On the eve of World Tuberculosis Day in 2009, 1.8 million youth from all over Afghanistan marched to express solidarity for tuberculosis patients and their families. This was the most successful contribution by a country in the Eastern Mediterranean region, and only one of the various events the Afghan Ministry of Public Health has been introducing as part of its educational program to raise awareness of tuberculosis in the country.

Tuberculosis has been threatening Afghanistan for decades. As the second highest tuberculosis- burdened country in the Eastern Mediterranean region, Afghanistan is also one of the 22 countries with the highest rates of tuberculosis in the world. Too many people die every year from this curable disease, yet tuberculosis is often treated as a taboo. At theMinistry of Public Health, we are convinced that education is crucial in stopping the spread of this silent killer.

It gives me immense pleasure and satisfaction when I see progress of tuberculosis care and control in Afghanistan. The Afghan health sector development faced immense challenges at the beginning of the century, including inadequate tuberculosis control. However in 1954, adopting theGlobal Stop Tuberculosis Strategy, the Ministry of Public Health developed the National Tuberculosis Control Program. The program is a comprehensive national strategy to combat this deadly disease that has proven to be a very challenging epidemic to tackle.

Although tuberculosis is a curable disease it still carries social stigma and myths associated with it. For over a hundred years, the disease has been considered an illness of the poor and those with imprudent social behaviors. Then, a tuberculosis diagnosis was often accompanied by death.

What people don’t know is that nowadays, tuberculosis is a preventable and curable disease. Patients and their families throughout the world continue to face discrimination because of inadequate education and low awareness of the progress that has been made in treatment of the disease. Other challenges associated with tuberculosis control are low case detection, little community involvement, a lack of empowerment of people affected by the disease, and low political commitment and resources for tuberculosis control.

To change these perceptions and educate the public about tuberculosis treatment and prevention, the National Tuberculosis Control Program is using a multi-sectoral approach that has shown to be a key factor in the success of the program. The National Tuberculosis Control Program has established an advocacy, communication and social mobilization (ACSM) unit with a strategy aimed at engaging all sectors and stakeholders, an approach that has been validated by many achievements.

Today, educational programs to raise tuberculosis awareness are being broadcast on national and private TV and radio channels. Both print and electronic media are being used efficiently to teach the public about tuberculosis and eradicate the age-old stigma associated with the disease.

Every year, World Tuberculosis Day is commemorated at national and sub-national levels. This annual event is organized in collaboration with the ministers of education, culture and information, and public health. During World TB Day 2009, the National Tuberculosis Control Program and the Ministry of Public Health in collaboration with the Stop TB Partnership in Afghanistan mobilized over 1.2 million school children under the banner of Million Youth March in the Eastern Mediterranean region, raising awareness of the disease and teaching about its presence in our society.

Another important level of disease control is engaging other organizations and establishing alliances such as the Stop TB Partnership at a national and sub-national level. These coalitions are advocating for maintaining high-level political commitment, raising resources, using different means of increasing awareness about the disease and the efforts being made by the National Tuberculosis Control Program for its care and control.

However, while educating the general public and advocating for political commitment is significant, one of the most important groups the National Tuberculosis Control Program is successfully involving in its educational efforts are tuberculosis patients and survivors. Established in 2009, Afghan Tuberculosis Patients Association is expanding rapidly. This organization enables treated tuberculosis patients to be involved in various activities of care and control. The Patients’ Charter for Tuberculosis Care outlines the rights and responsibilities of people with tuberculosis and empowers patients and their communities through increasing knowledge of the disease. Initiated and developed by patients from around the world, the Charter makes the relationship with health care providers a mutually beneficial one. This association is working towards identifying tuberculosis patients through active case findings and ensuring successful completion of treatment course for diagnosed tuberculosis patients. By doing so, they are aiming to make local communities tuberculosis free.

Concerted efforts by the National Tuberculosis Control Program and the Ministry of Public Health are supported by our collaboration with other ministries and departments to raise awareness and improve tuberculosis treatment in Afghanistan. Ministries of prisons, education, and justice as well as the Afghan parliament are now active partners of our program.

To truly make our approach multi-sectoral and involve all stakeholders, the program is also working closely with United Nations agencies and international organizations. The World Health Organization is a strong technical and implementing partner. The World Food Program is providing food support to all diagnosed and registered tuberculosis patients. International donors including the Global Fund, Canadian International Development Agency, Japan International Cooperation Agency, United States Agency for International Development, MSH, and the Italian Cooperation are major partners of the program. Many other local and international NGOs like BPHS/EHPS implementers; BRAC, IESPO, Afghan Anti TB Association (AFGATA) and Afghan Tuberculosis and Lung Disease Association (ATLDS) are working together on various areas of the program starting from implementation to advocacy.

We believe that such cooperation is key in developing education programs and fighting tuberculosis. To lift the veil covering this disease, we must combine forces and teach the public about the symptoms of tuberculosis, early diagnosis, treatment and the possibility to defeat the disease and live a healthy and productive life. Tuberculosis is killing more and more people, despite being completely curable. Through education, we can increase the number of diagnosed and cured cases in Afghanistan and eventually stop the disease.