PARIS 2008: Afghanistan’s DOTS coverage up from 38% to 97% in 5 years

Photo by Army.milReports of an increase in Directly Observed Treatment Short-course (DOTS) coverage in Afghanistan from 38% in 2002 to 97% in 2007 released at the 3rd Afghanistan Partners Forum 2008 during the 39th World Conference on Lung Health in Paris are impressive.

This significant increase is a considerable achievement for Afghanistan considering the financial, healthcare, access and security constraints the country faces. It is also impressive considering Afghanistan’s position as a high tuberculosis (TB)-burdened country.

Afghanistan’s health system is unique in structure and function as the delivery of health services are conducted through a variety of integrated packages including the Essential Package of Hospital Services and Basic Package of Health Services. The latter is predominantly implemented by NGOs and includes provisions for TB treatment and control.

“I have great hope of seeing more progress and success in the quality of DOTS and the execution of TB control activities readily available to the TB-affected community,” Dr Shah Wali Maroofi, Director of Afghanistan’s National TB Control Program (NTP), said earlier this year.

While there is little information available on nation-wide civil society engagement, representation and participation in national TB programs, if correct, these DOTS figures, are impressive for a country recovering from US military strikes and reeling from the onslaught of infectious diseases.

Decades of conflict, civil unrest, political uncertainty and mass displacement have made public health efforts difficult. But these figures demonstrate the strength of communities affected by these issues and their ability to respond to massive public health challenges.

In 2007, new TB and HIV initiatives were launched in the country and the NTP organized a number of TB task force meetings as well as ensuring that World Food Programme food assistance packages were reaching people in need.

The NTP also developed working plans for joint programs to fight TB and HIV and initiated projects designed to tackle multi-drug resistant TB. But between 2007 and 2008, the monitoring and evaluation of TB programs became a casualty of inadequate financial resources.

The efforts of Afghanistan towards TB care and control are commendable considering the country’s history of conflict. The development of mechanisms to promote the inclusion of civil society in the fight against the disease will further improve the quality of TB and HIV interventions.

Bobby Ramakant-CNS

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