Vision: TB FREE Pakistan
Introduction
Greenstar Social Marketing Pakistan (GSM) was established in 1991 as a national-level not-for-profit organization, working for more than 34 years. Our goal is working for the health of the people of Pakistan, with key focus on Family Planning, Mother and Child Health, Family Health and TB Control with a network of around 14,000 health Care Providers. The implementation is managed by engaging communities and private sector health care providers.
The objective is improvement in the overall health system specially the women's health, through strategic collaboration between the public and the private sector health care providers. This is achieved by capacity building of private providers and establishing reach and access of the people to providers and products through an ecosystem of a health network of 7000 female and 7000 trained male providers, 58,000 chemists and 140,000 retailers, thus reducing morbidity and mortality of mothers and children.
Greenstar is working in the private sector for more than 02 decades in collaboration with the National and Provincial Government for TB control in Pakistan. The Project is designed to strengthen Pakistan's response to tuberculosis in line with WHO guidelines through a comprehensive, patient-centered, and system-focused approach.
TB Program Scope
The TB program is designed to strengthen Pakistan's response to tuberculosis through a comprehensive, patient-centred, and system-focused approach. Guided by national priorities and aligned with global TB strategies, it aims to minimize barriers in detection, treatment, prevention, and care.
- Strengthening Early Detection: Expanding access to quality TB screening, diagnostics, and active case finding.
- Improving Treatment Coverage & Outcomes: Enhancing adherence support for drug-sensitive and drug-resistant TB.
- Addressing Drug-Resistant TB: Scaling specialized services for MDR/XDR-TB.
- Reducing Mortality: Prioritizing timely treatment initiation.
- Closing System Gaps: Strengthening surveillance, notification systems.
- Engaging Communities & Partners: Mobilizing communities and health providers.
- Equity and Accessibility: Reaching vulnerable populations.
Global TB Epidemiology: Global vs Pakistan – Pakistan Ranks 5th
High Burden Countries: India (25%), Indonesia (10%), Philippines (6.8%), China (6.5%), Pakistan (6.3%)
Global Estimates
Incident TB10,700,000 (9.92M–11.5M)
Incidence rate /100k131 (122–141)
RR/MDR-TB incidence390,000 (360k–430k)
MDR/RR-TB rate /100k4.8 (4.4–5.3)
HIV-negative mortality1,080,000 (987k–1.18M)
HIV-positive mortality150,000 (120k–183k)
WHO Global TB Report
Pakistan Estimates
Total TB Incidence669,000 (468k–893k)
Incidence rate /100k266 (186–355)
DR/RR-TB cases14,000 (8,700–18,000)
MDR/RR-TB rate /100k5.4 (3.5–7.3)
HIV-negative TB mortality51,000 (39k–64k)
HIV-positive mortality690 (15–2,600)
NTP/WHO estimates
Greenstar, History of TB Control Efforts - 20 Years of Success
Program Title: Contribution towards achieving the targets of the national strategic plan for TB prevention, care and control in Pakistan.
Goal: To reduce the TB mortality rate by 35% in year 2026 compared to 2015.
Greenstar's Current TB Grant: Greenstar works as a Sub-Recipient (SR) to Mercy Corps (MC) in the GC7 grant funded by the Global Fund (2024-26) and operates in 29 districts across four provinces of Pakistan.
- Private Provider Network of 5500 General Physicians/Consultants
- Network of 166 private laboratories catering diagnostic support
- 35 Gene Xpert Machines across districts
- 08 hi-tech digital X-Ray plants
- Mobile Screening Vans equipped with Digital X-Ray, CAD-4 Software and Gene Xpert machines
Greenstar contributes: 20% in the National TB Case Detection | 44% contribution in PPM in TB Program.
