Urban Dots in Afghanistan: Fighting TB in Kabul And Beyond


Afghanistan faces a burden of tuberculosis (TB) among the highest in the world, according to the World Health Organization (WHO). An estimated 60,000 new cases arise yearly, with 110,000 Afghans now living with TB; 14,000 Afghans died from the disease in 2015. Only about two in three presumed patients are found, and the treatment success rate is only 49 percent on average in the country.

To win their fight against TB, the Ministry of Public Health’s (MoPH) National Tuberculosis Program (NTP) and partners must make significant progress in Kabul, where nearly 4.5 million people live--approximately 15 percent of the country’s population. New cases of all forms of TB exceed 8,000 a year in this crowded capital city.

Yet Kabul presents particular challenges to TB control. Observers note a seeming lack of motivation among public health staff, likely related to low salaries. Infrastructure presents another barrier to high quality care: 45 percent of Kabul’s public health facilities do not own the buildings they work in; they rent houses, where infection control may be difficult. Private hospitals also lack standardized buildings and often fail to conform to ministry guidelines. Almost half of all patients go to private facilities for health care: private facilities are more conveniently located, have shorter wait times, more reliable electricity, and a better reputation.

Before 2009, private facilities did not provide TB services. In 2009, to respond to the growing TB epidemic in Kabul, the USAID-supported project TB CAP introduced urban DOTS (Directly Observed Treatment, Short Course), a systems strengthening strategy the World Health Organization (WHO) recommends to improve treatment outcomes and increase case detection.The USAID-funded TB CARE 1 expanded urban DOTS to new public and private health facilities and the current Challenge TB (CTB) continues to support and expand TB control.