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12 Diphtheria Diphtheria is a bacterial infection in the upper respiratory tract with high mortality rate. It is now rare in most of the developed countries. Outbreak of diphtheria was observed in 2015, especially in Punjab, with the number of diphtheria-related deaths reaching 34. As per World Health Organization (WHO) guidelines, even a single confirmed case of diphtheria is suggestive of an outbreak. A major reason for this outbreak was the non-availability of vaccine. The Punjab government approached the health ministry with the request of importing diphtheria vaccine from Croatia, the only country producing this vaccine for the entire globe. Polio Pakistan witnessed a major turnaround in the prevalence of polio last year as compared to 2014, which was the worst year in more than a decade for the country. There was a drastic reduction in the number of reported polio cases in The polio cases dropped from the 306 recorded in 2014 to 51 in This is the lowest-ever count recorded since 2009, according to official data. The tribal areas accounted for 16 cases last year as compared to the 179 reported in The second highest number emerged in KhyberPakhtunkhwa, where 15 polio cases were reported in 2015, as compared to 68 reported in the previous year. Polio cases dropped from the 306 recorded in 2014 to 51 in State of Human Rights in 2015

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16 The Sindh AIDS Control Programme's (SACP) provincial manager, Dr Mohammad Younis Chachar, shares that an estimated 45,000 HIV/AIDS patients belong to Sindh. The major high risk groups, he adds, include long-distance truck drivers, female sex workers, transgender sex workers, men having sex with men (MSMs), injecting drug users (IDUs), jail inmates, children born to infected parents, street children and victims of unsafe medical procedures. In 2015, 1,157 HIV/AIDS positive cases 1,017 male, 122 female and 18 transgender were reported in Sindh, while 304 people had died from HIV/AIDS since 2004 and 26 met the same fate this year in the province. The federal and provincial governments of Pakistan launched awareness drives to educate people. Testing for HIV and other sexually transmitted infections is being strongly advised for all people exposed to any of the risk factors so that they can access necessary prevention and treatment services without delay. Screening for jail inmates and the staff, as well as repatriated workers and those at high risk have also been suggested to obtain realistic figures regarding prevalence of this disease. Stillbirths About 7,200 babies are stillborn every day some 2.6 million per year and half of these deaths occur during delivery, said studies published by The Lancet. Unfortunately, the worst performer, out of 186 Pakistan stillbirths per 1,000 total births 16 State of Human Rights in 2015

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19 for dengue cases at NIH, training on rapid response teams in provinces and awareness seminars, etc. A recent presentation given to the chief minister of Punjab states that in the whole of Punjab the control of dengue is a success story except in Rawalpindi and Multan. Identifying the reasons for outbreak of dengue fever in Rawalpindi, the presentation sees many gaps in vector surveillance and control procedures such as workforce issues, lack of commitment, late start of vector related activities, inability to follow SOPs, presence of unidentified cases who never went to hospitals thereby exposed to further mosquito bites, uneducated and unmotivated masses, solid waste mismanagement, inability of surveillance teams to enter houses, inability of teams to engage household living on first, second or higher floors, non usage of nets for cases at home and otherwise, incomplete case responses and inactive line departments. The residents of Rawalpindi having water reservoirs and ponds inside their houses to store drinking water also leads to growth of dengue mosquito. In Multan, the Health Department stated that reasons of dengue outbreak included supportive weather and inability in raising a timely alert. National Health Insurance Programme The end of the year 2015 brought a good news in the form of Prime Minister's National Health Insurance Programme (PMNHIP). The programme covers families earning less than Rs 200 per day. Such families are now entitled to health insurance facility to access free Diagnostic tests or hospital care are out of reach for many poor people in Pakistan Health 19

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22 and 4. The latter lot is denied admission at the hospitals and the main reason for this is the shortage of cancer hospitals in the country. The international practice is that there should be a cancer hospital for every 5 million people in a country. In New Delhi, there are more than 10 cancer hospitals but in Pakistan there only two proper cancer hospitals for a population of around 200 million-one in Lahore and one in Peshawar, says Dr Shehryar referring to the Shaukat Khanum Memorial Cancer Hospitals. Doctors and paramedics faced violence throughout the country Violence In 2015, doctors and paramedics faced violence throughout the country. The reasons were found to be somewhat similar, for such incidents, reported from different parts of the country. The highest incidence was observed in emergency section and wards where the attendants of the patients would get violent with the hospital staff for allegedly ignoring them. In this context, a research carried out in Karachi's hospitals this year is reflective of what goes on in other parts of the country. The International Committee of the Red Cross (ICRC), in collaboration with the Jinnah Postgraduate Medical Center (JPMC), worked on this project and interviewed doctors, nurses, paramedics, non-medical hospital staff and law enforcement authorities to gauge the enormity of the problem. As per findings of the report, almost two-thirds (65.6per cent) of healthcare providers in the city have either experienced or witnessed 22 State of Human Rights in 2015

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