Healthy People, Empowered Communities
To improve Health and well- being among communities through capacity building and promotion of innovative leadership
KANCO is a membership organization established in the early 1990s in Kenya with operations in the Eastern Africa region. Its membership comprises of Non- Governmental Organizations (NGOs), Community Based Organizations (CBOs), and Faith Based Organizations (FBOs), Network organizations and learning institutions that have a focus on health advocacy and or implementing health programs.
A trait common in both Tuberculosis (TB) and COVID-19 (Corona Virus) is the characteristic fast and easy spread in the absence of – or non-adherence to – strict prevention measures. Their highly communicable nature can easily overwhelm a health system with adverse fountain effects to normal life.
Over the last one month, most of the world’s crucial activities have wound down with some countries and cities completely ground to a halt following the exponential spread of COVID-19.
With the pandemic having grabbed total global attention, the World TB Day 2020 may pass unnoticed or receive very little attention if any.
The World TB Day is an important marker of the global TB response where countries take stock of their achievements, challenges, highlight plans and recommit, yet again, to ending TB.
If WTBD 2020 passes silently, as it may likely do with all the attention directed to COVID-19, we may miss a good chance to reflect on our proactiveness, and/or readiness to deal with such diseases.
Historically, most countries capitalize on March 24 (World TB Day) and the run up days to create awareness, galvanising political goodwill, setting targets and outlining goals in efforts to eliminating the menace.
Without overemphasizing on the attention given to COVID-19, it is almost unfair that the much older and more persistent TB has not drawn such immense response.
As a matter of fact, mortality due to TB, largely compounded by poor housing and living conditions in low income communities, has not triggered as much enthusiasm in addressing the squalid living conditions or the weak health systems and extremely limited political will, supplies and human resources to catapult preparedness as its younger counterpart COVID-19 has done.
Whereas this comparison may be criticised, the uniqueness in the COVID-19 response lifts the lid on our shortcomings in salient responses towards strengthening the fight against communicable diseases like TB.
First, it has managed to garner global attention and concerted efforts not just by leveraging great political good will across global leaders, but also has revolutionised research efforts globally, with scientists working round the clock to find relief / cure for this virus.
Secondly, it has reinvigorated philanthropy towards combating it as well as great citizen support for the cause.
Thirdly, there has been a remarkable breakthrough in technology and health systems strengthening. China set the pace with the construction of a state of the art quarantine facility in a record 10 days. I use the word quarantine emphatically given that its one of the biggest challenges we have in African health systems in the TB response, despite being an important structure in the TB management and control we still are lagging behind being in setting out this isolation facilities.
Fourth, the information flow through concerted global media efforts has been commendable. Citizens have had real time updates both from global and national media on the disease evolution, with messages on prevention, spread and who is vulnerable circulating every second. These efforts have gone a long way in spreading awareness and inspiring citizens to be cautions but also in underscoring the implications of their actions on the wellness of their communities. It is however worth mentioning that in this internet age, this period has also seen the fuelling of many untruths and stereotypes especially on social media, detrimental to the global efforts in the fight against the virus.
Fifth, there is a general increase in health seeking behaviour, citizen heath policing, an array of emergency health hotlines and greater communications on the preparedness of the health systems to offer services related to the COVID-19 response. In Kenya, there is an emergency 24 hour hotline for the COVID-19 response in all the 47 counties as well as a clear and continuous communication on the risk factors and what needs to be done. There are general community and health systems coordinated efforts in the response. Furthermore, government efforts on contact tracing have been commendable, a strategy that has been traditionally used in TB management albeit not with such thoroughness. The briefing on the death toll and the full understanding of the implications of the epidemic and our individual actions may have been instrumental in promoting citizen vigilance on the pandemic.
Back to TB. Drawing comparison with the COVID-19 response, TB claimed 1.5 million people in 2019, and there is an estimated 10 Million cases of TB per year while COVID-19 had claimed nearly 10,000 deaths as at March 20, 2020 and over 250,000 infections since it broke out according to WHO.
Further, for TB, a huge number of the new cases go undetected. This fuels fears that the WHO’s end TB strategy by 2020 may not be on track given that only a 6.3 percent drop compared to the 20 percent drop target in 2019 has been recorded. The death toll has fallen only by 11 percent compared to the 35 percent target.
WHO further points out that the fight against TB is chronically underfunded, hampering efforts to strengthen its combat.
