The TB Program was established in 1980, with specialized staff at national, provincial and district level. The role of these staff was to provide technical guidance and supervision of TB and leprosy control activities. Then as now, TB diagnostic and treatment services were delivered within the primary health-care system, at hospital, health centre and dispensary level; services were available free-of-charge in all government facilities. The main health sector reform that affected TB control during this period was decentralization of responsibility for providing health services to the district level in 1983, through a strategy called ‘District Focus for Rural Development (DFRD)’. Decentralization was accompanied by intensive training and orientation of district-level personnel.
1999 – 2004:
Kenya’s first National Health Strategic Plan (NHSP) was developed in the late 1990s, for the period 1999-2004. During this time, major health sector reforms, principally focusing on decentralization and an essential health package, occurred. The TB Program was actively involved in these reforms, as a member of the secretariat of the national health sector reform team. The main developments relevant to TB included:
- Procurement and distribution of drugs and supplies were decentralized to the district level. However, antituberculosis drugs and vaccines were identified as priority public health goods for which procurement and distribution would remain at central-level.
- The TB Program altered its planning processes, to adapt to decentralization. Planning of TB control activities was integrated in district and provincial-level planning, to ensure that TB control activities were planned as part of a district’s overall activities, and that TB was a priority health concern at local level. The central unit made major efforts to ensure that district TB and leprosy coordinators were involved in planning.
- TB diagnosis and treatment services were expanded to a broader range of health facilities. With an ever-expanding network of laboratories, the number of facilities where smear microscopy services were available reached 776 by 2006. Microscopes purchased and provided by the TB Program helped to strengthen other diagnostic services at health centre and dispensary level, and also contributed to an increase in TB notification.
- The TB Program contributed to human resource development, building on the decentralization process. District TB coordinators were trained annually, and in turn provided training to local health-care workers.
- All faith-based hospitals and clinics were supplied with free anti-tuberculosis drugs and laboratory reagents through the central unit.
- Private sector involvement in TB control was initiated in collaboration with the Kenyan Association for the Prevention of TB and Lung Disease (KAPTLD). Antituberculosis drugs and laboratory supplies were provided to private sector providers collaborating with the TB Program, so that diagnosis and drugs could be provided to patients being treated by these providers free-of-charge. This initiative was particularly important in the context of an increasing trend for TB patients seeking care in the private sector.
The second National Health Strategic Plan (2006–2010) emphasized the importance of local ownership and community involvement in health care, with the establishment of District Health Management Boards (DHMBs) that included community representatives. In line with the second NHSP the TB Program strategic plan (2006–2010) stressed the need to strengthen the infrastructure and human resources for health. Priorities included improving outreaches into urban slums and other hard-to-reach places, rolling out TB/HIV collaborative activities throughout the country, advocating for adequate funding, involving communities, creating and nurturing public–private sector partnership for improved case detection, holding and reporting. In 2007, the Ministry of Health raised the status of the TB Program in the ministerial structure from programme to divisional level by creating the Division of Leprosy, TB and Lung Disease. Financing of the Kenya Essential Package of Health (KEPH) proposed in the NHSP was expected to be provided by the Government of Kenya, the private sector, grants from developmental partners, the Global Fund and a national social health insurance fund. The plan envisaged a phased introduction of a national social health insurance fund that was to give universal free health care to all Kenyans. Funding for health from the Government of Kenya was expected to rise from 5.6% to 12% of GDP by 2010.
In 2011, the program transitioned from paper-based to electronic (TIBU) reporting , this made reporting easier and real-time to the national level .
The Division name changed to National Leprosy, Tuberculosis and Lung Disease Program (NTLD-P). The Program conformed to the new constitution which led to devolution of Health services resulting in delivery of TB control activities in the 47 counties. With advent of devolution, the DTLCs and PTLCs were faced out. Sub county and County TB and Leprosy coordinators (S/CTLCs) were appointed to control TB activities within the county.
In 2015-2016, the program conducted first ever post independence TB prevalence survey which denoted that we were missing approximately 40% of persons with TB. From the finding of the survey, the program embraced active case finding (ACF) initiatives.
2019 to date
In 2019, the Ministry of Health launched a targeted and prioritized National Strategic Plan (NSP) for Tuberculosis, Leprosy and Lung Diseases (2019 – 2023). The NSP lays out the strategic and technical direction for the elimination of TB and leprosy nationally acknowledging funding gaps and presenting evidence-based optimisation of resource allocation alongside alternative impact targets given reduced funding scenarios.
The country successfully submitted Funding Request (Global Fund) for the period July 2021 – June 2024. This grant is implemented through two principal recipients; the State (National Treasury) and Non state (AMREF Health Africa).