As the world copes with one of the most catastrophic pandemics of modern times, laboratory services and testing capabilities are proving to be most critical in tackling the COVID-19 outbreak. Countries with robust testing capabilities and more widely available laboratory services have been more successful in responding to the pandemic than those with weaker health systems and testing capabilities.
In Afghanistan, medical labs and systems put in place through a partnership between the Global Fund, the Government and UNDP are proving critical in the country’s COVID19 response.
Currently, it is only Central Public Health Laboratory facilities and regional reference labs in five regions of Afghanistan that have the capacity to diagnose COVID-19 in the country. CPHL and its related regional labs have constantly been supported by UNDP under its Global Fund Program.
The CPHL started testing for COVID-19 in February 2020 with kits provided by the CDC and WHO. In response to the evolving COVID-19 environment, testing capacity was decentralized to Herat, Balkh, Nangarhar and Kandahar regional reference labs in March and April 2020.
As of 15 April 2020, over 5000 samples have been tested in these labs. With the investments made so far, the CPHL has the capacity to process 200-300 samples in 24 hours in addition to the regional daily testing capacity of 150 in Herat, 100 in Balkh, 100-150 in Nangarhar and 120-150 in Kandahar province.
Since 2014, financial and technical support from the Global Fund for AIDS, TB and Malaria, has assisted the Ministry of Public Health (MoPH) to strengthen the capacity of the laboratory sector at the Central Public Health Laboratory (CPHL) and in five regional reference laboratories and provincial diagnostics settings.
Laboratories play key roles not only in individual patient diagnosis and care, but also in disease surveillance and control. Laboratories are critical in times of epidemy of viral and infectious diseases. It also plays a vital role in provision of accurate health data for national planning and resource mobilization. Globally, the world is looking for diagnostics capacities as public health leaders call for the expansion of testing capacities.
Global Fund grants significantly contributed to strengthening quality diagnostic services through construction, renovation, equipping and provision of laboratory supplies for all levels of laboratory settings in the public health sector of Afghanistan. In 2018, UNDP under its Global Fund program assessed the public and private laboratory sector across the country with the assessment findings identifying critical gaps and weaknesses related to the laboratory sector development, which were included in the MoPH strategic plan for 2019.
Despite the significance, the health laboratory component is often neglected and undervalued in resource limited countries, consequently leaving millions of people, particularly in rural and underserved areas, with little access to basic and reliable health laboratory services. In Afghanistan the picture is even grimmer. More than four decades of prolonged conflict has ruined health infrastructure and system in the country. Despite huge investments in the health sector over the past two decades, the majority of the population do not have access to good quality health care and laboratory services are limited to major urban centres.
Global Fund also assisted the MoPH to establish the Laboratory Management Information System (LMIS), improving data quality and combining all relevant disease indicators in a centralised national database, and to establish and maintain the National Laboratory Network (NLN), to provide basic clinical diagnostic services and to introduce molecular diagnostics, serology and bacteriology services with acknowledged impact on health indicators. Further technical assistance was also provided to train 25 regional and provincial laboratory staff in use of sophisticated high-tech machines.
Global Fund’s continued efforts for strengthening and scaling-up of Afghanistan’s laboratory networks has ensured that sites for the screening, diagnosis and treatment of the Global Fund’s target diseases (HIV, Tuberculosis and Malaria) and other viral diseases’ diagnostics requirements would be met. Global Fund’s advocacy work in this field has secured additional funding for strengthening the laboratory sector in the country. The applied Global Fund interventions have helped the public health sector in Afghanistan to own its first histopathology lab in the country and more broadly aided UNDP to renovate and construct a new building for the histopathology department and equipped the laboratory with quality machines, supplies and training to the relevant staff.
In the words of the Senior Advisor to CPHL, Dr. Redi Gul Alami, “if such support of UNDP and Global Fund were not available in this country, the MoPH and its partners would have not been able to provide such complicated services in a short period of time”. However, cconsidering the need and demand for tests, this capacity is still very limited, and all partners need to work together for further enhancement of diagnostic capacity in the health sector of Afghanistan. To further support MoPH in strengthening diagnostic capacity of COVID-19, UNDP with support from the Global Fund have commenced major interventions and programmes.
As part of overall UN support to Afghanistan to combat COVID-19 in the country, UNDP has developed a comprehensive programme which focuses on health needs and social trends to address social determinants of health related to the disease. “UNDP supports to enhance health and security sector in Afghanistan to prevent spread of COVID-19 in the country” says Abdallah Al Dardari, UNDP Resident Representative for Afghanistan. “While we are reinforcing the frontlines against the disease, as SDG integrator we are also preparing to lead UN system in backing the post-COVID-19 socioeconomic recovery phase”.
The pandemic is at an early stage in Afghanistan and the real challenge is ahead of us. UNDP and Global Fund remain committed to working in support of the Government of the Islamic Republic of Afghanistan to contain the spread of the virus. Together we can get through this.