GC-7 Interventions – Flagship Approaches
Gp Model
General Physicians & private clinics engagement
Large Private & Parastatal Hospital
Enhanced case finding & referral
Pharmacy Rx Tracker
Pharmacy Engagement for presumptive TB
ACF-Mobile Chest Camp
Active Case finding - Mobile X-ray screening camps
Private Laboratory Network
Engaging Private labs for diagnostics support
Gs Gene Xpert Sites
Gene X-pert Sites network expansion
GS x-Ray Units
Digital X ray units for TB screening
Specimen Transportation
From source to diagnostics facilities
TB Preventive Treatment (TPT)
Preventing Spread & latent TB management
Childhood & MDR TB
Screening children and drug resistant TB
Greenstar's TB grant Implementation Districts
| Province | Districts covered - 29 |
|---|---|
| Sindh | Karachi (All 07 Districts), Hyderabad, Sukkur, Ghotki |
| Punjab | Lahore, Faisalabad, Rawalpindi, Muzaffargarh, RYK, Rajanpur |
| Khyber Pakhtunkhwa | Peshawar, DI Khan, Lakki Marwat, Karak, Tank |
| Balochistan | Gwadar, Naseerabad |
Quarterly Performance
Digital Engagement of Private Providers (DEPP) – Real time TB case Notification
A case-based digital notification system for the TB Public Private Mix (PPM) program using the DHIS2 software. The DHIS2 system tracks TB patient data, visualizes key indicators on a dashboard, and generates reports on case registration and treatment outcomes. Digitalization of TB Case Notification via DHIS2 ensures real-time tracking.
Intervention Galleries
Community Feedback Mechanism – TB
Orientation Session
Community Feedback
DHIS2 - Digital Transformation in TB Care: From Paper to Real-Time, Case-Based Reporting
Training
Dashboard
Mobile Reporting
In a major step toward modernizing tuberculosis (TB) control, Greenstar Social Marketing has successfully transitioned to a fully digital, case-based TB reporting system across its program areas. This transformation marks a shift from fragmented, paper-based records to a unified digital platform,
ensuring that every TB patient is registered, tracked, and managed in real time.
Building on years of programmatic experience and recent digital innovation,
Greenstar has implemented a robust system that captures individual patient data at the point of care—from screening and diagnosis to treatment initiation and follow-up.
This approach ensures that no patient is missed, and every case is accounted for.
Through the digital system:
The digitalization initiative has been implemented across 29 districts, covering urban centers, tehsils, and remote areas, with trained field teams entering data directly through mobile devices and tablets. This has enabled frontline health workers to capture and report data instantly, even in challenging field settings. Importantly, this shift has eliminated duplication of effort by reducing reliance on multiple parallel systems and paper registers, streamlining workflows for healthcare providers. It has also strengthened data quality, transparency, and accountability, ensuring that reported data truly reflects the ground realities.
The impact of this transformation is far-reaching:
By embracing digital innovation, Greenstar is not only improving operational efficiency but also empowering healthcare providers with actionable insights—ultimately leading to better patient outcomes. This transition to case-based digital TB data management represents a critical milestone in Pakistan’s TB response—bringing the country closer to a future where every TB patient is identified, treated, and cured.
Through the digital system:
- All TB patient data is recorded in real time, improving accuracy and timeliness
- Each patient is managed through a case-based tracking system, enabling better follow-up and treatment adherence
- Data is instantly available for program monitoring, decision-making, and reporting
- Delays associated with manual reporting have been significantly reduced
The digitalization initiative has been implemented across 29 districts, covering urban centers, tehsils, and remote areas, with trained field teams entering data directly through mobile devices and tablets. This has enabled frontline health workers to capture and report data instantly, even in challenging field settings. Importantly, this shift has eliminated duplication of effort by reducing reliance on multiple parallel systems and paper registers, streamlining workflows for healthcare providers. It has also strengthened data quality, transparency, and accountability, ensuring that reported data truly reflects the ground realities.
The impact of this transformation is far-reaching:
- Improved case notification and tracking
- Enhanced patient management and continuity of care
- Data-driven planning and resource allocation
- Stronger integration with national TB reporting systems
By embracing digital innovation, Greenstar is not only improving operational efficiency but also empowering healthcare providers with actionable insights—ultimately leading to better patient outcomes. This transition to case-based digital TB data management represents a critical milestone in Pakistan’s TB response—bringing the country closer to a future where every TB patient is identified, treated, and cured.
