ACSM TA KENYAS ExperienceBy Jane Nyangara OnteriProgramme officerDivision of Leprosy, TB and Lung diseaseACSM at country level sub-group Working Group MeetingAt Southern Sun Hotel- Cape Town5th -6th November 2007

Kenya

BackgroundRepublic 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 epidemicGDP (2006 est.): $22.79 billionAnnual economic growth rate (2006): 6.1%Gross national income per capita (2006): $455

Background cont.Kenya is ranked 10th among the worlds 22 countries with a high TB burden.Kenyas 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

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

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

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 activitiesTo develop suitable indicators for monitoring and evaluation of ACSM activities To hold quarterly ACSM review meetings

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)

TA for ACSMFor formation of Task forceDevelopment of R5 GFATMDevelopment of advocacy and communication strategy documentsDevelopment of overall TB strategic plan 2006-2010.Development of TB M&E framework

Tools developed for ACSMNational 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)

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

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

FundingACSM 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

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

ACSM Achievements Advocacy TB/HIV advocacy strategy draft is in progressA task force on ACSM formed, functioning and meets on quarterly basisCommunicationTB/HIV communication strategy has been developed and disseminatedMass media campaign on going Magnet theatre trainings going on Over 600 persons trained on TB/HIVQuarterly newspaper advertisement done and on going Production of IEC materials- Posters, Brochures, T-shirts, pamphlets, leaflets, flyers, stickers, spin wheels

Achievements cont.Social MobilizationPublic 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

Specific Activities 1.Mass Media campaign 2007TV - Citizen, KTN, NTV between 8pm - 9pmMakutano 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 - 7pmRadio 30 minutes call in show 12 shows done with 12 TB/HIV topics Print Nation, Taifa leo and Standard Newspapers

Mass media campaign cont.

New paper adverts

Newspaper adverts cont.

Newspaper advert

2. IEC Materials produced

3. T-shirts

Monitoring and Evaluation Campaign placement is being monitored through Steadmans media monitoring service, to ensure that commercials are aired correctly and according to scheduleSupport supervision is being offered to the districts and the provinces on ACSMA survey will be carried out on the impact of ASCM activities soon

ChallengesHow to increase case detection and treatment success rates Reduction of defaulter rates and out of controlsPrevention of emerging MDR-TBHow to motivate and increase staff morale How to integrate TB services with other public health servicesHow to build a cohesive provincial and District teamsHow to reduce TB/HIV stigmaHuman resource issues such as shortages and training

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

Let us join hands together and fight TB

THANKS