advocacy, communication and social mobilization for tb control in kenya
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Advocacy, Communication and Social Mobilization for TB Control in Kenya. Chakaya J. M NLTP, Kenya. TB Disease in Kenya. 2004 105, 747 of all types in 2004 41,467 New smear positive 41,220 New smear negative 14,949 New extra-pulmonary 8, 482 re-treatment cases - PowerPoint PPT PresentationTRANSCRIPT
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Advocacy, Communication and Social Mobilization for TB Control in Kenya
Chakaya J. M
NLTP, Kenya.
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TB notifications NLTP Kenya 1987-2004
0
20000
40000
60000
80000
100000
120000
1987
1988
1989
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1991
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1994
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1997
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2004
Year
Nu
mb
er o
f ca
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Total TB SSP TB Retreatment
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TB Disease in Kenya
• 2004– 105, 747 of all types in 2004– 41,467 New smear positive– 41,220 New smear negative– 14,949 New extra-pulmonary– 8, 482 re-treatment cases
• TB CNR: 320/100,000 for all TB • 9-fold increase since early nineties• Average annual increase: 16%• CDR 50% of estimated incidence• Estimated that over 60% HIV+
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HIV
Poverty
The key reasons for the TB epidemic in Kenya
and
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TB notification versus HIV prevalence among ANC clients in Kenya 1990-2004
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5
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35
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45
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004
Year
%
0
50
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Not
ifica
tion
rate
all
TB
% annual increase TB % HIV among ANC TB NR
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TB Trends in Kenya: 1990 - 2004
106,000
212,000
0
50,000
100,000
150,000
200,000
250,000
'90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04
Year
Num
bers
All registered TB cases
TB Incidence
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TB Treatment outcomes 2003 cohorts (percentages)
Treatment success
rate
Failure rate
Death rate
Out of control
rate
Transferred out rate
Nrs evaluated
New PTB+ 80 0.2 5 9 6 34,068
New PTB- 76 n/a 7 11 6 33,008
EPTB 74 n/a 8 11 7 11,862
Re-treatment 75 0.5 11 7 7 3,032
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Constraints to TB control In Kenya
• A weak public health care system with inadequate health infrastructure including a low health facility density
• Inadequate Human resource for health• Financing for TB remains inadequate and short
term• General knowledge of TB in the population is
high but specific action oriented knowledge is low.
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The ACS Strategy
• The GOAL• To use advocacy, communications and social
mobilization to achieve the 70/85 TB control targets and to sustain this effort to eventually achieve the Millennium Development Goal 6 – target 8 – ie “To have halted by 2015 and began to reverse the incidence of TB in Kenya”
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The ACS strategy
• The ACS objectives• Advocate for development of supportive
policies and increased funding for TB programs
• Increase awareness and knowledge of TB and reduce its associated stigma in the general public
• Mobilize the community and build its capacity to respond to the TB epidemic
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The ACS strategy in Kenya
• Multiple partners –the ACS working group
• A variety of behavior change approaches
• Multiple audiences
• Needs assessment/evaluation of on-going programmes an essential first step
• Funding gap analysis
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Advocacy• Target audiences include parliamentarians, ministry of health
officials, the business community, religious leaders etc
• High light the growing TB problem and the socio-economic impact of TB to these decision makers
• Increase funding for TB control in Kenya
• Improve coordination of TB control activities.
• Impact assessment: – funding gap analysis– and regular surveys of knowledge of TB among the decision makers in
government, industry, trade unions etc– Macro and Micro-economic impact surveys
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Communication
• The activities • Mass media campaign• IPC –peer education, traditional folk media,
non-conventional media in communities, schools and among health care workers
• IEC materials for mass pamphleteering
• Impact assessment• Case detection and treatment outcomes• KAP Surveys
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Communication
• Target audience• General public• School going youth• Teachers• Health care workers• Journalists
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Social Mobilization
• Target audiences• Religious leaders• Civic and cultural institutions• People at work sites• Current and former TB patients• People infected and affected by HIV• Community based organizations
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The ACS strategy in Kenya
• An ambitious ACS strategy? Can it really be done?
• Who is going to do it? • The capacity to do it.
• Will it be funded and if yes will the funding be sustained?
• If well implemented will we be able to meet the demand for services created by ACS activities?
• Impact assessment-Is this all?• Examine funding gaps• Inclusion of TB in key Poverty Reduction and Development papers• In depth knowledge of TB among various groups• Case notification and detection rate• Treatment outcomes
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Overcoming the ACS challenges
• Request for Technical assistance• Train and support ACS health care
workers• Increase number of players and sustain
interest of these players in the ACS working group
• Hope for a successful intervention to increase funding and sustain funding as a result of advocacy activities.
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ACS
• Need sustained effort- ACS should be a long term affair
• Need long term financing
• Need a multiplicity of players
• Need to vary communication and social mobilization approaches to local context