Initiative 

Noncommunicable diseases (NCDs) are currently causing an estimated 109 000 deaths every year in Afghanistan. In order to address this burden, Afghanistan’s Ministry of Public Health jointly with the World Health Organization (WHO) and other partners deployed the NCD emergency kit in four primary health care centers in different provinces with declared emergencies. The Kit supports treatment for chronic disease patients in emergency settings. It provides essential medicines and medical devices for the management of hypertension and cardiac conditions, diabetes and endocrine conditions, chronic respiratory diseases, and mental health and neurological conditions for outpatient care in primary health care settings. This initiative showed that integration of NCD services into primary health care is feasible and acceptable, the NCD emergency kit can bridge gaps during emergencies, and partnerships are essential to success..

Context

NCDs are the leading cause of disability and death in low- and middle-income countries, disaster-prone areas and emergency settings including armed conflicts followed by civil service disruption and refugee crises. Afghanistan’s continuing conflict leads to insufficient access to diagnosis and treatment for people living with NCDs, putting them at risk of premature death from avoidable complications. Traditionally, humanitarian health response to emergencies focused on the management of acute conditions. The NCD emergency kit was introduced in four primary health care centers in different provinces with declared emergencies in order to combine the emergency and NCD agendas. The Kit targets the most common and manageable NCDs such as diabetes, hypertension, chronic respiratory diseases and selected mental health conditions, enabling these centers to diagnose and treat patients, limit referrals and meet the priority NCD health needs of thousands of people.

Initiative

In July 2019, Afghanistan’s Ministry of Public Health jointly with WHO and other partners deployed 27 NCD emergency kits in four primary health care centers in different provinces with declared emergencies. This initiative aimed to respond to supply chain disruptions to ensure continuity of care, monitoring and follow-up for people living with NCDs. It also marks the country’s first attempt to address these conditions, in provinces with declared emergencies, by integrating NCD services into primary health care as traditionally, humanitarian health response to emergencies focused on the management of acute conditions.

Each of the 27 NCD emergency kits deployed provided a regular supply of medicines and medical devices to meet the priority NCD health needs of 10 000 people for three months. This included oral medicines, basic diagnostic equipment, renewables and additional products needing cold chain, such as insulin, accompanied with treatment guidelines. Only medicines included in the WHO Model list of essential medicines were available in the Kit. The selection of these medicines has been aligned with the WHO Package of essential noncommunicable disease interventions for primary care in low-resource settings and the WHO mhGAP humanitarian intervention guide for mental health management, including treatment of psychosis, depression and epilepsy, making the NCD emergency kit a standardized, evidence-based kit.

Afghanistan’s Ministry of Public Health implemented this initiative jointly with WHO, Afghanistan’s Red Crescent Society, International Federation of Red Cross and Red Crescent Societies, International Committee of the Red Cross, and Primary Care International. Together, the partners managed the deployment of the NCD emergency kit in the four primary health care centers, trained staff in these centers on management of NCDs in accordance with WHO guidelines, and conducted regular visits to each of the four centers to monitor, evaluate and report on implementation of this initiative including training outcomes, adherence to guidelines, use of medicines and registrations. Funding for this initiative was provided by the Central Emergency Response Fund, which is a humanitarian fund established by the United Nations General Assembly in 2006 to enable more timely and reliable humanitarian assistance to those affected by natural disasters and armed conflicts.

Impact

This initiative demonstrated that integration of NCD services into primary health care is not only feasible but was also accepted by the communities in the four provinces with declared emergencies in Afghanistan. It also showed that NCD integration into primary health care can bring Afghanistan closer to achieving universal health coverage given the increase in the number of people diagnosed and managed during implementation of this initiative, decrease in referrals resulting in better use of health services, and level of trust achieved between patients and staff in primary health care centers.

Lessons Learnt

Integration of NCD services into primary health care is feasible and acceptable. The deployment of the NCD emergency kit in the four primary health care centers in provinces with declared emergencies showed that integration of NCD services into Afghanistan’s Basic Package of Health Services at primary health care level is not only feasible but also acceptable for staff and communities.

The NCD emergency kit can bridge gaps during emergencies. The deployment of this kit in provinces with declared emergencies showed that it is a viable option for bridging the gap in NCD services when supply chains are disrupted and medicines are scarce. In emergencies, the NCD emergency kit can help health care providers at primary health care level target the most common and manageable NCDs such as diabetes, hypertension, chronic respiratory diseases and selected mental health conditions, as well as enable them to diagnose and treat patients, limit referrals and meet the priority NCD health needs of thousands of people.

Partnerships are essential for success. This initiative demonstrated the importance of partnerships with established national and international organizations, that have strong links to the community, in saving lives. Partnerships proved effective in deployment of the NCD emergency kit, training of staff in the primary health care centers, and regular monitoring and evaluation of this initiative.

Related links

Noncommunicable diseases country profiles 2018: Afghanistan

Story originated in 2021.