Despite decades of ongoing advocacy for increased political good will to end TB, increased resources for TB, strengthening of the health systems to effectively address TB, and bold commitments such as those made at the + United Nation High Level Meeting, globally we are still far from ending TB.
Bearing in mind the devastating effects of TB and the catastrophic cost of addressing the disease, one wonders why we are yet to pronounce it as a global epidemic to garner more political goodwill and resources that are needed to make eradicating TB a reality. Sadly, most countries are yet to allocate adequate resources to curb the disease despite being signatories of the global commitments to end TB.
In Kenya, up to 40 percent of all TB cases are still missing (and potentially spreading the disease). TB literacy still remains very low with new or emerging guidelines in the TB management and control, rarely reaching the communities especially in comparison to the COVID – 19 information flow in the short time it has been here.
As we mark this rather quiet World TB Day, it is imperative that we truly introspect on what is needed to realistically address TB and what role each person should play to end it.
As economies take a beating with the World economic Forum, estimating COVID-19 to cost about $1 trillion and as nations turn to research and faith in effort to defeat this virus, we must remember that TB remains one of the leading communicable diseases, compounded by the evolution of the bacteria to more multi-drug resistant strains, and truly commit to ending TB for good, because every life matters.
References
As we mark the World Food Day 2019, in line with the Sustainable Development Goals (SDG) 2, that envisions zero hunger, under theme “Our actions are our future. Healthy diets for zero hunger’ we must remember that the future begins today, it is the little routine actions that amount to the great impact that we desire.
Globally the triple burden of malnutrition (undernutrition, micro-nutrient deficiency and Overweight/obesity) continues to bite, coupled with the rise of communicable diseases with nutritional implications that continue to be exacerbated by poor dietary habits. Further global reports indicate that hunger is on the rise and the absolute number of undernourished people continues to increase.[1]
Failing food systems that speak to the structures and mechanism of food production and access continue to suffice, Consultative Group for International Agricultural Research (CGIAR) 2019[2], forwards five related problems that continue to exert the failing systems including: Insufficient supply of food from agricultural production to feed the growing world population; Inefficient delivery of foods from farmers to consumers due to market logistical challenges that often lead to large losses and wastages during transport, handling and storage; Unequitable access to sufficiently healthy and diversified diets, due to highly segmented food markets: Unaffordable opportunities especially for the poor and Unsustainable food supply due to negative environmental impacts.
As these overarching systematic and process failures continue to pose challenges, solutions need to be sought: for example Information must be unpacked, from this big, large and sometimes abstract idea of ‘ending hunger’, to actual, simple and doable actions from the household, national and global levels to realise zero hunger. Hunger and nutrition related knowledge levels across the different stakeholders must be built to help wield a force toward the realization of this global vision.
Going forward we must see the smaller and the global pictures and establish deliberate and concerted efforts to improve the health outcomes at each level: For example, well-nourished mothers have healthier babies with stronger immune systems, and thus at the household maternal child nutrition must be prioritised, exclusive breastfeeding and optimal complimentary feeding must be emphasised.
The link between investment in nutrition and development need to be communicated clearly: Proper nutrition early in life could mean a 46% more in lifetime earnings, could save 3.1 million children per year, could increase a developing country’s GDP by 16.5 percent, ending nutrition related child mortality could increase a workforce by 9.4 percent and every dollar invested in hunger prevention has a return between USD15 and USD 139 in benefit[3]. In Kenya 53% of child deaths can be averted through investment in nutrition and 3.2 Trillion shillings saved in the next 20 years.[4] Specific actions at household level to global level to actualise this, must be relayed clearly.
Ending hunger must move from mere rhetoric to action, information must be broken down for every stakeholder to understand what they can do towards the cause. It must be owned from the household level, translate to policy and must wield political good will and resources to actualise it. Stakeholder’s coordination to end hunger must be strengthened, with the understanding that ending hunger is everybody’s responsibility.
By Wachira Charity
Communication
Officer
[1] Food and Agriculture Organization of the United Nations 2019: The State of Food Security and Nutrition
in the World 2019
[2] Consultative Group for International Agricultural Research, 2019-https://a4nh.cgiar.org/2019/02/01/repairing-food-systems-failures-policies-innovations-and-partnerships/
[3] Food and Agricultural Association: https://www.greeningtheblue.org/event/world-food-day
[4] Nutrition Profiles 2010
Depression is the most common illness worldwide. Kenya was ranked at position four in Africa with 1.9 million people who have the condition (WHO Report, 2014).According to the Kenya Mental Health Policy (2015-2030), mental disorder cases in Kenya continue to rise rapidly. Estimates point that 20-25 percent of outpatients seeking primary healthcare present symptoms of mental illness at any one time, while government statistics indicate that at least 1 in every 4 Kenyans suffer from a mental illness at one point in their lives.
