Non-communicable diseases in Afghanistan: a silent tsunami

Abstract

Afghanistan is experiencing an untypical humanitarian crisis resulting from a chronic 40-year conflict and political upheavals. This crisis has led to a rapid economic collapse, inflation, drastic rises in poverty, hunger, and risk of malnutrition.1UN Office for the Coordination of Humanitarian AffairsAfghanistan humanitarian needs overview 2023.https://reliefweb.int/report/afghanistan/afghanistan-humanitarian-needs-overview-2023-january-2023Date: Jan 23, 2023Date accessed: March 28, 2023Google Scholar Afghanistan is suffering from the double burden of communicable and non-communicable diseases. Outbreaks of many communicable diseases such as acute watery diarrhoea, measles, dengue fever, pertussis, and Crimean–Congo haemorrhagic fever in addition to COVID-19 have worsened the situation. Non-communicable diseases (NCDs) account for almost 50% of mortality in the country with a transition towards a heavier burden by 2030. If these diseases are not addressed by context-based interventions, they will cause more than 70% of years lived with disability in a country with a population of 48 million by 2030 and more than 60% of mortality mainly among women by 2030.2Neyazi N Mosadeghrad AM Tajvar M Safi N Trend analysis of non-communicable diseases and their risk factors in Afghanistan.Chronic Dis Transl Med. 2023; (published online March 7.)https://doi.org/10.1002/cdt3.62Google Scholar NCDs are a neglected issue in the Afghanistan humanitarian context. NCD services are mostly only available at the tertiary-care level and through the private sector, which makes accessing the services challenging for patients. Given that services for NCDs are expensive, these services, including medicines, might not be available in those facilities that should provide them at the public primary health-care level. A national assessment on the provision and use of essential health services in 2022 showed that NCDs were the most disrupted services and an unmet need of the Afghan population during the COVID-19 pandemic. This study showed that people need diagnostic tests and medication for the treatment of chronic diseases.3Neyazi N Lindan C Perdes S Ibrahimi AG Horemans D Al Afsoor D The provision and utilization of essential health services in Afghanistan during COVID-19 pandemic.Front Public Health. 2023; 101097680 Crossref Scopus (0) Google Scholar Afghanistan's health system is highly dependent on financial donors. To provide NCD management as routine health care to the Afghan population, the Ministry of Public Health has designed the Integrated Package of Essential Health Services, which is an integration of two existing packages, the Basic Package of Health Services and the Essential Package of Hospital Services.4Safi N Singh LS Naseri S Anwari P An alternative model for health service delivery in Afghanistan.Lancet. 2021; 398: 1481-1482Summary Full Text Full Text PDF PubMed Scopus (5) Google Scholar However, the new package has never been implemented due to high costs and because NCDs have not been the priority for donors and many humanitarian actors in the country. To control this silent tsunami in Afghanistan, humanitarian actors should integrate NCD care into their activities and allocate specific budgets for harmonising and enhancing NCD management in humanitarian crises. The key points to be considered are training of health workers on the identification of NCDs, access to treatment, continuity of care through the referral pathways, patient self-management and education, health promotion, and community engagement. This approach has been developed by WHO in the Package of Essential Non-Communicable Diseases that can be piloted and implemented in Afghanistan. Only a collaborative approach by all actors will address the needs of people affected by NCDs during this humanitarian crisis.5Bausch FJ Beran D Hering H et al.Operational considerations for the management of non-communicable diseases in humanitarian emergencies.Confl Health. 2021; 15: 9Crossref PubMed Scopus (10) Google Scholar We declare no competing interests.