Strategies for controlling communicable diseases in Afghanistan: a realist review

Afghanistan faces a high burden of communicable diseases (CD), with past efforts focused on fragmented vertical programs. System-level interventions remain limited. This study explores effective strategies for CD control in contexts similar to Afghanistan.

A realist review approach was employed, with systematic searches conducted across PubMed, ScienceDirect, Scopus, MagIran, SID, Google, and Google Scholar for grey Literature search from October to December 2024. Out of an initial 10,846 documents, 181 were deemed eligible for inclusion. Data were analyzed using Ritchie and Spencer's five-stage framework. To assess quality, the RAMESES (Realist and Meta-narrative Evidence Syntheses: Evolving Standards) guidelines were applied for each intervention.

A total of 47 interventions aimed at controlling CD were identified, categorized under key health system building blocks: governance and leadership, health financing, health workforce, information systems, facilities, equipment and medicines, and service delivery. More than half of the included documents were published after 2020, with the majority originating from the United States, Iran, and the United Kingdom. 42% of the documents were original research articles. The interventions ranged from regulatory measures to the provision of post-hospital services for CD.

Within the broader political, economic, social, and technological environment (Context), system-level CD interventions enhance engagement among health authorities and the workforce (Mechanism), resulting in improved, cost-effective services and reduced disease burden (Outcome). To maximize impact, strengthening governance, community health literacy, digital infrastructure, international collaboration, and public-private partnerships (PPP) is essential for sustainable and equitable disease control.