Free Chest Camps – Active Case Finding
Mobile Camp
X-Ray
Sputum
Community Camp
CAD4TB
Counseling
Registration
Lab Testing
Under Active Case Finding (ACF) intervention there are activities of:
Chest camp is an essential activity for expansion of TB control through PPM and finding missing TB cases. This strategy is adopted for the provision of quality TB services through outreach for active case finding and to take services to the areas which are underserved and are hotspots for TB. The effort is to reach the unreached and mossing TB cases.
The purpose of the chest camp is:
The purpose of the chest camp is: General public of specific area including women, children and elderly During chest camps, presumptive TB case get screened on digital X-ray (using CAT4TB software), the sputum of all such cases are directly put on Xpert testing.
- Meeting with area notables
- Chest camp
Chest camp is an essential activity for expansion of TB control through PPM and finding missing TB cases. This strategy is adopted for the provision of quality TB services through outreach for active case finding and to take services to the areas which are underserved and are hotspots for TB. The effort is to reach the unreached and mossing TB cases.
The purpose of the chest camp is:
- TB awareness
- Presumptive case identification
- Case detection
- Contact tracing
The purpose of the chest camp is: General public of specific area including women, children and elderly During chest camps, presumptive TB case get screened on digital X-ray (using CAT4TB software), the sputum of all such cases are directly put on Xpert testing.
Community Engagement for TB Screening: Mobilizing Local Voices
Imams Meeting
Muzaffargarh
Local Leaders
LHWs
Teachers
As part of our commitment to reaching the unreached and strengthening early detection of tuberculosis (TB), a community notable meeting is conducted within three days prior to Chest Camp in the community where camp is planned.
This strategic engagement brings together key community stakeholders, including religious leaders (Imams), school teachers, Lady Health Workers (LHWs), local political representatives, and administrative personnel. These trusted voices play a vital role in shaping health-seeking behavior within the community.
During the session, participants are sensitized on:
The meeting emphasizes the critical role of community influencers in identifying and encouraging individuals with TB symptoms to attend the camp and benefit from early diagnosis and care.
By empowering local leaders with the right information, we ensure that awareness spreads organically within the community—helping to reduce stigma, improve timely care-seeking, and ultimately contribute to a TB-free Pakistan.
During the session, participants are sensitized on:
- Awareness on TB prevention, diagnosis and treatment
- The purpose and importance of the free Chest Camp
- Camp details (date, location, and timings)
- Common symptoms of TB, including persistent cough, fever, weight loss, and night sweats
- The availability of free screening and diagnostic services
The meeting emphasizes the critical role of community influencers in identifying and encouraging individuals with TB symptoms to attend the camp and benefit from early diagnosis and care.
By empowering local leaders with the right information, we ensure that awareness spreads organically within the community—helping to reduce stigma, improve timely care-seeking, and ultimately contribute to a TB-free Pakistan.
Pharmacy Engagement
Pharmacy Visit
CEO Engagement
Chemist Training
TB Patient Home Visits
Counseling
Supporter Visit
Medication Check
Family Counselling
Follow-up
Psychosocial Support
Events & Activities Gallery
Conference Participation & Research Papers
Denmark Conference
Research Poster
Attrition Study
PPM Quarterly Review Meeting (QRM): Ensuring Data Quality and Accountability in TB Care
Data Validation
EQA Session
As part of its commitment to strengthening Public–Private Mix (PPM) for tuberculosis (TB) control, Greenstar Social Marketing facilitates Quarterly Review Meetings (QRM) at the district level to ensure the accuracy, validation, and integration of private sector data into the national TB reporting system.
These meetings are led by District Coordinators and bring together key stakeholders involved in TB service delivery within the private sector, including healthcare providers, laboratories, and district health authorities. The primary objective is to validate and verify data reported by private facilities, ensuring its reliability before inclusion in official district reports.
