1. ACSM TA KENYA’S Experience By Jane Nyangara Onteri Programme officer Division of Leprosy, TB and Lung disease ACSM at country level sub-group Working Group Meeting At Southern Sun Hotel- Cape Town 5 th -6 th November 2007

2. Kenya

3. Background Republic of Kenya covers an area 582,646 sq kms About 80% of its land is arid or semi-arid and is sparsely populated Population was projected to be 33, 829, 590 (est. 2005): Life expectancy had dropped from 56.8 years in 1992 to 51 years in 2004 due to the AIDS epidemic GDP (2006 est.): $22.79 billion Annual economic growth rate (2006): 6.1% Gross national income per capita (2006): $455

4. Background cont. Kenya is ranked 10th among the world’s 22 countries with a high TB burden. Kenya’s TB burden and rates have increased dramatically — a more than tenfold increase from 10,000 in 1987 to 115,234 in 2006. Case notification rate increased from 110 per 100,000 population in 1987 to 325 per 100,000 in 2006

5. Background cont. TB treatment success rate stands at about 81% as of 2005 TB case detection rate of sputum smear positive cases (SS+) has remained low, at about 45% (WHO, 2007)

6. ACSM TASK Force. Formed in 2005 Terms of reference are:  To develop strategies for the implementation of ACSM activities  To promote multi-stakeholder involvement in the implementation of ACSM activities

7. ACSM Task Force TORs Cont.  To develop suitable health care worker training programs, training manuals/guides and other materials to promote best practices in the implementation of ACSM activities  To develop suitable indicators for monitoring and evaluation of ACSM activities  To hold quarterly ACSM review meetings

8. The ACSM TASK Force Cont-- TASK Force Membership  DLTLD-Focal persons for ACSM (MOH)  DLTLD-Focal person for CB-DOTS (MOH)  PATH (Partner)  FHI (Partner)  AMREF (Partner)  NASCOP (MOH)  PSI (Partner)  NEPHAK (Partner)  Division of Environmental Health (MOH)  Division of Health promotion (MOH)

9. TA for ACSM For formation of Task force Development of R5 GFATM Development of advocacy and communication strategy documents Development of overall TB strategic plan 2006-2010. Development of TB M&E framework

10. Tools developed for ACSM National TB/HIV Communication strategy was developed and launched ( Lights of Hope) DLTLD National strategic plan -2006 to 2010 developed (issues on ACSM addressed) Monitoring and Evaluation framework for DLTLD has been developed (ACSM Addressed) Development of the National Advocacy Strategy to Fight TB/HIV is in progress (draft is available) TB community sensitization guide for community, business and religious leaders (Draft available)

11. National Communication strategy The communication strategy was developed and launched March 2007 ( Lights of Hope)  It addresses issues of symptoms, diagnosis and treatment and communication channels

12. National Advocacy strategy National Strategy to Fight TB/HIV draft is available  It address issues of policy,  stakeholders/developm ent partners,  TB/HIV collaboration  human resource and logistics

13. Funding ACSM is funded by GFATM round 5 The main objectives in the Round five proposal were:  To advocate for development of supportive policies and increased funding for TB programs  To increase awareness and knowledge on TB and reduce its associated stigma in the general public and people with TB/HIV

14. Funding cont.  To mobilise the community and build its capacity to respond to the TB epidemic  To monitor and evaluate ACSM Activities Apart from Global fund and GOK, the program also receive funds from CDC and WHO for ACSM activities

15. ACSM Achievements Advocacy  TB/HIV advocacy strategy draft is in progress  A task force on ACSM formed, functioning and meets on quarterly basis Communication  TB/HIV communication strategy has been developed and disseminated  Mass media campaign on going  Magnet theatre trainings going on –Over 600 persons trained on TB/HIV  Quarterly newspaper advertisement done and on going  Production of IEC materials- Posters, Brochures, T- shirts, pamphlets, leaflets, flyers, stickers, spin wheels

16. Achievements cont. Social Mobilization  Public health Officers sensitized on ACSM- 73 /80 districts(91.25%)  Civic and religious leaders sensitized in 32/80 districts(40%)  Training and retaining of TB ambassadors on going  Peer to peer education at workplace on going- about 599 persons from different companies trained on TB/HIV  Survey on private DOTs providers offering low cost TB services and those willing to do so on going

17. Specific Activities 1.Mass Media campaign 2007 TV - Citizen, KTN, NTV between 8pm - 9pm Makutano Junction a TV 30 minutes program supported by CDC on going. Radio spots- Citizen, Easy, Ramogi, Inooro, Kameme, Simba and Mulembe. Time: between 6am - 9am and 4pm - 7pm Radio 30 minutes call in show – 12 shows done with 12 TB/HIV topics Print – Nation, Taifa leo and Standard Newspapers

18. Mass media campaign cont. MediaJuly spots August spots October/Nov. spots Total of spots Print56920 Radio10336512480 TV1610026 Total515

19. New paper adverts

20. Newspaper adverts cont.

21. Newspaper advert

22. 2. IEC Materials produced

23. 3. T-shirts

24. Monitoring and Evaluation Campaign placement is being monitored through Steadman’s media monitoring service, to ensure that commercials are aired correctly and according to schedule Support supervision is being offered to the districts and the provinces on ACSM A survey will be carried out on the impact of ASCM activities soon

25. Challenges How to increase case detection and treatment success rates Reduction of defaulter rates and out of controls Prevention of emerging MDR-TB How to motivate and increase staff morale How to integrate TB services with other public health services How to build a cohesive provincial and District teams How to reduce TB/HIV stigma Human resource issues such as shortages and training

26. Conclusion TB progam in Kenya is well managed, working and with continued support that we are currently receiving, we envisage significant reduction of TB cases and hope to reverse the trends

27. Let us join hands together and fight TB THANKS