Although substantial progress has been achieved over the past 10 years, many elements of the health system are still fragile and require continued support. Basic health services remain limited in hard-to-reach and insecure communities. Major constraints include: inadequate numbers of skilled health workers and female staff in rural areas; absence of managerial and organizational structures that provide incentives and accountability for results; inadequate physical infrastructure including laboratory facilities, roads, electricity, improved water supplies and sanitation facilities; poor quality of pharmaceuticals and medical commodities; weak linkages between the public and private health sectors; and low levels of education, particularly for females. In Afghanistan, the infant mortality rate (probability of dying in the first year) is 45 deaths per 1,000 live births. The under-five mortality rate is 55 deaths per live births. This means that 1 in every 18 Afghan children dies before reaching their fifth birthday and 55 under five mortality is in the upper rank in the list of developing countries.
Tuberculosis is considered as a serious public health challenge in the country. According to the Global Tuberculosis Report 2017, Afghanistan is one of those countries that has high incidence rate of TB in WHO EMRO region. The incidence of TB is estimated at 189/100,000 population and TB related mortality at 33/100,000 population per year.
Malaria is still a public health problem in Afghanistan, particularly eastern provinces (Nangarhar, Kunar and Laghman) located along the border with Pakistan and reporting more than 80% of the total cases of the country. Based on 2016 data, 27% of Afghan population lives in areas at high risk for malaria, 49% at medium risk and the remaining 24% live in areas with no risk or very low risk of malaria transmission.
HIV rates currently remain under 0.05 percent, with infections concentrated among high-risk groups, such as injecting drug users, women with high risk behavior (WHRB) and men with high risk behavior (MHRB). Most of the HIV cases remains hidden to stigma and discrimination. Injecting drug use is the main driver of the epidemic.
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.
The Global Fund support the Government of Islamic Republic of Afghanistan since 2004, by providing resources to fight three devastating diseases: HIV/AIDS, TB, and Malaria. In July 2014, UNDP Afghanistan was selected as the Principal Recipient of four Global Fund Grants: HIV, TB, malaria and health system strengthening.
UNDP works closely with the Ministry of Public Health, and has the management role of the grant, mainly in procurement and management of supplies, timely financing of all activities, and ensuring grant implementation in accordance with the approved work plan and internationally acceptable procedures. Additionally, UNDP provides support to establish Family Health Houses, Private Health Providers and train community health nurses in underserved communities to enhance the level of access to primary health care services. In addition, the grant supports the Health Management Information System and M&E including data management. Furthermore, the grant has special measures to strengthen the capacity of medical laboratory system and drug quality-control laboratories and supporting of Central and Regional Medical Stocks.
To combat tuberculosis, UNDP supports improved prevention and diagnostic services, strengthens case notification through screening among under-covered and high-risk groups such as prisoners, IDPs and children, expansion of Public Private Mix to new provinces and Contact Management for active case finding.
To reduce malaria, the UNDP supports the distribution of long-lasting insecticidal nets in all transmission areas, run awareness campaigns and helps improve monitoring, case management and access to facility and community-based treatment.
To prevent HIV, UNDP scaled up HIV interventions among Key Affected Populations in the country through provision of comprehensive HIV preventive and treatment services to People Who Inject Drugs, Women with High Risk Behavior, Men with High Risk Behavior and Prisoners.
What we have accomplished so far
- During 2017, 47,406 confirmed TB cases have been notified and enrolled for treatment. In 2017 the TB case notification rate reached 157 per 100,000 populations, which is a notable increase compared to the 2013 baseline of 111 per 100,000 population.
- The treatment success rate has remained stable in the past years at 89% for all forms of TB and 92% for bacteriologically confirmed TB cases.
- Construction of Herat, Balkh, Nangarhar, Paktia and Kunduz TB MDR management wards where treatment and care of MDR-TB is provided. Till the end of 2017, 634 multi drug resistance (MDR-TB) cases has been enrolled for treatment.
- 791 (238 female) PLHIVs People Living with HIV are currently receiving ART antiretroviral therapy.
- During 2017, 22,485 TB patients have been tested for HIV.
- 3,299 Women with High Risk Behaviour (WHRBs) have been reached with HIV prevention packages.
- 18,644 prisoners are reached with HIV prevention packages and 13,559 prisoners have been tested for HIV.
- 3,254,450 needles and syringes are distributed to HIV key affected population and 14,744 PWIDs have been tested for HIV.
- Universal coverage for malaria case management by training of 37,585 health workers including; Medical Doctors, Laboratory Technicians, Community Health Supervisors and distribution of 1,270075 RDT test and 191287 doses of ACT.
- Vector control; distribution of more than 4 million LLINs through mass campaign and continues distribution, covering over 6 million people including pregnant women.
- Malaria confirmation has increased remarkably from 28% to 74%.
- In an effort to strengthen quality of diagnostic services in the country, UNDP supported the following; Construction of the first ever Histopathology lab of the Central Public Health Laboratory, renovation and equipping of 12 Provincial labs and the National Public Health Laboratory, Construction and Of a Regional Reference lab in Paktia.
- Establishment of a laboratory LMIS linking the NPHL with regional labs to strengthen information/data flow.