During the QRM:
Importantly, these meetings are conducted prior to public sector quarterly reviews, enabling a unified and comprehensive picture of TB burden and response at the district level. A critical component of the QRM is the External Quality Assurance (EQA) of private laboratories. The District Lab Supervisor and Cross-Checker actively participate to ensure diagnostic quality. As part of this process, the cross-checker conducts random sampling of slides from laboratory technicians to assess accuracy and maintain high diagnostic standards. The meeting also serves as a platform for performance review and strategic planning. The Regional Coordinator (RC) presents district-wise performance against targets, highlighting achievements, identifying gaps, and outlining actionable solutions and way forward.
Through these structured quarterly engagements, Greenstar strengthens:
By ensuring that every reported case is accurate, verified, and counted, Greenstar reinforces evidence-based decision-making—bringing Pakistan closer to the goal of a TB-free future.
During the QRM:
- Data from all participating private healthcare providers and laboratories is carefully reviewed and validated
- The District TB Coordinator (DTC) and District Lab Supervisor (DLS) verify the completeness and accuracy of reporting
- Validated data is prepared for integration into district-level reports (TB07 and TB09), ensuring representation of private sector contributions
Importantly, these meetings are conducted prior to public sector quarterly reviews, enabling a unified and comprehensive picture of TB burden and response at the district level. A critical component of the QRM is the External Quality Assurance (EQA) of private laboratories. The District Lab Supervisor and Cross-Checker actively participate to ensure diagnostic quality. As part of this process, the cross-checker conducts random sampling of slides from laboratory technicians to assess accuracy and maintain high diagnostic standards. The meeting also serves as a platform for performance review and strategic planning. The Regional Coordinator (RC) presents district-wise performance against targets, highlighting achievements, identifying gaps, and outlining actionable solutions and way forward.
Through these structured quarterly engagements, Greenstar strengthens:
- Data quality and transparency
- Accountability within the private sector
- Integration of private providers into the national TB response
- Quality assurance of diagnostic services
By ensuring that every reported case is accurate, verified, and counted, Greenstar reinforces evidence-based decision-making—bringing Pakistan closer to the goal of a TB-free future.
Bi-Annual Staff Meeting: Driving TB Control through Coordination, Accountability and Capacity Building
Regional
Provincial
Planning
Group
Huddle
Workshop
Leadership
For over a decade, Greenstar Social Marketing has been consistently conducting bi-annual staff meetings at regional and provincial levels to strengthen tuberculosis (TB) control efforts across Pakistan.
Currently working across 29 districts, spanning major cities, tehsils, and remote towns, Greenstar brings together its diverse field teams through these meetings to ensure alignment, shared learning, and coordinated action.
Each session begins with a review of previous action points, reinforcing accountability and continuity. This is followed by a district-wise performance review, where teams assess progress, identify challenges, and develop targeted, practical action plans to accelerate results.
The meetings also provide an opportunity to review the current reporting quarter and plan ahead, while ensuring teams are updated on key guidelines related to operations, finance, security, data, and program implementation.
Importantly, the platform encourages open discussion on field-level challenges, enabling timely problem-solving and stronger program delivery.
Through this sustained effort, Greenstar continues to foster a culture of collaboration, accountability, and adaptive management—driving impact at scale and advancing the vision of a TB-free Pakistan.
Currently working across 29 districts, spanning major cities, tehsils, and remote towns, Greenstar brings together its diverse field teams through these meetings to ensure alignment, shared learning, and coordinated action.
Each session begins with a review of previous action points, reinforcing accountability and continuity. This is followed by a district-wise performance review, where teams assess progress, identify challenges, and develop targeted, practical action plans to accelerate results.
The meetings also provide an opportunity to review the current reporting quarter and plan ahead, while ensuring teams are updated on key guidelines related to operations, finance, security, data, and program implementation.
Importantly, the platform encourages open discussion on field-level challenges, enabling timely problem-solving and stronger program delivery.
Through this sustained effort, Greenstar continues to foster a culture of collaboration, accountability, and adaptive management—driving impact at scale and advancing the vision of a TB-free Pakistan.
