Decades of conflict, poverty, natural disasters, and drought have led to many people in Afghanistan being on the move. Close to six million have gone to neighbouring countries, including more than 2.2 million registered refugees in Iran and Pakistan.  

This presents public health challenges. Afghanistan and Pakistan both have high rates of tuberculosis (TB). Iran has comparatively lower rates, but estimates are that Afghan migrants account for one in five cases in the country.

Ensuring good health for populations on the move is tricky. The multi-country Global Fund grant in Asia aims to find and treat TB cases among mobile populations across Afghanistan, Iran and Pakistan.  

Finding and treating new TB cases among mobile populations is one of the biggest challenges: many people are unregistered and undocumented, and the stigma around TB remains high. Even if they are registered, living conditions, socio-economic status and limited access to health care are barriers to TB services. It is very likely that many cases of TB are missed by health systems among mobile Afghan populations in the three countries covered by the Global Fund grant. These cases need to be found and treated to avoid further spread of the disease, including drug-resistant forms.

The Global Fund grant managed by UNDP works to strengthen collaboration and information sharing among Afghanistan, Iran and Pakistan to ensure continuity of care for patients relocating from one country to another. 

As part of this work, UNDP supported the introduction of a cross-border digital platform for recording and reporting TB cases among refugees, returnees and mobile populations. It was designed in partnership with national TB programmes, the Global Fund, the United Nations High Commissioner for Refugees (UNHCR), International Organization for Migration (IOM) and others.

The platform was developed by Dure Tech and leverages the WHO Prevent TB Digital Platform. It is based on open-source technology and includes a patient-centered module, as well as built-in interoperability with health information systems, enabling the monitoring of TB patients across the continuum of care and across borders.

The platform addresses the following issues:  

• Privacy and confidentiality: The platform uses a unique identifier code which enables health services in each country to track patients while preserving confidentiality.

• Tracking people across borders: transfer of information between different health information systems can be difficult. The platform enables easy transfer of data between countries. As a result, any health facility can find out what treatment a patient was taking in another country and see what other health conditions are present.

• Risk of losing patients during the move: transfer of data for a patient is automatic only to the extent that they inform their health facility of their move. Counselling is needed to ensure they communicate the change.

A field test completed at the end of 2021 confirmed that the application works in real world conditions. Training of trainers and field level health workers in 11 sites has been completed and IT equipment is being distributed. The platform is now moving to its second phase which will cover 12 sites in Afghanistan (four border crossing points and eight settlements for internally displaced people), 11 TB centres in Iran, and 45 refugee villages in Pakistan.

Sustained drive, investment and a partnership approach are key to ensuring that the platform developed under the Global Fund multi-country grant is brought to scale in order to capture as many ‘missing cases’ of TB as possible, and help accelerate progress toward the health-related SDGs and leaving no one behind.

In line with UNDP’s Strategic Plan 2022–2025 and its HIV and Health Strategy 2022–2025: Connecting the dots - Towards a more equitable, healthier, and sustainable future, UNDP partners with the Global Fund, governments and civil society to support and strengthen multi-sectoral national responses to HIV, TB and malaria, by providing integrated policy, programme and capacity development support.

World TB Day is observed on 24 March to build public awareness about the global TB epidemic and efforts to eliminate the disease. The theme of World TB Day 2022, “Invest to End TB. Save Lives.”, highlights the funding gap of US$9 billion that threatens to hamper global progress, and calls on world leaders to triple or quadruple the funding to save lives and end TB by 2030.

Authors:

KNUT OSTBY

Resident Representative, UNDP Pakistan

TRACEY BURTON

Manager Global Fund Partnership/Health Implementation Support Team, UNDP