Afghanistan
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In Afghanistan, tuberculosis (TB) is one of the main public health burdens. Afghanistan
ranks 22nd on the list of 22 high-burden TB countries in the world. According to the
World Health Organization’s (WHO’s) Global Tuberculosis Control Report 2008
approximately 42,000 new TB cases occur annually in Afghanistan, and 8,200 people in
the country died from TB in 2006. Almost 70 percent of Afghanistan’s notified TB
cases are women. In 1997, Afghanistan’s National TB Control Program (NTCP)
adopted the DOTS (directly observed treatment, short course) strategy. By the end of
2002, the country reported 38 percent DOTS coverage. While this was progress,
coverage was still low, and TB services were predominantly provided by a patchwork
of nongovernmental organizations (NGOs) and government health facilities. With
increased support, improved regional coordination, and greater collaboration between
private providers and communities, DOTS coverage is now at 97 percent; national
estimates of case detection are 74 percent, exceeding the WHO global target of 70
percent. In addition, the treatment success continues to be high, averaging 88 to 89
percent over the past four years, higher than the WHO global target of 85 percent.
The multidrug-resistant (MDR) and extensively drug-resistant TB situations in
Afghanistan have not been characterized, and diagnostic capacity is extremely limited.
Given re-treatment and failure cases, it is likely there are some MDR-TB cases.
USAID Approach and Key Activities
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USAID supports TB control efforts through the Basic Package of Health Services
(BPHS) and the Essential Package of Health Services delivery systems, currently funded
through a grant with WHO and implemented by international and national NGOs.
Through WHO, Management Sciences for Health, and the Royal Netherlands
Tuberculosis Association, USAID currently works with the Ministry of Public Health
(MOPH) at the central and provincial levels to build its capacity to guide the NTCP in
establishing national objectives, ensuring equity, and fostering sustainability. To date,
the program covers 12.9 million people in rural areas throughout the country, and the
program is committed to expanding the delivery services to reach 90 percent of the
16.5 million people in 13 target provinces in the next five years. USAID also provides
additional technical assistance to the NTCP to ensure that the DOTS strategy is well
implemented and integrated in Afghanistan. Specifically, USAID promotes expansion of
DOTS coverage, increased collaboration with private providers, improved laboratory
services, and engagement of communities in TB control. Between 2003 and 2007,
USAID funding for TB programming in Afghanistan averaged $1.7 million per year.
For fiscal year 2008, Afghanistan received $6.9 million for TB programming. USAID
assistance includes the following activities and interventions:
- Ensuring adequate stewardship to the MOPH for the integration of TB
activities into the BPHS
- Participating in a human capacity development plan for implementing TB
interventions within BPHS, with a focus on enhancing the role of nurses
- Providing training in DOTS expansion for NGOs implementing the BPHS in
the 13 target provinces
- Improving microscopy capability and increasing diagnostic capability at
peripheral levels and facilitating quality assurance of diagnostic centers
- Undertaking operational research to address TB program guidelines and
implementation
- Conducting onsite monitoring and supervision to improve quality assurance
for laboratories and
- DOTS Improving management skills of senior NTCP staff
- Strengthening the NTCP logistics management capacity at the regional and provincial levels
- Encouraging active case finding at the community level through community health workers (CHWs), mobile health
teams, and non-health sector actors, such as religious leaders and school teachers
- Establishing a drug management information system at the MOPH
- Promoting the discussion and dissemination of the International Standards for Tuberculosis Care
USAID Program Achievements
USAID’s assistance has significantly contributed to improvements in TB control in Afghanistan. In the past year, our partners have shown that rapid expansion of DOTS in a post-conflict environment is possible despite challenges. Achievements to date include the following:
- Expanded the number of DOTS health facilities operated by our partners from 15 in early 2004 to 348 in late 2008 and increased the number of TB cases detected and reported
- Supported the BPHS by strengthening laboratory services in all of the existing 202 laboratories in the 13 USAID-supported provinces by developing standardized curricula, providing refresher training for laboratory staff, and creating a regional external quality assurance system
- Developed plans for expanded basic health services, including TB treatment, to reach 90 percent of the 16.5 million people in the 13 target provinces
- Developed best practices in USAID-supported provinces, to be shared in turn with the Country Coordinating Mechanism of the Global Fund to Fight AIDS, Tuberculosis and Malaria to guide expanded delivery of Global Fund-financed TB services
- Developed, in collaboration with WHO and the MOPH, decentralized regional training centers for TB in the Kabul, Badakshan, Herat, Kandahar, Nangrahar, Balkh, Kunduz, and Paktiya regions
- Trained more than 7,000 CHWs to administer and observe patients taking their anti-TB medicines as well as spot people in the community with TB symptoms and refer those suspected cases to the local health facility
Case Detection and Treatment Success Rates Under DOTS
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Note: DOTS treatment success rate for 2006 will be reported in the 2009 Global Report.
Source: Global Tuberculosis Control: Surveillance, planning, financing:WHO Report 2006. |
Partnerships
The international community has provided extensive support to control TB in Afghanistan. The Japan International Cooperation Agency and WHO provide overall technical support, while the Canadian International Development Agency and the Italian Development Cooperation provide financial support. In addition, the German Leprosy and Tuberculosis Relief Association
provides TB diagnostic and treatment services in different catchment areas. The Global Fund awarded Round 2 funding in 2003 to
Afghanistan for $3.1 million for integrated control of communicable diseases, including TB. In 2005, the Global Fund awarded
Round 4 funding for $3.4 million for scaling up TB control activities. In 2009, Afghanistan requested $29 million in Round 8 for
scaling up TB control activities and was approved for $9.5 million.
February 2009
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