Scaling up malaria control interventions and strengtthening health care system in Afghanistan 1. Background and Summary  Malaria is widely recognized to be a major public health priority in Afghanistan requiring continued international assistance.  The disease is endemic in large areas below 2000 meters in elevation and is highly prevalent in river valleys used for rice cultivation. With an estimated population of 26.1 million in 2007 (WHO), approximately 80% of whom live in rural areas, it has been estimated that the annual incidence approaches 1.25 million cases per year .  Recognizing the unacceptable burden this places on the health and economic development of the nation, the Government and the Ministry of Public Health (MoPH) are firmly committed to the control of the disease.  In this context, the MoPH and the National Malaria and Leishmaniasis Control Programme (NMLCP) have endorsed the Global and Regional Roll Back Malaria (RBM) strategies and the Millennium Development Goals (MDGs).  In support of this program, a detailed Gap Analysis was conducted in March 2008 and a revised National Malaria Strategic Plan (NMSP) was developed for 2008-2013.  The current program is based on the revised Strategic Plan 2008-2013, considering the funding provided by the Global Fund in Round 5.   A comprehensive spectrum of activities shall be carried out to achieve the stated Goal and Objectives of the NMSP.  These initiatives will sustain and expand the set of activities supported during the Global Fund Round 5 grant period and propose innovative approaches to accelerate Programme implementation.  Key strategies include improving access to early diagnostic services by expanding the network of laboratory services to rural areas, introducing Rapid Diagnostic Tests (RDTs) at the community level, upgrading case management policies through revised evidence-based National Treatment Guidelines (NTGs) and promoting their proper utilization in both the public and private sectors, engaging Community Health Workers (CHWs) to provide Home-based Management of Malaria (HMM), utilizing new distribution modalities to provide free long-lasting insecticide-treated bed nets (LLINs), activating creative Behavioural Change Communications (BCC) modalities to improve awareness and promote behaviour change, and strengthening Quality Assurance mechanisms in all aspects of Programme implementation.  Specific measures will address efforts for the prompt detection and control of epidemics, to improve Monitoring and Evaluation (M&amp;E) activities and to strengthen Programme capacity to sustain this ambitious set of initiatives. Selected operational research activities have been designed to add to the scientific basis for continued strategic planning and to implement an aggressive integrated set of carefully-planned interventions to eliminate Plasmodium falciparum (P. falciparum) from the border areas of Tajikistan.  In addition to expanding services to females, special attention will be given to targeting Programme interventions in known risk areas and the vulnerable populations of pregnant women, children under five-years of age and populations in remote rural areas, often under-served by existing public sector health facilities.  Particular emphasis will be placed on increasing access to the key affected populations of refugees returning from neighboring countries (Returnees), Internally-Displaced Populations (IDPs) and nomads.  The Programme also includes three “cross-cutting” measures for Health Systems Strengthening (HSS), that will be implemented by the MoPH, to enhance health data management and use, to expand high quality early malaria and tuberculosis laboratory services in rural areas and to initiate a new Community Health Nursing  programme.  The Round 8 program will be implemented by three Principal Recipients, namely the MoPH, HealthNet TPO (HN-TPO), and Bangladesh Rural Advancement Committee /Afghanistan (BRAC Afghanistan).  2. Goal   To contribute to the improvement of the health status in Afghanistan through reduction of morbidity and mort