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
  1990s
• 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