Malaria continues to be a major public health problem in Afghanistan, particularly in the eastern and southeast provinces (Nangarhar, Kunar, Laghman, Nuristan, Khost and Paktika). The transmission of malaria is seasonal, and its distribution varies largely from place to place, depending on a variety of factors related to parasites, vectors, and human populations under different geographical, ecological and socio-economic conditions in the country. It is estimated that 27% of Afghan population live in areas at high risk for malaria, 50% at medium risk and the remaining 23% live in areas with no risk or very low risk of malaria transmission. There are two main species of malaria in Afghanistan Plasmodium Vivax (Pv) which 97.2% of malaria cases are attributed to, and Plasmodium Falciparum (Pf) which is the cause of remaining 2.8%.
Mass distribution of long-lasting insecticide treated bed nets (LLINs) has been a priority intervention for eastern region of Afghanistan which is malaria endemic with more than 85% of the malaria cases reported from the region annually. The national malaria control programme has been more focused on the eastern region especially Nangarhar province.
It was planned to distribute 2,289,875 bed nets in 2020, of which 572,469 were planned in the first quarter of 2020. However, the COVID-19 pandemic, the delivery of bed nets to the country was affected, and shipments of LLINs were delayed due to closure of Pakistan borders (Karachi and Torkham), therefore procured LLINs did not arrived in country as planned.
When WHO declared COVID-19 as pandemic, UNDP, NMLCP and WHO technical teams developed a comprehensive mitigation plan which was approved by Global Fund. One of the key interventions which was affected by the pandemic was mass distribution of bed nets. A special strategy was developed to carry out the mass distribution of the bed nets during COVID-19 pandemic in eastern provinces taking in to account safety of the frontline personnel and the beneficiaries. Unlike in previous programmes, where the nets were handed out at distribution points, additional protective measures were in place for distribution, that included physical distancing, hand washing, and use of personal protective equipment (PPE).
As a result of joint efforts by all stakeholders, 2,686,934 bed nets were distributed through mass campaign, more than the set target of 2,289,875 in second quarter of 2020. In total 2,833,365 LLINs were distributed through mass campaign in 2020 as compared to the annual target of 2,862,344 which was 99% of the target number, making up for the low number of distributions in the first quarter.
The implementation of the COVID-19 mitigation measures like the distribution of PPEs for community and health workers was instrumental for the ability to make the distributions widely and safely. Additionally, strong coordination, joint planning, and monitoring by national and provincial Malaria and Leishmania control programme, Sub-Recipients, and Principal Recipient contributed to the strong result.
The Global Fund acknowledged the success of the catch-up plan for the distribution of bed nets by rating the Malaria programme in Afghanistan A1 (exceeds expectation) for the first time in. “Although the target for the above indicator was not achieved in the first half of the year due to logistic issues in the supply chain as well as the impact of COVID-19 imposed restrictions of movement in the country, due to the PR, NMLCP, SRs and partner good coordination, best analysis of situation and effective acceleration plan, the mass distribution campaign successfully completed the targeted districts covered, the performance of this indicator was at 117% by the end of 2020” the Global Fund Management said in a letter.
The distribution campaign is part of the government’s commitment to continue with the provision of uninterrupted essential health services during the COVID-19 pandemic. Afghanistan has made a significant gain in achieving Universal LLINs Coverage to protect its entire population against malaria even during the COVID-19 pandemic.
NMLCP manager expressed gratitude for the cooperation and assistance of donors and implementing agencies, such as the Global Fund, UNDP, WHO, and other partners who work together to eliminate malaria in the country.
UND is a proud partner of the Global Fund and serves as interim Principal Recipient (PR). UNDP is responsible for the financial and programmatic management of the malaria grant as well as procurement of pharmaceutical and non-health items and the quality of the services provided under the programme.
During 2020, UNDP provided support to the National Malaria and Leishmaniasis Control Program for the implementation of malaria services across the country, such as procurement and supply of Rapid Diagnostic Test (RDT) and antimalarial medicine fir health facilities, as well as distribution of bed nets to malaria high risk provinces and districts. In addition, training programmes for health workers, printing and distribution IEC/BCC material, recording and reporting forms and programme management costs were undertaken by UNDP.
UNDP is also working to strengthen partnerships between MoPH, other government agencies, Implementing NGOs, development partners, UN agencies and communities to ensure more effective and inclusive governance of the national response against malaria.
UNDP with support from the Global Fund will continue to support the Ministry of Public Health and National Malaria Leishmaniasis Control Programme through Malaria cases management (early diagnosis, and effective treatment), procurement of RDT and antimalaria medicines, training of all health workers in malaria case management, procurement and distribution of bed nets to pregnant women seeking antenatal in targeted provinces, and procurement and distribution of bed nets.
This programme is generously funded by the Global Fund, to accelerate the end of AIDS, tuberculosis, and malaria as epidemics. As an international organization, the Global Fund mobilizes and invests more than US$4 billion a year to support programmes run by local experts in more than 100 countries. In partnership with governments, civil society, technical agencies, the private sector, and people affected by the diseases, we are challenging barriers and embracing innovation.