Hundreds of Community Health Workers Trained to Provide TB Services to Residents in Rural Afghanistan

Afghanistan is one of 22 countries that have been designated as having a high burden of tuberculosis (TB). Each year, roughly 11,000 Afghans die from TB--many of these deaths occur in rural regions where residents have limited access to TB screening and treatment. In response, USAID's TB CARE I project, implemented in Afghanistan by Management Sciences for Health (MSH), is helping Afghanistan’s National Tuberculosis Control Program strengthen TB diagnosis, treatment, and care in 19 provinces including Takhar, a rural region in northern Afghanistan.

When the project began in 2010, residents in the hard-to-reach areas of Takhar had difficulty accessing TB services and, community health workers (CHWs) had not been trained to address TB.

In 2011 and 2012, TB CARE I trained 600 CHWs and 44 CHW supervisors in Takhar to conduct TB screening, refer patients with TB symptoms to health facilities, and monitor patients taking their daily TB pills (the World Health Organization’s recommended directly observed treatment, short course (DOTS) strategy). 

Shortly after this workshop, one of the trainees, Abdul Rahman, began conducting door-to-door TB screening. Within two months, Abdul had referred seven people to the local Hazar Bagh Health Center for testing and four of these people were found to have TB. 

Dewana Qul was one of the residents diagnosed with TB. He had suffered from TB symptoms for seven months but had not been able to afford the long and expensive trip to the facility for diagnosis and treatment. Instead, Dewana had gone to multiple private practitioners and drug stores in search of a cure. Although he was prescribed many medications, none of them cured his cough. Thanks to Abdul’s screening visit and referral, Dewana was finally diagnosed with TB and has now received five months of TB treatment. 

Every day, Dewana goes to Abdul’s house to take his TB medicine. Using the DOTS strategy, Abdul observes Dewana taking his TB medicine to ensure his treatment and progress remain on track. “Abdul’s assistance saved me because I was not able to afford to attend the health facility every day to take my pills. I am pleased for the opportunity to receive free TB services. Without assistance from USAID and TB CARE I, I probably would have died from my illness,” he said. 

In 2012, the CHWs trained by TB CARE I successfully screened 6,000 individuals, identified 680 people with TB symptoms, and referred these people to local health facilities for testing. The facilities then diagnosed 52 residents with TB and immediately began treating them. Today, CHWs in Takhar are monitoring the daily treatment of 112 TB patients.

Dr. Ghulam Qader is a TB CARE I senior technical advisor at MSH.