1. Progress and challenges
towards eliminating malaria in
Afghanistan
Najibullah Safi, MD, MSc. HMP, DMPPM
National Malaria and Leishmaniasis Control Program Manager
MoPH - Afghanistan

2. Malaria Transmission in Afghanistan
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 2

3. Anti Malarial Treatment in Health Care
System of Afghanistan
 Health post (HP)
Clinical Malaria
 Basic health center (BHC)
 Comprehensive health center
 District hospital
Confirmed Malaria
 Provincial hospital
 Specialized hospital
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 3

4. Achievements
 Health care system cover 82% of the population
 Formulation of policies and guidelines
– National strategic plan
– National treatment protocol (adopting ACT for confirmed
PF)
– Epidemic preparedness and response
– Malaria microscopy for lab technicians
– Diagnosis and treatment of sever complicated malaria
– Treatment guideline for community health workers
– National IVM strategic plan
– Addition of malaria into school curriculum
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 4

5. Achievements cont.
 Establishment of 14 quality assurance centers
 Improvement in reporting system
– 980 health facility report malaria cases
– 8000 health posts (16000 CHWs)
– Piloting the Global Malaria Database
 Training
– Public (including BPHS implementing NGOs)
– Private (lab technicians, MDs, pharmacist…)
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 5

6. Achievements cont.
 GFATM (R5) approved 2.1 million LLINs over 5
years
 In current year more than 300,000 LLINs
distributed in target provinces
 Construction of new building for headquarter of
the program and research and training institute
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 6

7. Achievements cont.
 Vector surveillance
– Entomology unit established in NMLCP
• Plan to establish three Vector Control units in
provinces
 Regular monitoring of anti-malarial drugs since
2003
– Results up-to-date show 100% ACPR
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 7

8. Achievements cont.
Trend of Malaria 2002 – 2006
700000
600000
Number of Reported Cases
500000
400000
300000
200000
100000
0
2002 2003 2004 2005 2006
Years
Malaria reported cases
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 8

9. Challenges
 Insecurity
 Scarcity of resources
– Financial
– Human
 Lack of motivation
 Fragmented health care system
 Poor coordination among stakeholders
 Gratuitous interference
 Time-consuming bureaucratic channels
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 9

10. Challenges cont.
 Geographical, economical and cultural barriers
affecting easy access to facilities with laboratory
services (CHC and DH)
 Absence of lab facility in HP and BHC
– On average 1.5 lab/district exist to provide a
multitude of tests including malaria
 Reduction in proportion of confirmed cases
over the years
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 10

11. Challenges cont.
70 61.6
% of confirmed cases
60
50
40
30
19.4
20
10
0
2003 2006
Year
Proportion of confirmed cases
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 11

12. Challenges cont.
 Unregulated private sector
 Wide practice of self medication
 Sustainability of the program
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 12

13. Prospects
 Future of malaria control is promising
– Financial support from GF (Round 5)
• Plan to apply for the next round of GF
– Political commitment
– Enhanced technical support and better
cooperation with WHO
– Piloting RDT in three WHO CBI/BDN projects
– Upcoming cross border project with Tajikistan
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 13

14. Prospects cont.
– Establishment of new health facilities (sub-
centers) under GAVI fund for strengthening
health care system
– Establishment of 18 sentinel sites to monitor the
trend of malaria in high risk provinces
– Establishment of malaria advisory board
(enhanced coordination)
– Incentives for the staff from GF
– Changes in program leadership
WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 14

15. WHO meeting on progress achieved with malaria elimination in the WHO European region
Ashgabat, Turkmenistan, 30 October – 1 November 2007 15