Mr Gitonga Ndii, outside his Kathathani medical centre located at Kathathani Market, Chuka Sub County, Tharaka Nithi County. The clinic is part of the Tunza family health network, a franchise of more than 400 private health providers across the country supported by PS Kenya, a sub-awardee of the USAID funded Tuberculosis Accelerated Response and Care activity (TB ARC II) implemented by Centre for Health Solutions – Kenya to offer TB services.
On April 18, 2019, Mr Gitonga Ndii is seated attentively in one of the West Wind Hotel’s conference room in Meru. Mr Gitonga is the proprietor and nurse-in-charge at Kathathani Medical Centre, Kathathani Market, Chuka Sub County, Tharaka Nithi County. The clinic is part of the Tunza family health network, a franchise of more than 400 private health providers across the country supported by PS Kenya, a sub-awardee of the USAID funded Tuberculosis Accelerated Response and Care activity (TB ARC II) implemented by Centre for Health Solutions – Kenya (CHS). Tunza’s main objective is to enable private providers to offer friendly, quick and affordable quality services to the community.
It’s the fourth day of an integrated tuberculosis (TB) curriculum training and Mr Gitonga is eager to put into practice the knowledge gained from the training. Kathathani Medical Centre has been in operational for the last 10 years offering services on maternal and child welfare, family planning, laboratory, cervical cancer, among other. However, his facility did not offer TB services, he says, “I was not confident to talk about TB to my clients with the little knowledge I had on TB from my college study. This is the first training I have attended on TB since I left college many years ago, I actually thought TB is a non-issue hence paid little attention to it.”
TB remains a global threat to public health and is the leading cause of death (1.6 million deaths in 2017) by a single infectious agent. It is estimated that 10 million people developed TB disease in 2017 but only 6.4 million (61%) sought care. The ‘missing’ millions make up the majority of the 1.6 million people who died from TB in 2017 due to lack of care. (World Health Organisation, Global tuberculosis report 2018).
Kenya is among the WHO high TB burden countries.
Why private sector?
According to the Kenya Tuberculosis Prevalence Survey, 2016, 16% of participants who had respiratory symptoms, sought prior care from private providers. The Patient Pathway Survey analysis showed that 42% of people presumed to have TB sought initial care at the private sector (formal and informal). Despite the above figures, private health facilities only contribute 15% TB case notifications.
Lack of knowledge and capacity for TB diagnostic, weak and ill-defined referrals networks leading to lost opportunities, and delay and poor documentation are some of the barriers to private sector contribution to TB service provision.
To promote tuberculosis service provision by private health providers and linkages with the public sector to find the missing cases, PS Kenya with support from TB ARC II is currently implementing TB services in private facilities through the Tunza network. 65 Tunza facilities from priority counties of Nairobi, Mombasa, Kisumu, Nakuru, Meru, Embu, Tharaka Nithi and Isiolo underwent a five-day integrated TB curriculum training. The training was conducted by the National TB Program and the respective county TB, leprosy and lung disease teams. It involved the use of power point presentations, interactive learning, discussions and demonstrations.
By the end of the training, Mr Gitonga and other providers could comfortably describe the components of active case finding; laboratory methods used in the diagnosis and control of TB and leprosy; the preferred treatment regimen for all forms of TB, leprosy and other lung diseases; describe TB treatment adherence strategies as well as list adverse reactions to drugs used to treat TB disease; infection prevention, control, advocacy and communication; commodity management, nutrition, monitoring and evaluation among others.
Training output
During a follow-up visit to Kathathani Medical Centre two months after the training, we met an elated Mr Gitonga attending to his clients. His first words to us were, “TB services are now available here; I have sensitised all the staff on TB screening, and we are now empowered to offer TB services.”
“I initiated TB service provision immediately after the TB training. The county team has been very supportive. I received presumptive register and sputum collection tools and I am linked to Chuka Level 5 Hospital for GeneXpert services”, he continued as he showed us his tools of trade.
After participating in the integrated TB training, he saw that there was a need for TB services and was motivated and equipped to offer TB services. He uses his own resources to transport sputum samples and collect results. The facility also receives TB drugs on behalf of clients on treatment hence has TB4 register.
The knowledge gained from the training is helping Mr Gitonga to confidently educate his community about TB during barazas and church meetings. His vision is to see Kathathani Medical Centre upgraded to a diagnosis and treatment site to increase access of TB services. He recommends support for outreach activities in the community to actively seek out missing cases.
Capacity building, continuous mentorship and support supervision and access to TB commodities is a motivation and builds self-efficacy among private providers to engage in finding the missing TB cases.