Advocacy, Communication and Social Mobilization for TB Control in Kenya

1. Advocacy, Communication and Social Mobilization for TB Control in Kenya Chakaya J. M NLTP, Kenya.

3. TB Disease in Kenya • 2004 • 105, 747 of all types in 2004 • 41,467 New smear positive • 41,220 New smear negative • 14,949 New extra-pulmonary • 8, 482 re-treatment cases • TB CNR: 320/100,000 for all TB • 9-fold increase since early nineties • Average annual increase: 16% • CDR 50% of estimated incidence • Estimated that over 60% HIV+

4. The key reasons for the TB epidemic in Kenya HIV and Poverty

6. TB Trends in Kenya: 1990 - 2004

7. TB Treatment outcomes 2003 cohorts (percentages)

8. Constraints to TB control In Kenya • A weak public health care system with inadequate health infrastructure including a low health facility density • Inadequate Human resource for health • Financing for TB remains inadequate and short term • General knowledge of TB in the population is high but specific action oriented knowledge is low.

9. The ACS Strategy • The GOAL • To use advocacy, communications and social mobilization to achieve the 70/85 TB control targets and to sustain this effort to eventually achieve the Millennium Development Goal 6 – target 8 – ie “To have halted by 2015 and began to reverse the incidence of TB in Kenya”

10. The ACS strategy • The ACS objectives • Advocate for development of supportive policies and increased funding for TB programs • Increase awareness and knowledge of TB and reduce its associated stigma in the general public • Mobilize the community and build its capacity to respond to the TB epidemic

11. The ACS strategy in Kenya • Multiple partners –the ACS working group • A variety of behavior change approaches • Multiple audiences • Needs assessment/evaluation of on-going programmes an essential first step • Funding gap analysis

12. Advocacy • Target audiences include parliamentarians, ministry of health officials, the business community, religious leaders etc • High light the growing TB problem and the socio-economic impact of TB to these decision makers • Increase funding for TB control in Kenya • Improve coordination of TB control activities. • Impact assessment: • funding gap analysis • and regular surveys of knowledge of TB among the decision makers in government, industry, trade unions etc • Macro and Micro-economic impact surveys

13. Communication • The activities • Mass media campaign • IPC –peer education, traditional folk media, non-conventional media in communities, schools and among health care workers • IEC materials for mass pamphleteering • Impact assessment • Case detection and treatment outcomes • KAP Surveys

14. Communication • Target audience • General public • School going youth • Teachers • Health care workers • Journalists

15. Social Mobilization • Target audiences • Religious leaders • Civic and cultural institutions • People at work sites • Current and former TB patients • People infected and affected by HIV • Community based organizations

16. The ACS strategy in Kenya • An ambitious ACS strategy? Can it really be done? • Who is going to do it? • The capacity to do it. • Will it be funded and if yes will the funding be sustained? • If well implemented will we be able to meet the demand for services created by ACS activities? • Impact assessment-Is this all? • Examine funding gaps • Inclusion of TB in key Poverty Reduction and Development papers • In depth knowledge of TB among various groups • Case notification and detection rate • Treatment outcomes

17. Overcoming the ACS challenges • Request for Technical assistance • Train and support ACS health care workers • Increase number of players and sustain interest of these players in the ACS working group • Hope for a successful intervention to increase funding and sustain funding as a result of advocacy activities.

18. ACS • Need sustained effort- ACS should be a long term affair • Need long term financing • Need a multiplicity of players • Need to vary communication and social mobilization approaches to local context