers and adopt a person-centered approach to testing and care that addresses the challenges faced by diverse segments of society. 

The Scope of the Problem 

Pakistan bears an astounding hepatitis burden, with 10 million people affected by hepatitis C (world’s largest population of people living with hepatitis C infections) and four million living with hepatitis B. 

These diseases silently claim lives, contributing to liver cancer and liver failure at alarming rates. Every 20 minutes, a Pakistani dies of hepatitis C-related complications.

Hepatitis elimination, as stated in the WHO’s Global Health Sector Strategy, is achievable but requires significant interventions. As a populous country with a large disease burden, Pakistan is positioned to play a flagship role in regional elimination efforts. Success here would not only save millions of lives but also demonstrate the feasibility of hepatitis elimination in resource limited settings. 

Barriers to Hepatitis Testing in Pakistan 

Despite progress, multiple structural, systemic, and person-level barriers impede the path to hepatitis elimination.

Pakistan’s hepatitis response is hindered by significant structural and policy gaps. The underfunding of national programs leaves hepatitis testing and treatment services unable to meet demand.

Centralized testing policies prioritize urban tertiary care facilities, neglecting the needs of rural communities. Programs heavily rely on unpredictable funding streams. Compounding this is a widespread stigma affecting both patients and healthcare providers, particularly in marginalized communities. 

The healthcare system struggles with limited resources and a shortage of trained personnel, especially in rural and underserved regions. Diagnostic facilities are inadequate, and weak surveillance systems result in data gaps that hinder evidence-based decision-making. Missed opportunities for integration with other health services, such as tuberculosis and HIV programs, further exacerbate inefficiencies in hepatitis care delivery.

At the individual level, patients face significant barriers to accessing care. Testing and treatment costs remain prohibitive for many, particularly for advanced diagnostics like virologic testing. 

A lack of awareness about hepatitis symptoms and risks discourages individuals from seeking care. Additionally, the high costs and logistical challenges of traveling to centralized healthcare facilities make it even harder for rural populations to access timely diagnosis and treatment.

Person-centered way forward 

To address these barriers and make the new national hepatitis elimination program effective, Pakistan must embrace person-centered care using the recently released operational guide from the World Health Organization (WHO). This approach prioritizes the needs, preferences, and circumstances of individuals at every stage of care. Below are seven key strategies to operationalize this vision.

Decentralizing testing and treatment services is essential to improving access, particularly for rural and underserved populations. Integrating these services into primary and community healthcare centers will allow individuals to access care closer to home.

Expanding point-of-care testing in remote areas can provide rapid diagnosis and significantly reduce turnaround times for results. Additionally, deploying mobile clinics to underserved regions can bridge critical gaps in care delivery, ensuring that even the most marginalized populations receive timely testing and treatment.

The national programme must ensure financial accessibility by subsidizing diagnostic costs, particularly for virologic testing which remains prohibitively expensive for many. Securing funding from donors and international organizations can help sustain affordable diagnostic tools and treatment options, ensuring financial protection for vulnerable populations.

Strengthening healthcare systems is crucial for delivering person-centered care. Training healthcare providers to offer respectful and stigma-free services is a vital first step. Supply chains must be strengthened to ensure the consistent availability of affordable diagnostic kits and treatment regimens. Furthermore, leveraging technology such as telemedicine can enhance access to care and enable real-time tracking of hepatitis cases, improving overall system efficiency.

Engaging communities is critical to overcoming barriers such as stigma and lack of awareness. Partnerships with local leaders, NGOs, and civil society organizations can help raise awareness and encourage testing. Culturally sensitive public awareness campaigns are also needed to address misconceptions, improve risk perception, and promote the uptake of testing and treatment services.

Differentiated service delivery models with care tailored to individual needs can improve outcomes and reduce the strain on healthcare systems. Uncomplicated cases can be treated at primary care levels, while complex cases are referred to tertiary care centers. Targeted “micro-elimination” strategies in high-prevalence areas can focus on specific populations, enabling efficient and localized hepatitis elimination efforts.

A robust surveillance system is vital for identifying disease hotspots and monitoring progress. Establishing hierarchical systems and using digital tools for data collection and visualization can support evidence-based decision-making, ensuring resources are directed where they are most needed.

Finally, integrating hepatitis testing into existing health services can maximize resources and increase reach. Combining testing with HIV, tuberculosis, and maternal health services can streamline care delivery, while including hepatitis testing in routine health checkups and immunization drives ensures greater coverage and early diagnosis.

Call to Action 

By addressing the hepatitis crisis, Pakistan can become a model for other nations in South Asia and beyond. Its large-scale elimination efforts, if successful, could inspire global confidence in the feasibility of achieving the WHO’s 2030 targets. 

The recent funding pledge by the Prime Minister reflects strong political will, but sustained commitment by all provinces is needed to translate plans into action. 

Hepatitis elimination in Pakistan is feasible, but it requires a paradigm shift toward person-centered care, equitable resource allocation, and strong political commitment. As WHO highlights in its new operational guide, hepatitis elimination is not just a health goal but a step toward social equity and justice. 

Dr Nida Ali is a Hepatitis Evaluation, Research and Outreach (HERO) Fellow with the Coalition for Global Hepatitis Elimination, a program of the Task Force for Global Health. The Coalition pursues worldwide elimination of viral hepatitis by strengthening local capacity and bringing together global partners to share knowledge and experiences related to prevention, testing and treatment.

Image Credits: Nida Ali.