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

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%

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

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