Zarghona Salihi – Pajhwok Afghan News*
KABUL, Apr 16 2006 (IPS) – For once, Afghanistan can report good news on the public health front. The country has been selected for a special award for its effective fight against tuberculosis (TB), which claims 20,000 lives every year, the majority of them women, the World Health Organisation (WHO) has announced.
The selection of Kabul for the award is a matter of pride for both the ministry of public health and WHO, observed Dr Abdi Momin Ahmad, representative of the Geneva-based world health body, at a meeting in the Afghan capital, earlier this month.
Afghanistan s minister for public health, Syed Muhammad Amin Fatimi, said the number of TB cases was finally on the decline. Some 520 TB treatment centres in different parts of the country were providing free medication. Controlling tuberculosis is one of our top priorities, he said.
According to the minister, the prize money of 65,000 US dollars would be spent on training more medical personnel to deal with TB.
In conflict-torn Afghanistan, TB is a major public health challenge and it ranks 20th among 22 high-prevalence countries. According to WHO, approximately 70,000 new TB cases were reported in 2003, two-thirds of which were women an alarming statistic. On a worldwide basis, women represent only 37 percent of total TB cases.
Lancet, the authoritative British medical journal, has pointed out that Afghan women have been particularly vulnerable not just because of a gender imbalance in the general population. Women comprise only 48 percent of Afghanistan s population. There are other factors involved: factors predisposing women to infection, different gender access to health care and underreporting.
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Traditionally, Afghan women tend to stay in one section of the house, commonly with poor ventilation and heavy smoke produced during cooking. The limited data available indicates that malnutrition is common among women.
Simultaneously access to health care has been restricted due to the severe shortage of female health workers and restrictions on women s travel, particularly during the years of Taliban rule.
In addition, stigma attached to TB has driven the disease underground. Women refrained from seeking care and accessed TB facilities late which also facilitates transmission of TB within the close women s circles.
According to the WHO, not even one in 50 people who develop multi-drug-resistant tuberculosis (MDR-TB), that is resistant to two or more of the primary drugs used for the treatment, currently have access to effective treatment. The vast majority of victims die.
Although its National TB Control Programme (NTP) adopted the directly observed therapy short-course (DOTS) strategy in 1997, the country regularly reported very low coverage till 2002. TB services were predominantly provided by some 20 health-related, non-governmental organisations.
The health status of Afghans is among the worst in the world. Roughly one out of every five children dies before the age of five from diseases that are 80 percent preventable. One woman dies from pregnancy-related complications every half an hour. A third of the population suffers from anxiety or post-traumatic stress disorder.
Vulnerable and poor populations across the globe are especially at risk of contracting TB, which is spread through the air, attacking the lungs and killing gradually and painfully.
Physicians for Human Rights, a global group campaigning to promote health by protecting rights, in its report Maternal Mortality in Herat Province: The Need to Protect Women s Rights , documented 593 maternal deaths in every 100,000 live births.
The rate of maternal mortality in a society is a critical indicator of the health and human rights status of women in a community, said Lynn Amowitz, one of the organisation s doctors. What appears to be simply a public health catastrophe in Herat province also speaks of the many years of denial and deprivation of women s rights in Afghanistan.
The international community has provided extensive support to control TB in Afghanistan. USAID, together with WHO, has been providing overall technical support, while the Canadian International Development Agency (CIDA) and the Italian Cooperation Agency provide financial support (2.9 million dollars).
The Japan International Cooperation Agency (JICA) is funding the development of a TB laboratory network, while the German Leprosy Relief Organisation, German Medical Services, and other NGOs provide TB diagnostics and treatment services in different catchment areas.
Fatimi said the five-year National Development Strategy for reducing poverty and vulnerability and promoting development in Afghanistan, approved at the London Conference in February 2006, had asked for 99 million dollars for health that would be donated by the world community.
Despite concerted international aid programmes and pledges of massive funding for Afghanistan, lack of infrastructure and trained personnel mean that substantial progress is likely to take years or even decades to achieve.
(*Released under arrangement with Pajhwok Afghan News agency)
