Advocacy, Communication and Social Mobilization for TB Control in Kenya

Chakaya J. M

NLTP, Kenya.

TB notifications NLTP Kenya 1987-2004

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2004

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Total TB SSP TB Retreatment

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+

HIV

Poverty

The key reasons for the TB epidemic in Kenya

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TB notification versus HIV prevalence among ANC clients in Kenya 1990-2004

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% annual increase TB % HIV among ANC TB NR

TB Trends in Kenya: 1990 - 2004

106,000

212,000

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'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04

Year

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All registered TB cases

TB Incidence

TB Treatment outcomes 2003 cohorts (percentages)

   Treatment success

rate

Failure rate

Death rate

Out of control

rate

Transferred out rate

Nrs evaluated

New PTB+ 80 0.2 5 9 6 34,068

New PTB- 76 n/a 7 11 6 33,008

EPTB 74 n/a 8 11 7 11,862

Re-treatment 75 0.5 11 7 7 3,032

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.

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”

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

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

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

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

Communication

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

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

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

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.

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