Established in the Afghan Public Health Institute (APHI) of MoPH in December 2006, the DEWS core staff consist of an external and internal coordinator, 8 regional surveillance officers, a data manager and a logistic officer. Staff also include a program assistant, two radio operators, two lab receptionists, and two warehouse assistants.

Afghanistan was divided into 8 surveillance regions, each with 4-5 provinces where logistics was accessible from a major province. Starting from the original 8 major provinces, the DEWS has expanded now to 34 provinces. Each province has a DEWS Assistant responsible for reporting and logistics and an Emergency/ Outbreak Response Team, usually consisting of provincial officers for HMIS, Communicable Disease Control, Malaria, EPI, hospital doctors and others, for an integrated response to outbreak threats.

In each of the 8 major provinces, 7 sentinel sites are selected at provincial hospitals, district hospitals and comprehensive health centers (CHCs); in minor provinces 3 sentinel sites are selected. Focal points at each sentinel site collect data from registration books of the OPD and IPD of the clinics and hospitals and search for any deaths which may have occurred in the clinics or hospital and report it on a weekly basis to the Provincial DEWS Assistant by hand or by phone. The regional Surveillance Officer collects and computerizes the reports and then sends the regional report by email to central level in Kabul.

For each communicable disease there is an “alert threshold” indicating when the focal point should contact the surveillance officer to consider investigating the case and determining if an outbreak is threatening. Collecting specimens from suspected cases and submitting for laboratory testing is an important part of confirming an outbreak. To facilitate this process, specimen collection kits, reverse cold chain, and transportation and communication facilities are provided by DEWS. Field investigations often take place in village mosques, in makeshift structures outdoors, or in family homes.

DEWS Laboratory Receptionists are available 24 hours a day to receive specimens and preserve them at the right temperature for future testing. Virology, Bacteriology and Serology Departments at Central Lab have been upgraded with contributions from WHO, NAMRU3 and other partners in order to respond to the demand for more testing and analysis of communicable diseases.