21 Aug Kenya: National Tuberculosis Program scales up Active Case Finding approach to entire country
[vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_separator type=”normal” thickness=”2″ up=”20″ down=”20″][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” use_row_as_full_screen_section=”no” type=”full_width” angled_section=”no” text_align=”left” background_image_as_pattern=”without_pattern”][vc_column][vc_gallery type=”nivo” interval=”3″ images=”2082,2081,2083″ img_size=”full”][vc_column_text]The National Tuberculosis Leprosy and Lung Disease Program (NTLD-P) in Kenya is scaling up Facility Based Active Case Finding (FB-ACF) as part of its efforts to find the missing people with TB. This approach consists of a systematic screening for TB among all patients presenting to health facilities regardless of whether they present withTB symptoms or not.
The main aim is to ensure early TB diagnosis, as previous literature has shown that there are various leakages in the care cascade ranging from low index of suspicion among Health Care Workers, inadequate leadership at the facility level, weak linkages, and low priority of sputum processing, amongst others. FB-ACF seeks to compensate on these shortcomings and maximize on the care cascade.
This case finding approach was initially implemented in a phased approach whereby only 1 referral hospital was targeted in 13 counties, which were a mix of low, medium and high TB burden areas. Now the aim is to scale it up to the entire country, using a three-pronged approach.
The first part is the sensitization of County Health Management Teams (CHMTs) on FB-ACF. CHMTs lead health-related matters in each of their respective counties and are therefore important gatekeepers. Obtaining their collaboration and active participation is crucial to ensure the sustainability of the project; they can make a big difference by incorporating key TB symptoms to look for during their routine supervisions.
The second part is to sensitize sub county Trainers of Trainers (TOTs). The NTLD program focused on obtaining a pool of trainers at the sub county level who had intimate knowledge of the facilities in their jurisdiction. A total of 5 people with a unique skill mix (managerial, patient management, record keeping) were targeted per sub-county and sensitized on FB-ACF in order to reach high volume facilities under them. The current focus as supported by the budget is on two high volume facilities per sub-county, although with support from other local implementing partners more facilities could be sensitized.
Finally, the facility level sensitization consists of sub-county TOTs visiting high volume facilities to sensitize them on FB-ACF. This is normally held in the form of Continuous Medical Education and/or departmental meetings in each facility. The information then percolates to a wider number of Health Care Workers who are responsible for screening patients for TB across various service delivery points.
Results from phase 1 of FB-ACF implementation showed that the highest impact departments were Maternal Child Health, Out-patient and In-patient departments. For the scale up of the approach, priority will be given to these departments in facilities where resources are constrained or where the recording and reporting tools are not adequate.
Facility Based Active Case Finding has contributed to an increased case notification with commendable results obtained from the 13 counties in the initial phase. Furthermore, case notification for drug-susceptible TB and drug-resistant TB has been on the increase for the first two quarters of 2018 in comparison to the same period in 2017.
For the current and next quarters of 2018, there will be continued emphasis on sensitizing Health Care Workers on FB-ACF since they represent the first point of contact with patients visiting health facilities. As resources become available, the number of facilities to be incorporated in the FB-ACF approach will progressively increase.
In order for the scale up to be successful, lessons and insights will be shared with all people involved. That is why in the next 2 months the country will hold the second FB-ACF Experience Sharing Forum where representatives from across the 47 counties will share their FB-ACF journey and learn from their peers. The first FB-ACF Experience Sharing Forum was fruitfully held in November of 2017.
Upcoming innovative approaches in finding People with TB in Kenya
In the near future, NTLD-P plans to implement 3 case finding approaches:
The first approach is Kenya Innovation Challenge TB Fund (KIC-TB): an exceptional opportunity for organizations/groups working with communities in Kenya to show how innovative and impactful they can be in the national fight against TB. Emphasis is on finding missing people with TB using innovative strategies that are specific to issues identified in local settings. This strategy will complement the country’s efforts to motivate and engage other key stakeholders to find the missing people with TB in the community.
The second approach is Pay for Performance. Health facilities diagnosing and managing TB patients will be reimbursed for each additional TB case notified at a predetermined rate. In addition, the health facilities will be rewarded for adherence to the national standards and protocols for TB prevention and care. This amount is expected to offset some of the direct costs incurred by the health facility in relation to use of x-ray, laboratory and personnel efforts.
The third approach is Public Private Mix. It remains critical to engage all relevant health care providers in order to find the missing people and address quality of care for TB patients. This approach will target small stand-alone formal and informal health providers, including chemists/pharmacies, drug stores, private clinics, radiology clinics, NGO clinics, parastatal/institution clinics, company clinics, mission dispensaries and standalone laboratories.
The concept notes for these 3 strategies have been developed and shared with the Global Fund for review and approval. Needs for technical assistance have been identified and a local consultant will be hired to support their implementation.[/vc_column_text][/vc_column][/vc_row]