EMPHNET’s first collaboration with the Afghanistan Ministry of Public Health (MOPH) started in 2015 with a focus on supporting polio eradication and expanded to building workforce capacities in other areas. 

Our first collaboration with the Afghanistan MOPH started in 2015 with a focus on supporting polio eradication and strengthening routine immunization (RI) in a country that is still polio endemic. Through a project designed to create demand for immunization, we implemented appropriate interventions to increase demand for immunization whereby the local community from influencers to teachers and volunteers engaged in the project’s activities to improve knowledge, attitude, and practices regarding immunization to, eventually, contribute to improving immunization coverage. Building on the success of this intervention, another innovative communication activities were implemented in 2021 and 2022. With support from us, the MOPH engaged community elders and religious leaders in Afghanistan to communicate the importance of vaccines and build trust in immunization services. 

Since 2016, we have been supporting the Ministry in building the capacities of the Expanded Program on Immunization (EPI) workforce. We also worked with MOPH to strengthen the skills of the team running the Management Information System of the EPI, the EPIMIS, to ensure best use of EPI data for action. This collaboration came in response to the need for skilled personnel in this data collection and analysis at the provincial and regional levels. We also collaborated to address the need for enhanced performance of the EPI team by investing in supportive supervision and monitoring within provincial EPI teams, supporting training of EPI supervisors from the 34 provinces of Afghanistan in planning, conducting, and reporting supportive supervision visits.

We expanded our support to the Ministry toward enhancing the capacities of the EPI workforce through capacity building activities focused on outbreak preparedness and response to equip relevant EPI workers with the skills needed to undertake effective response to stop the transmission from polio virus or cVDPV outbreaks. We also worked to strengthen interpersonal communication for vaccinators and community health workers in low-performance provinces. 

While adopting the One Health approach and consolidating Polio eradication efforts in the country, we built the technical capacities of polio programs in Water, Sanitation and Hygiene Promotion (WaSH) and Environmental Surveillance, while also focusing on creating synergy between these programs and WASH activities. 

In 2019 and with support from us, the Ministry established a congenital rubella syndrome (CRS) surveillance system that obtains standardized data on CRS incidence and creates a basis for documentation and verification of rubella virus elimination, detection, and isolation of CRS-affected infants. Availability of such a system ensures early provision of appropriate care for the disease, and hence rapid mitigation of it.

As part of its contributions to the use of public health research for informed policies and evidence-based interventions, we conducted various types of research in collaboration national and international partners in Afghanistan in areas of routine immunization.

To also explore means of strengthening public-private sectors engagement to improve coverage in hard-to-reach populations, we supported the Ministry in conducting a rapid assessment of the Partnership with the Private-for-Profit Health Service Providers. Based on recommendations of this assessment, the Ministry and other stakeholders decided to expand the engagement of private health providers to other provinces, particularly the insecure ones, according to a standard implementation guide to ensure success which served as a basis for recommendations where to increase engagement to improve routine immunization coverage in low performing provinces in Afghanistan.

In 2020, in collaboration with Aga Khan University, we conducted a serosurvey to estimate population immunity to polio virus in two provinces of Afghanistan. This survey was a follow up to a previous one which targeted 14 provinces and was which limited to sample collection at health facility level. In the most recent study, a community-based seroprevalence survey in Kandahar and Nangarhar cities was included. We also carried out a social listening activity to assess the social and behavioral determinants of under vaccination, with a particular focus on the role of rumors and misinformation on vaccine-seeking behavior. This has been part of a regional initiative. 

Afghanistan is also among the countries supported by EMPHNET in strengthening National Immunization Technical Advisory Group (NITAG) processes to reinforce evidence-based immunization governance.

EMPHNET’s work in Afghanistan grew when we supported the establishment of the Afghanistan Field Epidemiology Training Program (FETP) in early 2019. This FETP is an intermediate, one-year program hosted and run by the Afghanistan National Public Health Institute, with several departments within the MOPH providing joint oversight to the program implementation.

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In one of the earliest collaborations between EMPHNET and the MOPH, health professionals from human health and veterinary laboratories, in the capital and major provinces, have been trained in biosecurity and biosafety best practices. In a more recent project, we started to build laboratory capacity in the handling of biological samples and safe storage and disposal of reagents- both of which are key in the practices and procedures pertinent to laboratory network and management in Afghanistan.

A fruit of this collaboration was the development and publication in 2021 of an SOPs documents under the title Standards Operating Procedures (SOPs): Chemical Waste Handling and Disposal Handling, Packaging and Transport of Infectious Substances Biological Sample Collection, Packaging, Labeling and Transport from the Field to the Laboratory. 

Afghanistan is included among the countries benefiting from EMPHNET’s regional Rapid Response Team (RRT) trainings, which strengthen national capacities in outbreak investigation and emergency management.

In late 2018, EMPHNET and the MOPH signed an MOU under which both parties agreed to utilize collective efforts and exchange of resources with the purpose of improving public health status in Afghanistan. Under this MOU, both parties are working toward enhancing the management of common public health problems and threats for eventual improvement of population health outcomes in the country.