Afghanistan Projects

Fighting Tuberculosis with Community DOTS


Afghanistan is a nation of beauty and contrasts. From the bustle of Kabul to the tree lined streets of Herat; from the orchards of Helmand to the mountains of Kunduz, it is a country of captivating beauty. Its people are some of the most hospitable and rugged people in the world. It is also a country filled with tremendous tragedy and suffering contributed to by decades of war, drought, and civil unrest. It is a country which is beginning to proudly emerge from these years of suffering and loss. As it emerges, infrastructures which have all but disappeared are reforming and growing. One of these infrastructures is the fledgling health care system. One of the largest obstacles to a healthy population that Afghanistan faces long-term is the large amount of disease caused by tuberculosis found within its borders. Afghanistan has one of the highest incidences of tuberculosis in the world, estimated to be about 333 per 100,000. This is an especially high rate given that HIV / AIDS has not yet emerged as a significant health problem in Afghanistan. If HIV / AIDS were to emerge in Afghanistan, projections of what would happen to this already high incidence rate would be an epidemiologist’s “perfect storm”. The situation would be nothing short of catastrophic.

Rays of light can be seen in the darkness of this tuberculosis-stained landscape. The National Tuberculosis Program has emerged under good leadership and a vision of tuberculosis eradication. Local Ministries of Health are organizing and making control of tuberculosis one of their top priorities. Multiple non-government organizations have answered the call to help control tuberculosis and communities are becoming increasingly aware of this battle. Global Partners has become involved in part of this battle by beginning and maintaining thirteen tuberculosis diagnosis and treatment centers in the Western Region of Afghanistan. These control centers are built on the foundation of DOTS – Directly Observed Therapy Short-Course, the only World Health Organization recommended method of tuberculosis control. World-wide DOTS is well-known both in theory and practice as an effective program to combat tuberculosis. It includes five standard components: political commitment, diagnosis by sputum microscopy, stable supply of drugs, efficient monitoring and data keeping, and direct observation of patients taking their medicines. It results in 9 out of 10 people being cured of tuberculosis and has received the honor of the World Bank naming it one of the most cost-effective health strategies in the world.


In experience Global Partners has gained from its first thirteen clinics, we have become convinced that although DOTS can take on several different shapes and forms, the form that it needs to take here in Afghanistan is ‘Community-Based DOTS’. The programs we have started here in Afghanistan have been community-based programs in which qualified individuals (DOTS Workers) from the communities in which our patients live are selected to observe their ill community members take their medicines for the required 8 months. Given the village nature of Afghanistan, in order to truly defeat tuberculosis, DOTS must move out to the village level. Barriers to the general population attending a facility-based program are great. From snow, to political instability, to lack of transportation, the reasons to take DOTS to the community are many.

Now is the time to act. Many of the pieces are now in place to make real progress in tuberculosis control in Afghanistan, but we must not stop short of the goal of taking DOTS to even the most rural of villages. Global Partners counts it a privilege to be involved in tuberculosis control in Afghanistan. We have seen the need first hand. We have seen what can be done. We desire to continue to act on what we have seen and learned and help to make Afghanistan’s future one that does not include a high burden of tuberculosis.

Facts About Afghanistan

  • Area: 652,230 sq. km.
  • Borders: China, Iran, Pakistan, Tajikistan, Turkmenistan, Uzbekistan
  • Arable Land: 12.13%
  • Natural Hazards: Earthquakes, droughts, flooding
  • Population: 29,835,392 (July 2011 est.)
  • Urban Population: 23% of total population (2010)
  • Infant Mortality Rate: 149.2 deaths / 1,000 live births (#2 in world)
  • Life Expectancy at Birth: 45.02 years
  • Literacy (age 15+ can read and write): 28.1% (Male: 43.1%; Female: 12.6%)
  • GDP - per capita (PPP): $900 USD (2010 est.)

More About Afghanistan:

The population of Afghanistan is about thirty million. Pashtuns are the predominant ethnic group in Afghanistan, comprising forty-two percent of the population. Other ethnic groups include the Tajiks (twenty-seven percent), Hazaras (nine percent), Uzbeks (nine percent) and other minority groups such as the Aimak, Turkmen and Baluch. Dari is the official language of the government. However, many other languages are spoken in Afghanistan, including Pashtu, Hazaragi, Uzbek, and Turkmen. Religiously, Afghanistan is over ninety-nine percent Muslim, with an estimated eighty percent Sunni Muslims and an estimated nineteen percent Shiite Muslims.

Read a brief history of Afghanistan

Today, Global Partners works alongside the United Nations and many other international NGOs to provide essential development and support. Afghanistan's infrastructure, such as roads, electricity, and water sanitation, is in poor condition. Medical care is lacking, especially in rural areas. This results in a national life expectancy of only forty-five years, the second highest infant mortality rate in the world, and the highest rate of maternal mortality. Furthermore, the educational system is struggling to recover after decades of war; less than thirty percent of men are literate and only about thirteen percent of women. Cultivation of poppies also remains a significant concern, as Afghanistan is the world's largest producer of opium. Although there has been a great deal of reconstruction in the past ten years, much, much more is needed in order to alleviate poverty, provide adequate health care, create economic opportunities, and educate the next generation.