March 6th, 2019
Joan Mutinda, Policy Advocacy
TB Crisis – The Facts
Tuberculosis (TB) is the world’s top infectious killer diseases today. According to World Health organization (WHO), TB is the ninth leading cause of death worldwide and the leading cause from a single infectious agent, ranking above HIV/AIDS. Over 25% of TB deaths occur in the African Region. Kenya is one of the 30 high burden countries that together account for more than 80% of the world’s TB cases. Kenya also faces a triple burden of HIV and TB, while TB remains the fourth highest cause of death among infectious diseases.
Key Challenges Facing The Fight Against Today
Multidrug – Resistant TB:
Although Kenya has made great strides in TB control, emergence of multidrug-resistant TB (MDR-TB) remains a big challenge in the country and poses a major health security threat and could risk gains made in the fight against TB. The effects are huge. According to the TB patient cost survey, which is in line with the World Health Organization (WHO) end TB strategy and the Universal Health Coverage (UHC), 62.5% of drug resistant TB (DR-TB) patients lost jobs due to TB. Some of these DR-TB patients have to go through the 6 to 8 months medication regime first before they start the drug resistant regime that runs for 20 months which is very costly. Patients with the DR-TB incur six times higher costs Ksh. 145,109.53 compared to drug sensitive TB (DS-TB) patients Ksh. 25,874.00 (Ministry of health, 2018). The case of Williamdemonstrates the impact TB is having on ordinary Kenyans and therefore validating the call : Its time to stop TB deaths
William is a TB survivor who had a long journey to be TB-free. William lost his wife from TB after she went through the 6 to 8 month TB treatment re- gime unfortunately she succumbed. After his wife’s death, he started having the same symptoms and he knew right away that he was suffering from TB. He too went through the 6 to 8 month TB treatment regime. William did not get any relief after the 8 months, his health kept deteriorating. He was re- ferred to a county hospital where he was tested with a GeneXpert machine which showed he had DR-TB. This time around he was put on medication for 20 months. The side effects were excruciating. After the 20 months, William fortunately tested negative for TB (Centre of health solutions- Kenya, 2018).
Inadequate testing facilities:
Only few government facilities have the GeneXpert machine and sometimes face shortages of cartridges which forces the health facilities to revert to microscopy testing (Oketch, 2018). William’s case demonstrates the need to have effective testing facilities in order to detect, initi- ate treatment and Stop TB Deaths!
Cost and management of TB:
Though TB drugs are free, patients still pay for examinations like X rays and scans. There is also still no clear policy on how to manage TB cas- es for treatment defaulters. The drugs may be free, but they have to be accompanied by a good diet-vitamin supplement (The standard, 2018). There are more William cases that do not have a happy ending as a huge proportion of people who suffer from TB are from below the poverty line and lack the means to do follow-up screenings and treatment.
In spite of the fact that funding has increased through the years, there is still a huge funding gap. Kenya relies on external funding to finance HIV, TB and malaria. An estimated Ksh 77 billion is accounted for by donors which amounts to 92% of the total need estimated at Ksh 84 bil- lion. At the end, the donors invest 1.3 times the total amount of the Ministry of Health budget. This constitutes 3.9% of the total national budg- et for the FY 2017/18. In 2014/15 financial year, the health allocation rose to 3.8 % from 3.17%, in 2014/15 and 2016/17 it rose to 4.1%. In 2017/18, the allocation fell to 3.9%. Overall, 8% of the budgetary need is not met in HIV and a 26% in TB (Muchangi, 2018).The government needs to add more funding for TB in order to be able to tackle this upcoming new challenges. TB can be fatal, fortunately it is a disease that has a cure.
Kenya signed Tuberculosis grants from global fund amounting to Ksh. 6.3 billion for January 2018-June 2021.The funds will support: Procure- ment of TB medicines ,equipment ,diagnostic supplies and therapeutic feeds; complement government efforts by putting about 338,550 new TB cases on treatment by 2021;provision of medicine to 1,890 drug resistance TB cases until June 2021;short term regimen for treatment of drug resistant TB cases and capacity building of facility/community health workers (National Tuberculosis, Leprosy and lung Disease program, 2019).
It‘s Time To Act- Stop TB Deaths
In addition to the ongoing initiatives above, the following action points could go a long way in stopping TB deaths:
- Scaling up prevention by addressing the congestion problem at community level and use CHWs to champion the agenda, put in place mechanisms to respond to the risks of the congestion in prisons and expand TB health education in schools
- Intensify awareness and Directly Observed Treatments (DOTs) to patients and their families/caregivers on the importance of taking drugs as prescribed and ensure 100% compliance in treatment (drugs) whereby CHWs can support in following up patients to reduce defaulter cases
- Enhance the capacity of service providers/health facilities to ensure early and effective testing with the right equipment to detect TB and drugs to treat all TB cases
- Increase domestic funding for TB both at the county an national levels
Its Time for a TB-Free Kenya– ACT Now!