Afghanistan
|
|
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 2009,
approximately 46,000 new TB cases occur annually in Afghanistan, and 8,200 people in
the country died from TB in 2007. Unlike many countries, more than twice as many
women are infected as compared to men; almost 70 percent of Afghanistan’s notified
cases are women. In 1997, Afghanistan’s National TB Control Program (NTCP)
adopted the DOTS (the internationally recommended strategy for TB control)
strategy. By the end of 2002, the country reported 38 percent DOTS coverage.
While this was an indicator of 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 64
percent, below the WHO global target of 70 percent, though reflective of the operational
challenges in the country. Treatment success also fell below 85 percent after four
years of being above the target of 85 percent. The management of multidrug-resistant
(MDR) TB, extensively drug-resistant TB, and diagnostic capacity is extremely limited.
USAID Approach and Key Activities
 |
|
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 to 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. For fiscal year (FY) 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
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
 |
Note: DOTS treatment success rate for 2007 will be reported in the WHO Report 2010.
Source: Global Tuberculosis Control WHO Report 2009 |
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 Afghanistan $3.1 million in
Round 2 funding in 2003 for integrated control of communicable diseases, including TB. In 2005, the Global Fund awarded $3.4
million in Round 4 funding for scaling up TB control activities. In 2009, Afghanistan requested $30 million in Round 8 for scaling up
TB control activities and was approved for $9.7 million.
May 2009
Related Links
|
