Challenges and Constraints for TB Control in Kenya

1. Challenges and Constraints for TB Control in Kenya Dr. James Nyikal Director of Medical Services, Kenya

2. Current status of TB Control in Kenya • DOTS initiated in 1993 and covered the entire country by 1997 • An average annual increase of 16% since the early 1990’s • 96, 043 cases reported in 2003 • Case detection rate estimated at 55% • Treatment success rate 80% • Mortality of registered TB cases 5% • Out of control rate about 15%

3. The constraints to achieving TB control targets in Kenya • Poverty -cuts across all other constraints • The large HIV disease burden • Inadequate general health care services –health care facilities, health care facility distribution, equipment • Human resource for effective DOTS implementation • Inadequate funding of proposed DOTS expansion activities • High proportion of nomadic and semi –nomadic population out of reach of TB services • A rising urban slum population straining program capacity to deliver TB services • Lack of a knowledge and awareness among Health Workers • A large private health care sector that is uninvolved DOTS especially in urban areas • Lack of community awareness • The stigma associated with TB and HIV stigma

4. The initiatives for DOTS expansion • Human resource development through the ISAC initiative • Communication strategy for influencing patient health seeking behavior • Tuberculosis/HIV collaborative activities • Decentralization to include dispensaries to improve access to TB services • Community involvement in TB care • Private –public sector collaboration • Special programmes for improving access to TB services in hard to reach areas • Special programmes for improving TB control in congregate populations like prisons • Improve training at both the pre-service and in service levels • Improving supervision