Trainings of Doctors, Capacity Building for TB Care: Two Decades of Empowering Frontline Providers
Clinical
Gene Xpert
Infection Control
MDR Workshop
Digital Reporting
Counseling
For over two decades, Greenstar Social Marketing has been at the forefront of strengthening tuberculosis (TB) care by training doctors, paramedical staff, and laboratory technicians across Pakistan. This sustained investment in human resource capacity has been critical in improving the quality, consistency, and reach of TB services—especially in underserved and hard-to-reach areas.
Recognizing that skilled healthcare providers are the backbone of effective TB control, Greenstar delivers structured, competency-based trainings aligned with national and international TB guidelines. These trainings are designed not only to build knowledge, but also to enhance practical skills required for early detection, accurate diagnosis, appropriate treatment, and patient-centered care.
The training program covers key areas including:
By engaging doctors, paramedics, and laboratory personnel together, Greenstar promotes a team-based approach to TB care—ensuring better coordination between diagnosis, treatment, and follow-up services.
A strong emphasis is placed on continuous learning and updates, enabling healthcare providers to stay aligned with evolving guidelines, emerging drug regimens, and programmatic innovations. This is particularly crucial in addressing challenges such as drug-resistant TB and improving treatment outcomes.
Over the years, these trainings have contributed to:
Beyond knowledge transfer, these sessions also serve as a platform for experience sharing, problem-solving, and motivation, strengthening the overall health system response to TB. Through its long-standing commitment to capacity building, Greenstar continues to empower frontline providers—ensuring that every patient, regardless of location, has access to quality TB care. This enduring effort remains central to achieving the shared vision of a TB-free Pakistan.
Recognizing that skilled healthcare providers are the backbone of effective TB control, Greenstar delivers structured, competency-based trainings aligned with national and international TB guidelines. These trainings are designed not only to build knowledge, but also to enhance practical skills required for early detection, accurate diagnosis, appropriate treatment, and patient-centered care.
The training program covers key areas including:
- Early identification of TB symptoms and risk groups
- Standardized diagnostic protocols, including the use of modern WHO recommended diagnostic tools
- Treatment guidelines and regimen management
- Infection prevention and control (IPC) measures
- Recording, reporting, and data quality assurance
- Patient counseling and adherence support
By engaging doctors, paramedics, and laboratory personnel together, Greenstar promotes a team-based approach to TB care—ensuring better coordination between diagnosis, treatment, and follow-up services.
A strong emphasis is placed on continuous learning and updates, enabling healthcare providers to stay aligned with evolving guidelines, emerging drug regimens, and programmatic innovations. This is particularly crucial in addressing challenges such as drug-resistant TB and improving treatment outcomes.
Over the years, these trainings have contributed to:
- Improved case detection and notification
- Enhanced diagnostic accuracy and efficiency
- Better treatment adherence and patient outcomes
- Reduced delays in care-seeking and service delivery
Beyond knowledge transfer, these sessions also serve as a platform for experience sharing, problem-solving, and motivation, strengthening the overall health system response to TB. Through its long-standing commitment to capacity building, Greenstar continues to empower frontline providers—ensuring that every patient, regardless of location, has access to quality TB care. This enduring effort remains central to achieving the shared vision of a TB-free Pakistan.
World TB Day Awareness Activities (24th March)
PKP Awareness
Community
Rickshaw
Rawalpindi Walk
DHA Seminar
Faisalabad
Karachi Rally
Session
Lodhran
DIK
Korangi
Greenstar Social Marketing Pakistan (GSM) stands steadfast in its vision of a TB-free Pakistan. On this World TB Day, which is commemorated every year on 24th March; this year a wave of advocacy and awareness sessions echoed across the nation. From cities to far-flung communities, voices rose to educate about TB, its spread, and its cure.
The message was clear and hopeful: TB is curable, and no one should suffer in silence.
GSM continues to light the path by engaging General Practitioners and the private healthcare sector.
Through strong partnerships, efforts are aligned to detect, treat, and eliminate TB.
Collaboration with Provincial and National TB Control Programs strengthens this shared mission.
Every session, every conversation, brings Pakistan one step closer to freedom from TB. With unwavering commitment, GSM marches forward—until TB becomes a story of the past.
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