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History of tuberculosis and leprosy control in Kenya

Until the Second World War services for leprosy patients mainly consisted of small "leper settlements", in Malindi, Lamu, Kakamega and Tumbe.

Systematic control work started in 1948 with the introduction of dapsone monotherapy. Between 1951 and 1957 a large leprosarium for 300 patients was built at Alupe in Busia district, Western Province .

In the early seventies a number of leprosy control projects were initiated by the GoK with the assistance of the Netherlands Leprosy Relief Association (NSL/NLRA), i.e. the West Kenya Leprosy Control scheme, the Meru and Kitui Leprosy projects and the Coast Leprosy Control scheme. These projects were brought together in the National Leprosy Programme (NLP) in 1976 and subsequently absorbed by the NLTP, which was launched by the GoK in 1980 to combine and integrate leprosy and tuberculosis control activities in the health services.

The first project agreement between the GoK and NSL/NLRA regarding the NLTP covered the period 1980-1985 and aimed at the establish­ment of a leprosy and tuberculosis control programme nation-wide by training of staff, health educa­tion to the public, provision of transport and development of a system of supervision.

After an extension of two years, in which the programme was con­solidated, this agreement was followed by a second agreement between the GoK and the NSL/NLRA covering the period 1987 to 1990.

The most important objective of this project agreement was to have achieved by the end of the project period full coverage of the multi drug therapy (MDT) regimen for leprosy, as recommended by the World Health Organization (WHO), for all leprosy patients in four provinces where leprosy was still endemic. This objective was attained satis­factorily by the end of the period.

Tuberculosis control in Kenya started in 1956 with the initiation of the National Tuberculosis control Programme (NTP). By the MoH circular "Control of Tuberculosis", issued in November 1973, procedures of diagnosis, chemotherapy, case-holding, bacteriological monitoring and recording and reporting to be implemented in all districts of Kenya were indicated.

In 1986 an agreement was signed between the GoK, the GoN, the KNCV and the Netherlands Development Organization regarding the control of tuberculosis among the nomadic population of Kenya for the period 1987-1991. This included the implementation of SCC treatment of tuberculo­sis and the construction of small villages for accommodation for the nomadic patients known as, "Tuberculosis manyatta project for Kenyan nomads". The rest of the country continued to use standard regimen for TB treatment until 1991, when the GoK and GoN signed another agreement for the period 1992-1995 for TB control which was to include introduction of SCC for the non-nomadic patients. KNCV/NSL were contracted by the Ministry of Foreign Affairs and Development Co-operation of the Netherlands to assist and advise the Ministry of Health, Kenya regarding the implementation plan as per the agreement, as well as to take care of the administration of the inputs from the GoN.

An end-term evaluation of this project was carried out in March 1995; recommendations were made for continued support to the GoK by the Netherlands government for another five years. This was done and more funding was given for the period 1996-2000. Short course chemotherapy (SCC) was started in 1993 for smear positive PTB patients and covered the whole country in 1997.

The funding agreement between the Netherlands and Government of Kenya (GoK) ended on 31 st December 2000, with flow of funds ceasing on the 30 th June 2001 . Since 2002 the NLTP has continued to undertake its activities with financial support from other donors such as CDC/Global AIDS Programme (GAP), WRP and USAID (initially through the United States Government LIFE initiative, later continued under PEPFAR), CIDA, the Italian Government, WHO and the Global Fund to fight AIDS, TB and Malaria (GFATM).

Structure of the DLTLD

The DLTLD is one of the disease control programmes of the Kenyan Ministry of Public Health and Sanitation. It is a Division which falls under the Department of Preventive and Promotive Services in the MoPHS. The DLTLD has its technical representatives at provincial and district levels where they are responsible for the implementation of the programme activities down to the level of the peripheral health units and community based health care initiatives. Although the programme is often called vertical, it is fully integrated in the primary health care system where TB suspects are selected, diagnosed and treated by peripheral health care workers under supervision of DLTLD technical staff. In 2009 TB and leprosy treatment was delivered through 2,318 health units managed by the Ministries of Health (Ministry of Public Health and Sanitation and Ministry of Medical Services (and other Ministries), NGO/FBO health units and private institutions. Smear microscopy services were available at 1,030 of these health units.