Despite admirable achievements made over the past 10 years, Afghanistan still faces a number of health challenges. These include high rates of maternal mortality (400 per 100,000 live births) and under-five mortality (97 per 1,000 live births).
Afghanistan is one of 22 countries facing a high-burden of TB. More than half the population live in areas affected by malaria, with more than 400,000 cases in 2011 alone.
Further problems include poor nutrition and sanitation shortage of skilled birth attendants and female health care providers, and mental health issues, illnesses and injuries caused by 30 years of war.
HIV rates currently remain under 0.05 percent, with infections concentrated among high-risk groups, such as injecting drug users, sex workers and men who have sex with men. Nonetheless, there is the potential for the epidemic to expand quickly.
The health care system lacks funding and infrastructure, in particular laboratory facilities. Women have limited access to health care services due to constrains on their movement and a shortage of female health workers, particularly in remote areas.
These problems are exacerbated by poverty, insecurity, limited road access, a high turnover of staff at the community level, a lack of diagnostic services, an inability to refer complicated cases to higher-level facilities, and an unregulated private sector.
As part of its wider engagement with the UN, the Global Fund has partnered with UNDP since 2003 to ensure that grants are implemented and services delivered in countries facing complex challenges. This partnership focuses on implementation support, capacity development and policy engagement.
In such cases, the Global Fund and/or the Country Coordinating Mechanism can request that UNDP serve as the interim Principal Recipient of grants until national entities are able to assume full responsibility.
In July 2014, UNDP Afghanistan was selected as the Principal Recipient of four Global Fund Grants: HIV, TB, malaria and health system strengthening. Implementation has begun for three grants and the HIV grant is expected to start in 2016.
UNDP is working with the Ministry of Public Health, the National Tuberculosis Programme, the National Malaria and the Leishmaniasis Control Programme, as well national and international NGOs, to strengthen the health system.
UNDP helps train nurses and improve access to community-based healthcare services. We also improve the collection and use of data for monitoring health outcomes. This includes improvements to the Laboratory Reference Network and the creation of one national database for health indicators.
To combat tuberculosis, we support improved prevention and diagnostic services. We also strengthen case notification through screening among under-covered and high-risk groups such as prisoners, IDPs and children.
As well as healthcare interventions, we work to reduce stigma and discrimination against TB patients through trainings and community awareness programmes, as well as improved diagnosis and treatment.
To reduce malaria, we support distribution of long-lasting insecticidal nets in all transmission areas, run awareness campaigns and help improve monitoring, case management and access to facility-based treatment.
What we have accomplished so far
- Recruitment of project management unit staff is almost complete.
- The first progress update report of the TB grant has been rated satisfactory by the Global Fund.
- Implementing partners have been contracted for the health system strengthening and TB grants and the process is underway for the malaria grant.
- UNDP has placed orders for a number of procurement items, including more than 1 million bed nets.
- 210 female students have been enrolled in six community nursing schools.
- UNDP has purchased gene-testing machines for three provinces to allow allow faster and more accurate diagnosis of TB. In Kabul, we continue to support this new method of testing in one hospital.