Dr. Joseph Sitienei
Head, DLTLD
MOPHS - Kenya
Population
36.54 Million
Recurrent Health
sector
9%
GDP per capita
US$328
TB CDR (WHO-2008)
70%
Incidence of TB (2007)
116,723
Case Notification Rate
(2007)
338/100,000
HIV prevalence (KAIS
2007)
7.9%
TB patients with HIV
(2007)
48%
Mortality
72/100,000
CNR 1990-2007
400
350
338
n/100,000 of population
300
250
200
PTB+
All types TB
150
111
100
50
0
'90
'91
'92
'93
'94
'95
'96
'97
'98
'99
Year
'00
'01
'02
'03
'04
'05
'06
07
Distribution of health facilities by type and provider: Kenya
MoH
FBO/NGO
Private for profit
Number %
Number
%
50
67
30.7
42
19.3
218
80
100
17.4
15
2.6
575
60.9
595
23.6
391
15.5
2,523
Type
of
facility
Number %
Hospital
109
460
Health
Centre
Dispensary 1,537
Total
Nursing
and
maternity
0
0
11
58
180
94.2
191
Medical
care
Total
43
0.1
72
10.2
592
83.7
707
2,149
51
845
20.1
1,220
29
4,214

Medical Professional Associations in Kenya
◦ Medical Doctors: KMA, KPA, KAP, KAPHA (Private
Hospitals Assn)


Private Medical Providers ( at least MBChB) –
Individual and Institutional
Plans to involve other cadres:




Drug shops,
Clinical officers,
Nurses,
Traditional healers through the use of DOTS
Representatives




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
Match available resources to TB control needs
(an increasing urban TB disease burden with a
vibrant health sector in the cities)





The KAPTLD led initiative is active in the 5 largest
urban areas with a total of 88 DOTS centers-total
population covered – about 5 million
Faith based, military and prison health services
form part of the public sector DOTS providers
network
There is substantial but un-quantified private for
profit involvement in (diagnosis, referrals and
treatment) TB control across the country
Private sector contributes 2% of the country’s TB
cases
HIV testing stands at 67% in 2007



1997 - Agreement is reached that KAPTLD should
manage the private sector TB treatment “project”
Initially focusing on Private physicians
Agreement is reached that a prepayment scheme will
be used to create a revolving fund to sustain the
initiative and also to enhance case holding

1999 - NLTP provides drugs enough to treat initial
1,500 patients in the private sector

2002 - More drugs “loaned” to KAPTLD by one pharmaceutical

2007 – Consensus meeting and adoption of ISTC by
institutions

2008 - Involving the Training Institutions in
integration of ISTC into curriculum
company (heavily subsidized in cost)



In NVA (sponsored by
Sanofi Aventis)
Meeting attended by:
◦ learning institutions
(Universities and KMTC)
◦ Referral Hospitals
◦ Professional
Associations
Kenyan photos used in
the ISTC
INSTITUTIONS THAT ENDORSED ISTC



Launch of ISTC and Patient
Charter by the minister for
Public Health and Sanitation
in Sept 2009
Endorsement of the ISTC by
the minister
Plans to use the standards
for accreditation of health
facilities




Through development and dissemination of
monthly cards for physicians in private
practice: each month a different standard and
message
All patient packs supplied to the private
sector have the patient charter – government
to follow suit
Patients given the charter at registration
International standards to be used to accredit
health facilities
Transitioning the sick
Lets join hands to fight TB and make poverty history
Thanks for listening to me