Tobacco control and mental health care in Afghanistan. Lessons from the COVID-19 pandemic

Over the last 20 years, Afghanistan has led the way in proving the importance and feasibility of tackling noncommunicable diseases (NCDs) in emergency situations. The country has shown that partnerships and a multisectoral approach, involving everyone from international government to local community leaders, are essential to deliver results. This commitment to addressing NCDs that cause 44% of the country’s deaths has continued, despite the COVID-19 pandemic.

Key activities

Afghanistan has worked over a number of years to introduce bans on tobacco advertising, promotion and sponsorship.

Authorities introduced a baby-friendly village strategy to help families give their children the best start in life.

The Government introduced sentinel-based nutrition surveillance to combat the dangers of malnutrition across the country.

Since 2001, Afghanistan has implemented a complete reform of its mental health system, putting mental health treatment at the heart of its health care strategy.

The Government showed its commitment to mental health by ensuring continuity of mental health support during COVID-19.

Partnerships between Government ministries, UN agencies, the private sector and civil society to curb tobacco use

Afghanistan ratified the WHO Framework Convention on Tobacco Control (WHO FCTC) in 2010. The National Tobacco Control Coordination Committee has been supporting that commitment by encouraging partnerships between Government ministries, UN agencies, the private sector and civil society to curb tobacco use. This strong, multisectoral coordination led to Afghanistan’s first law dedicated to tobacco control in 2015, which included a comprehensive ban on tobacco advertising, promotion and sponsorship, with fines for violations.

The Government has used TV, radio and social media to publicize anti-tobacco messages and has also:

• Designated three national parks in Kabul city as tobacco-free areas
• Implemented a checklist for monitoring smoking in public places
• Ensured organisations adhere to the clear positioning of tobacco health warning signs in public places
• Trained hospital staff, teachers and police on tobacco monitorinG
• Stopped tobacco use in public buildings

Supporting breastfeeding beyond hospitals in community settings

n 2009, Afghanistan piloted a baby-friendly village project to promote and support breastfeeding beyond hospitals in community settings across Takhar, Badakhshan and Kunduz provinces. The project engaged mothers, fathers, mothers-in-law, and their social support networks to promote appropriate infant feeding practices. By the end of the project, exclusive breastfeeding for babies up to six months in age had increased from 47.4% to 79.4%. Success was achieved by working at the village level through support groups and at health facilities through young child feeding counsellors. This project informed the development of the Ministry of Public Health’s national community-based nutrition programme in 2017.

Meanwhile, a sentinel site nutrition surveillance system has been helping to shape programmes to improve nutrition across the country since 2013. One hundred and seventy-five sentinel sites gather data for children aged up to two years old, while a total of 953 health posts act as community-based sentinel sites, gathering data with the support of community health workers. The system, which was set up with the support of WHO, UNICEF and funding from the Government of Canada, enables action to be taken swiftly against malnutrition and is an important part of Afghanistan’s progress towards the 2030 goals.

Mental health at the heart of the health care strategy

Afghanistan has put mental health at the heart of its health care strategy since 2001, when there were just two psychiatrists and 138 health care staff to meet the needs of 25 million people.

Rebuilding the mental health system has required strong political will and multi-agency coordination between Government, donors and nongovernmental organizations. The Ministry of Public Health focused on integrating mental health into primary health care and training general health workers in basic psychiatry alongside psychological and social interventions.

By 2013, this policy was described as “One of the continent’s most successful experiences in integrating and scaling up mental health care in selected areas of a country.” (Building Back Better, 2013)

This ongoing commitment has trained more than 1000 health workers in basic mental health care, established a mental health hospital, set up a drug rehabilitation centre and provided essential care for hundreds of thousands of patients.

However, the COVID-19 pandemic has had a major impact on public mental health, affected medical supplies and reduced the public’s willingness to visit mental health facilities.

Afghanistan responded quickly to ensure the continuity of mental health services throughout the pandemic by:

• Launching six helplines in May 2020 to provide remote health and psychosocial support
• Distributing psychosocial support guidance, translated into local languages
• Tracing and contacting people who tested positive for COVID-19 to offer psychosocial support
• Setting up units in six COVID-19 hospitals to give support to health care workers and families of patients

Through interdepartmental collaboration and community engagement, Afghanistan ensured that primary health care centres and general hospitals could maintain mental health services during the pandemic.

This country story is part of a series on sharing successful strategies from the Eastern Mediterranean Region mitigating noncommunicable diseases and mental health disorders during the COVID-19 pandemic and beyond. Discover additional stories and insights in the full report published by the World Health Organization Regional Office for the Eastern Mediterranean.