TB Programme Objectives

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Background

• The country is still recovering from 23 years of
  war. In spite of promising progresses
  (constitution approved, elections planned for
  Sep. 04), security remains shaky and primary
  health care delivery largely unsatisfactory.
• TB recognized as a public health priority but TB
  control, as all other health programmes, still
  entirely funded by donors money
• New cases (all types) estimated at 70,000/year
  (WHO)
• TB-related deaths estimated 20,000/year (WHO)
• 65-70 of all cases notified in women of
  reproductive age. Operational research carried
  out in 2003 suggested some possible causes.

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STAG RECOMMENDATIONS FOR AFGHANISTAN (Rabat,
17-19 June 2003)          To strengthen
leadership of NTP to coordinate and harmonize
inputs from multiple partners, by September
2003        Develop a plan for human resources
development, by end 2003        Strengthen
management system including logistics, laboratory
network, by April 2004        Hold a planning
workshop on cross border collaboration with
neighbouring countries, by September 2003
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STAG Recommendation n. 1

• To strengthen leadership of NTP to coordinate and
  harmonize inputs from multiple partners, by
  September 2003
• Achievements
• Appointment of Provincial TB Coordinators by MoH
• Establishment of a weekly NTP coordination
  meeting (NTP, WHO, JICA, Medair)
• Revision, translation into Dari and distribution
  of guidelines for TB control
• Four ICC meetings held in Kabul
• Regional Quarterly Review Meetings held in all
  regions
• A new NTP manager recently appointed by MoH
• ToR for technical staff of NTP and NTI prepared
  and made available to MoH
• Signed MoU with a 6 NGOs and extended MoU with
  WFP for food to TB cases
• Unaccomplished

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STAG Recommendation n. 2

• Develop a plan for human resources development,
  by end 2003.
• Achievements
• W/shop on National Training Plan for TB control
  held in March 2004
• Draft Laboratory Training Manual developed by
  JICA after w/shop
• Unaccomplished
• Plan not yet developed

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STAG Recommendation n. 3

• Strengthen management system including logistics,
  laboratory network, by April 2004.
• Achievements
• Supply of TB drugs and other consumables for all
  country secured for at least all 2004
• System for rational requisition of supplies
  developed and implemented
• Central warehouse made operational at NTI
• 8 pickup and 29 motorcycles procured and
  distributed to regional and provincial TB
  coordinators to facilitate supervisory activities
  and drug distribution
• Internet facilities available at NTI
• Supervisory visits to regions carried out by
  joint NTP/WHO team
• Rehabilitation of Regional Laboratory Training
  Centre for TB and malaria is under way in
  Mazar-e-Sharif
• Several laboratories located in DT centres
  involved in DOTS
• Unaccomplished
• System for laboratory quality control
• Preparation of ready-to-use reagents at local
  level

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STAG Recommendation n. 4

• Hold a planning workshop on cross border
  collaboration with neighbouring countries, by
  September 2003
• Achievements
• List of health facilities providing DOTS in all
  Afghanistan prepared and made available to
  concerned parties in order to refer cross-border
  cases.
• Unaccomplished
• Workshop not organized due to lack of effective
  coordination between main stakeholders

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Other achievements

• Operational Plan for DOTS expansion in 2004 drawn
  in Dec. 2003
• Training of 24 lab. technicians by JICA
  consultant at NTI in Kabul
• Training of 69 MDs, 76 nurses and 65 lab.
  technicians in all regions, supported by WHO
• Operational research on TB and gender in
  Afghanistan carried out and its preliminary
  results presented at IUATLD Conference in Paris
  (Nov. 2003)
• Grant for operational research on DOTS in the
  private sector in Kabul issued by EMRO
• Postal stamps on TB awareness produced by
  Ministry of Telecommunication with technical and
  financial support from NTP and WHO
• A short movie portraying traditional beliefs and
  stigma concerning TB in Afghanistan produced by
  an Afghan-American movie director
• World TB Day celebrated in different ways all
  over the country
• Application to the 4th round of proposals of the
  Global Fund submitted in April 2004
• applied for 3.5 million US over three year for
  the TB component.

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Progress indicators

• Case-finding (new cases and relapses)
• Year S S- Relapses E/P TOTAL
• 2001 4,529 2,148 325 2,579 9,581
• 2002 6,035 3,201 566 3,069 12,871 (
  25.6)
• 2003 6,440 3,392 599 3,185 13,616 (
  5.5)
• Treatment outcome
• Year Cured T/C Died Failure
  Default T/O__ Success rate
• 2001 52.3 35.4 3.2 1.3
  5.5 2.4 87.7
• 2002 58.9 27.5 3.9 1.9 4.9
  2.9 86.4
• No. of districts covered by DOTS ( population
  covered)
• By end of 2001 36 (20)
• 2002 70 (39)
• 2003 126 (54)
• No. of health facilities offering DOTS
• By end of 2001 36
• 2002 79
• 2003 144

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Financial outline

• Agency When Allotted Remarks
• WHO July 2002 1,703,738 from CIDA
  May 2003 843,243 from Italy
• Jun 2004 3,000,000 from CIDA
  Italy together
• Global Fund Feb. 2003 approx. 500,000 not
  yet disbursed
• JICA 2002-2003 1,000,000 mainly for NTI
  rehabilitation
• 2004-2008 5,000,000 not yet allocated
• MEDAIR 2003-2004 940,000 from CIDA

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Plan for 2004

• Continue DOTS expansion according to operational
  plans
• Carry out training of trainers in Kabul
  training of staff at regional/provincial level
• Set up a system for quality control of laboratory
  performance
• Procure TB drugs, consumables and equipment for
  2005 from GDF and other reliable suppliers and
  distribute supplies to regions and provinces
  timely and efficiently
• Expand collaboration with partners for DOTS
  implementation countrywide
• Conduct operational research on topics most
  relevant to TB control
• Hold discussions with NTP Iran and Pakistan on
  cross-border TB control
• Collaborate with Global Fund governing bodies at
  country level
• Explore feasibility for expansion of
  Community-Based DOTS and PPM
• Rehabilitate laboratory network and set up
  hostels for patients living far away from DOTS
  centres, starting from hospitals of main
  provinces.