The document discusses the impact of the COVID-19 pandemic on Afghanistan's already strained healthcare system. It outlines the status of the pandemic in Afghanistan, including limited testing and underreporting. It also discusses the health system response, including expanding surveillance, labs, and hospital capacity as well as training healthcare workers. However, the recent political changes have put health sector gains at risk by interrupting services and funding. Sustained support is needed to strengthen the health system and vaccination efforts amid ongoing challenges.

1. The COVID-19 pandemic: An opportunity
to strengthen health systems in
Afghanistan
Najibullah Safi, MD, MSc. HPM

2. Outline of the presentation
• Introduction
• Status of COVID-19 in Afghanistan
• Risk factors
• Response to COVID-19 pandemic
• Non-medical intervention
• Health system response to COVID-19 pandemic
• Conclusion
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3. Introduction
• Afghanistan’s health care system has already been strained by
four decades of conflict
• The COVID-19 pandemic further constrained the health system
• Readiness of Afghanistan’s healthcare system to respond
rapidly and effectively to the outbreak of COVID-19 remains
limited
• The fall of Kabul to Taliban on 15th of August 2021
• The recent political development put at risk the gains of last 2
decades in health sector
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4. Status of COVID-
19 in Afghanistan
as of 20th Nov
• Overall inadequate
testing and contact
tracing is done
• Under reporting
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783,734
156,864
9,649 7,363
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
Total sample
tested
Total cases Total active
cases
Total death

5. Major risk factors
• Due to recent political development, interruption in the provision of
health services
• Cross border movements
• Poverty and large number of daily workers
• Social ties, large and extended families
• High density of population
• Religious and cultural belief
• Stigma
• Low level of awareness
• Shortage of health care providers
• Shortage and inappropriate use of PPEs
• Brain drain
• Insecurity and threats
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6. Response to the COVID-19 pandemic
Non-medical interventions
• Closure of schools and universities
• Ban on all religious and traditional gathering
• Closure of nonessential businesses
• Restriction on movement
Adverse effects of non-medical interventions
• Increased poverty, reduced utilization of health services
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7. Health system response to
COVID-19 pandemic
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7

8. Health system
response to COVID-19
pandemic
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• Allocation of additional
resources for health
• Strengthening coordination
• Expansion of surveillance
• Expansion of labs
• Infection prevention and control
• Training of more than 10,000
health care providers on ICU
care, case management, nursing
care and Infection Prevention
and Control, training and
provision of supplies to rapid
response teams
• Continuation of essential health
services

9. Health system
response to COVID-
19 pandemic
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• Deployment of surveillance and
risk communication teams to
crossing points on border with Iran
and Pakistan
• Expansion of hospital IPD capacity
by more than 1000 beds
(construction of 10 new hospital
and renovation of existing one)
• Strengthening of EPI
- Expansion of Cold Chains System for COVID-
19 vaccine
- Recruitment of addition vaccinators
• Increased supply of oxygen
- Procurement of more than 4,000 oxygen
concentrators
- Construction of 15 oxygen production plants

10. Expansion of
surveillance and lab
network
• Strengthening
surveillance,
reassignment of 34,000
AFP surveillance staff for
COVID-19 surveillance
(screening at the point of
entry, case detection,
investigation, contact
tracing, testing)
• Comprehensive training
• Strengthening and
expansion of Lab
• Testing capacity
expanded from
ZERO to 10,000
samples per day
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• Establishment of 35 PCR COVID-19 labs
till date

11. COVID-19
Vaccination as of
20th Nov 2021
• As of 20th Nov,
4,274,977 individuals
are vaccinated (around
11.5% of the
population)
• Recruitment and
training of more than
2,000 vaccinators
• Expand cold chain
capacity
• National COVID-19
vaccination campaign in
late Oct
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12. Additional financing
for health sector
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100
40
25
10
Funding for COVID-19, in millions of USD
WB ADB Gov PEFF
• Since 15th August 2021, major donors paused their funding to Afghanistan,
which put in risk the gains of last two decades

13. Conclusion
• Immense need for sustaining the health care delivery
• Effective utilization of existing and expanded facilities
• Need for accelerating COVID-19 vaccination
• Need for strengthening multi-sectoral response
• Reinforcement of all non-pharmaceutical interventions
• Systematic approach for social protection and provision of a
meaningful benefit package to the poor
• Community engagement particularly in security compromised
areas
• Need for increased transparency and accountability
• Serious concerns about sustaining the gains in long term
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