In recent times, we are waking up to many shocking incidences ranging from people including school children committing suicide, others murdering their loved ones. Although not all these cases are attributed to depression and other mental related disorders, a good number have been confirmed to result from this. In almost equal stride, many people including prominent personalities have come out sharing their mental health challenges. Some have shared how despite having been top performers in their jobs, they abandoned their jobs or terminated due to non-performance arising from lost interest. Others turning to alcohol and substance abuse as others cut relationships with their close family members. Despite the doom and gloom associated with mental illness and those who have embraced it not only get well but set a precedent for others that the condition can be managed. .
Why Mental health Matters
The Kenya Mental Health Policy (2015-2030) states “Mental health is a key determinant of overall health and socio-economic development. It influences individual and community outcomes such as healthier lifestyles, better physical health, improved recovery from illness, fewer limitations in daily living, higher education attainment, greater productivity, employment and earnings, better relationships with adults and with children, more social cohesion and engagement and improved quality of life,”
Challenges facing Mental Health Management and Treatment in Kenya
Low Awareness: One of the biggest challenges is low awareness of mental disorders, particularly, the symptoms of this condition among the persons suffering from the condition and community at large. The fact that the symptoms affect emotions, thoughts and behaviors make it difficult to understand and accept. This has largely led to conformity of norms, where mental illness continue to be marred by myths and misconceptions including being a curse, witch craft, spiritual problem etc. instead of a disease that can be treated and managed if and when addressed appropriately. More often the affected person(s) resort to isolation and don’t seek medical help.
Cost and Management of treating mental illness in Kenya: In Kenya, mental health is underfunded and there is no separate budget for mental health. The country has approximately 100 psychiatrists for a population of 45 million (ratio 1:450,000). In addition, clinical psychologists and medical social workers who are central to the management and treatment of mental illness are very few. They are relatively inaccessible to the majority who need mental health services due to geographical distance as majority are based in the urban areas with high consultation fees. This forces most of those suffering to seek private treatment which is very costly and those who cannot afford are force to deal with their conditions themselves without professional assistance (WHO Mental Atlas, 2014). According to the Office of the Auditor-General (OAG), the referral system in place cannot work for provision on mental healthcare services since most of this staff are unavailable in almost all institutions in level 1 to 4 of the referral systems while others are thinly distributed between level 5 and 6 facilities. Mathari Hospital, is the only affordable public facility and the only public hospital in the country offering specialized psychiatric services and training.
Ongoing Mental Health Interventions in Kenya
The Kenya Mental Health Policy (2015-2030) provides a framework on interventions for securing mental health systems reforms in Kenya. This policy seeks to address the systemic challenges, emerging trends and mitigate the burden of mental health problems and disorders. It aims at ensuring people have access to comprehensive, integrated and high quality, promotive, preventive, curative and rehabilitative mental health care services at all levels of healthcare and strengthen mental health systems especially from the community level.
To realize the above and with the aim of bridging this human resource gap, Ministry of Health (MOH) – has been training community health volunteers (CHVs) on how to address common mental health problems so they can effectively offer assistance to people suffering from the same. The training focuses on a novel cost-effective method for treating common mental illnesses – such as depression, anxiety and chronic stress – known as Problem Management Plus (PM+) which has been approved by the World Health Organization (WHO). This is in the view that effective mental health interventions must be cognizant of the diversities in our environment. The WHO states ‘Presenting mental health care services in culturally-sensitive ways may be essential to increasing access to and usage of mental health care services, as local beliefs about mental health often differ from the Western biomedical perspective on mental illness. Before changing practices, evaluating the existing practices by mapping clinical outcomes is a helpful route. Governments should move away from large mental institutions and towards community health care, and integrate mental health care into primary health care and the general health care system.
In view of the above, it will be important for all health stakeholders to take up mental health as a serious health issue. They need to undertake intensive awareness campaigns on the condition, prevention, early symptoms and management and treatment services. The Government should also allocate more funding to mental health services and train health workers at all levels to manage and treat mental Health Challenges. At the community level, grassroots advocacy present both opportunity for empowerment towards demystifying stigma and influencing policy through ground up advocacy to effectively address the challenge.
References
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