Multisectoral Partnerships, key to ending Tuberculosis (TB) in Kenya by 2035

Tuberculosis (TB) is a major public health concern in Kenya that has impacted social-economic development. Data from the Ministry of Health – Kenya posits that at least 140,000 people get infected with TB every year, but only 50% of them get diagnosed and linked to treatment. People with TB face undoubtedly enormous social and economic challenges – stigma, exclusion, discrimination and catastrophic costs which go a long way to impacting working relations, interruption of education among school-going children and individuals’ self-esteem. There is an urgent need to establish appropriate mechanisms to end TB, preferably by addressing the social determinants in all sectors which work collaboratively with the health sector.    

TB is transmitted by the bacteria Mycobacterium tuberculosis, which spreads through the air when an infected person talks, coughs, sneezes or sings. Before the emergence of COVID-19, TB was the world’s leading cause of death from a single pathogen; the pandemic has exacerbated the social challenges faced by the communities and people with TB and those affected by the disease. Some of the gains made in the fight against TB in Kenya have been swept under the carpet as a result.  

Observed on March 24th, world TB Day serves as a global reminder of the socio-economic impacts Tuberculosis (TB) has on the well-being and the social-economic development of a country and encourages multisectoral collaborations to end the global epidemic through increased awareness, advocacy and strengthening systems for primary healthcare – training community health workers (CHWs) and community health volunteers (CHVs); investing in TB prevention, diagnosis, and treatment, as well as research.   

This year’s celebrations saw hundreds of Kenyans gather in Eldoret, Huruma Grounds in Uasin Gishu county. The event dubbed, “Yes, We can End TB”, was timely to reinforce the efforts towards ending TB in Kenya and reflect on the progress made by Civil Society Organizations (CSOs), national and county governments, and advocates have done to meet global targets and eliminate TB by 2035.    

Speaking during the ceremony, Dr Abdourahmane Diallo, WHO representative for Kenya Country Office, commended H.E President William Ruto for prioritising the health agenda. He acknowledged that Kenya has made significant progress towards achieving Universal Health Coverage (UHC), which is essential for ensuring access to quality, timely, affordable, and safe healthcare services for all without suffering financial hardship, which is particularly important for individuals with tuberculosis, given their evident socio-economic vulnerabilities.  

Dr Diallo also highlighted that preventive and promotive healthcare forms key pillars of UHC, emphasizing the need to strengthen systems for primary healthcare, “this is crucial for providing holistic, patient-centred TB care through human rights-based, equitable, and gender-transformative services”.  

Amref Health Africa in Kenya continues to work diligently through multi-sectoral partnerships to implement various TB interventions including those geared towards the prevention of community transmission, early diagnosis, and quality treatment to ultimately realise good outcomes. These interventions include; TB contact management, timely tracing of TB treatment interrupters, TB Active case finding in the health among facilities, and TB public-private mix interventions among others. Ensuring that people with TB in Kenya are diagnosed early wherever they are, put on treatment and followed up properly is core to ending TB.  

Amref is also working with communities, in supporting the country to implement novel interventions that have proven effective in finding people with TB among populations that were previously not easy to access and in unconventional settings. Through these innovations, over 2,700 people have been diagnosed with TB at the early stages of the disease in the last three years. Based on the successes, the country is in the process of mainstreaming the innovations into routine TB programming, to reach more people with limited resources.   

Further, Amref continues to empower community health workers who are at the frontline in the efforts towards reducing TB transmission at the community level. The collaboration we have with the community health workers providing health education and screening household contacts has yielded tremendous results, as over 146,543 household contacts of TB have been screened and linked with health facilities for appropriate management including the provision of TB Preventive Therapy.  

“Collaboration with other organizations has helped shape the national TB response through innovative initiatives aimed at increasing case detection and improving TB prevention, case holding, and treatment,” Benson Ulo, Global Fund TB Project Manager at Amref Health Africa, 

In 2019, Amref Health Africa in Kenya released an article highlighting ten innovations used as part of a revamped TB control plan to detect missing cases of TB:    

• Young But Effective – children would test themselves and their family members for tuberculosis
• Ice Cream for I-Screen – Users of the USSD platform for self-screening in Homabay county will be rewarded for switching to the I-screen platform
• Arobaini Initiative – engages inmates in prison and their families to screen for TB
• Smart TB Biometric System – Finding missing people with TB in Kajiado county’s urban settlements using STuBS, a technology-backed identification system
• Tibika Jikinge – finding missing TB patients in mobile populations
• Closing TB Gap – targeting populations that do not receive TB services, such as inmates, police officers, and their families
• TB Self-Screening – users can screen themselves using mobile phones on a USSD platform
• SELT-T – personal TB screening through an Automated TB Screening Machine (ATSM)
• Mobile Assisted TB Diagnosis – A 24-hour call centre where people can be tested for tuberculosis and connected to diagnostic and treatment services
• TB Screening in the Matatu Industry – targets men in the public transport sector. Peer-to-peer TB screening will be used to ensure that the culture of TB screening is integrated into society

The depth and breadth of these innovations imply that Kenya has made considerable progress in addressing the TB epidemic through multilateral partnerships. To complement these partnerships, the Government of Kenya aligned public policy with the National TB program, which seeks to make Kenya a TB-free zone by 2035.  

Of the 10 innovations, 4 posted exemplary results and received additional funding for implementation in the period July 2021 – June 2024. These include; Young But Effective, Tibika Jikinge, SELT-T and TB Screening in the Matatu Industry. 

Due to the Covid-19 pandemic, the number of people with undiagnosed and untreated TB increased. This resulted in an increased number of TB deaths, unplanned out-of-pocket health expenditures, community transmissions, co-infection, and many people contracting the disease – HE. Musalia Mudavadi, Prime Cabinet Secretary of Kenya.  

To meet global benchmarks and eliminate TB in Kenya, the Ministry of Health (MOH) in collaboration with Amref Health Africa in Kenya and other implementing partners has leveraged multisectoral partnerships and helped invest in the following:    

• Increased domestic resource allocation for TB programming
• Rapid allocation of innovations that hinges on WHO guidelines and recommendations
• Expansion of TB diagnostic capacities and improved integration of TB services to ensure equitable access to high-quality TB services
• Capacity building of Health Care Workers (HCWs) to provide education to vulnerable communities on the transmission and symptoms of TB

To end TB in Kenya, communities must be at the centre of the fight. Amref is committed to working with the national and county governments and community representatives, to identify and empower community members to participate actively to ensure that no one is left behind.

“We are building a great force of TB and TB/HIV champions and citizen advocates in the 47 counties, who are creating TB awareness in the community and ensuring people seek TB services; our efforts towards strengthening the capacity of civil society organizations to participate meaningfully in the health space has yielded more domestic funding towards TB, HIV and malaria in some of the counties”. Dr Bernard Langat, Programme Director, HIV, TB, Malaria and NCDs, Amref Health Africa in Kenya.   

It is our hope that, as the United Nations General Assembly prepares to hold the second high-level meeting on the fight against TB in September 2023, a more vibrant and inclusive platform will be created to further the discussions, commitment and spearhead the call for meaningful partnership towards increased funding for TB, expanding the latest TB screening and diagnostic technologies, and other evidence-based interventions to all people in Kenya.

Authors: Kendra Atenya, Communication Intern, Amref Health Africa in Kenya/ Noah Wekesa, CO, Amref Health Africa & Halima Sabwa, Communication Intern, Amref Health Africa in Kenya.