Building Public Health Capacity in Afghanistan to Implement the International Health Regulations: A Role for Security Forces

Abstract

The government of Afghanistan, with international partners and donors, has achieved substantial public health improvements during the past 8 years. But a critical gap remains: capacities to detect and respond to disease outbreaks that could constitute a public health emergency of international concern, as required by the International Health Regulations (IHR). The Afghan Ministry of Public Health seeks to build these capacities, but conflict and scarcity of resources hinder public health surveillance and response, diagnostic laboratory and clinical management capacity is limited, and massive international population movements could permit outbreaks to cross international borders. Several diseases covered by the IHR, such as polio, are endemic in Afghanistan, and risk of novel disease emergence may be elevated in some areas. The security forces of the United States and other countries with military presence in Afghanistan are potential partners for the government of Afghanistan in strengthening the public health capacity. They could extend specialized disease surveillance and response capabilities to the Afghan military and civilian sectors and could integrate surveillance and response capacity building into ongoing development programs, especially in insecure areas. The World Health Organization could provide the forum for coordinating military and civilian contributions to public health capacity strengthening in Afghanistan and could help ensure that international health sector development efforts address Afghan public health priorities in addition to IHR requirements.

Assessment of the potential for international dissemination of Ebola virus via commercial air travel during the 2014 west African outbreak

“…On Aug 8, 2014, the WHO proposed the use of exit screening. 10 However, since exit screening is likely to further draw on valuable health and human resources from resource-poor countries in the midst of an emergency, 11,12 support from the international community will be necessary to effectively implement these recommendations. For maximum efficacy, any screening programme should be coupled with strategies for the early detection of imported cases.…”

Descriptive review and evaluation of the functioning of the International Health Regulations (IHR) Annex 2

“…The IHR (2005) calls upon State Parties to enhance their surveillance and response infrastructure and necessary logistical and human resource capacity across all governments sectors by 2012 [13]. However, for many low resource countries, the development of an epidemic intelligence framework across multiple sectors, as has been done in the European Union for example [14], poses a serious financial challenge [15] and may explain the significant variation between States Parties' reported surveillance capacity [16][17][18][19]. These findings suggest there is scope for the WHO to further support States Parties in enhancing their national surveillance, potentially by leveraging existing bilateral partnerships focused on capacity building [20].…”

Ethical issues in public health surveillance: a systematic qualitative review

“…It was furthermore noteworthy that among the publications included only one focused specifically on a low- income country [35] and two focused on a method of data collection (verbal autopsy) that is generally only employed in a low-income context [36, 37]. Furthermore, five papers focused on global public health surveillance, which actually included the low- and middle-income countries’ perspective [38–42].…”