Aligning TB Control Activities to Devolved System of Governance in Kenya

A Wairia1, J Njenga1, E Masini2, F Ngari2, B Mungai1, M Maina3

Correspondence: awairia@chskenya.org

1Centre for Health Solutions- Kenya (CHS);2National TB, Leprosy and Lung Disease Program, Ministry of Health, Kenya

3United states Agency for International Development - Kenya

Key words: Devolution, co-ordination, counties, TB control, clusters

• Kenya adopted a new constitution in 2013

• As a result, all aspects of health care services includingTB control activities were devolved to the 47 newlycreated semi-autonomous counties

• One of the consequences of devolution in TB control inKenya was lack of coordination of control activitiesleading to severe shortage of TB drugs experienced in2014

• During that year, neither the counties nor the nationalgovernment budgeted for procurement of the drugs

• The country was forced to get drugs from Malawi

• To ensure proper coordination of TB control activitiesunder devolved system, there was need for the nationalTB control program to realign with the system

Background

Methods

• Efforts made by NTLD-Program to align TB control to thedevolved system have borne fruits.

• There is clear coordination of service delivery and littledisruption of services

• NTLD-Program has continued to engage county leaders onmatters related to TB control

• All counties have agreed all TB commodities to beprocured centrally and distributed through KEMSA

• Both levels of government agreed to work together in:

o Joint strategic planning

o Resource mobilization

o Joint monitoring and evaluation

o Provision of targeted high impact interventions

o Targeted capacity building of county health teamsby national government

• The NTLD-Program also continuously engaged thecounties to ensure deployment of qualified officers ascounty and sub county TB coordinators

• Electronic surveillance system was modified to be ableto provide data both at the national and county levels

• County pharmacists, initially not playing major role inTB control, were brought on board throughsensitisation and engagement in all management of TBcommodities

Conclusion

• In 2014, two consultative meetings were held betweenNational TB, Leprosy and Lung Disease Program (NTLD-Program) and County Health Managers from all the 47counties

County Health Directors and County TB Coordinators at the Consensus Building Meeting in Nairobi, 2014

Quarterly meetings

Developed and printed with the support of the United States Agency for International Development (USAID) through the Tuberculosis Accelerated Response and Care (TB ARC) Activity

Centre for Health Solutions - Kenya,Kasuku Road o� Lenana Road, CVS Building, 4th �oor, North Wing

P. O. Box 23248 - 00100, Nairobi, KenyaTel: +254 (0) 271 0077

www.chskenya.org

Results

• As at February 2016, all the 47 counties had appointedCounty TB and Leprosy Coordinators(CTLCs)

• Number of TB control zone coordinators rose from 257 in2013 to current 289

• Counties have been organized into 17 clusters for ease ofcoordination and facilitation of quarterly data reviewmeetings based on county proximity to each other andsimilarities in TB burden

• Each of the 17 clusters have held independently 8quarterly meetings with technical assistance from NTLD-Program

• NTLD-Program has conducted 4 technical assistancemissions jointly with county health officials

• Two data quality assessment missions

• Counties have access to their specific TB data

• Few counties have set aside money for TB controlactivities in their annual budgets

• However, there are still aspects that counties need to takeup including facilitating sub county coordinators toconduct routine support supervision, provision of tools,and support of the electronic surveillance system

Quarterly meetings