Dr. J. SitieneiHead, DLTLD

Kenya

Population 39.4 Million

Recurrent Health sector

9%

GDP per capita US$328

TB CDR (WHO-2009) 80%

Incidence of TB (2008) 110,251

Case Notification Rate (2007)

329/100,000

HIV prevalence (KAIS 2007)

7.1%

TB patients with HIV (2008)

45%

Infant Mortality Rate 72/100,000

� Started in 1997

� Private sector substantial- provides service to substantial number of Kenyans (49%)

� Standardize TB management practices in the private sector

� To offer affordable and quality anti-TB drugs in the private sector

� To accelerate DOTS implementation to achieve WHO recommended TB control targets

� Kenya’s economy relies heavily on Agriculture

� Export of tea is a major source of foreign exchange

� Multinational Tea companies scattered in Parts of central and Rift Valley provinces (more than 20)

� Employs a lot of employees for tea picking

� Housing is based on communal villages

� Congestion is common and disease transmission

POVERTY AND TB: COMMON IN THE TEA ESTATES

1. Poor housing

2. Overcrowding

3. Poor ventilation

4. Malnutrition

5. Poor nutrition

6. Poor access to health care

7. Poor quality of health care

AWARENESS COMPAIGNS IN THE WORK PLACE

� Estates have organized health care delivery systems linked to the public sector (Doctors scheme)

� Dispensaries scattered in tea estates and refer patients to HC and Dispensaries

� Diagnostic capacity in HC and Hospitals

� Allocates substantial amounts of funds for employess

DIAGNOSIS

•Lab reagents•Medicines•R and R tools•Supervision•Training

COMPANY HOSPITAL

INSURANCE

COMMUNITY

DISTRICT HOSPITAL/DISPENSARY/OTHERS

COMPANY HC/DISP

COMPANY CONTRIBUTION

PARTNERSHIPS

•NTP•GBC•KAPTLD

� For commodities◦ Lab reagents

◦ TB medicines

◦ TB M and E tools

(All provided to the patients at NO COST)

� Allows◦ Training of staff

◦ Referral of patients where there is need

◦ Supervision of services by TB staff

◦ EQA system with public sector

◦ Awareness campaigns for TB and HIV

0

50

100

150

200

Unilever James Finlay

TB Cases detected

HIV Coinfection

Cases detected by Unilever and James Finlay Tea plantations amonCases detected by Unilever and James Finlay Tea plantations amonCases detected by Unilever and James Finlay Tea plantations amonCases detected by Unilever and James Finlay Tea plantations among g g g workers and dependentsworkers and dependentsworkers and dependentsworkers and dependents

•Both companies had high cure rates(85Both companies had high cure rates(85Both companies had high cure rates(85Both companies had high cure rates(85----90%) 90%) 90%) 90%)

•Very low default rates (close to 0) Very low default rates (close to 0) Very low default rates (close to 0) Very low default rates (close to 0)

� Treatment success rates comparable or higher to national data

� Defaulter rate very low because of DOTS

� Dually infected patients put on cotrim (100%)

� Linkages to ART through referral system

� Stigma and discrimination low due to advocacy

� Housing remains a big challenge in tea estates

� Referrals sometimes take time

� Lack of guidelines for TB control in estates

� Introducing TB workplace policy

� The journey of a thousand miles starts with one step. Author unknown

� While the first steps to getting the program running have been taken a lot is happening, but more needs to be done to ensure that the program get to performing at excellent levels