Aligning TB Control Activities to Devolved System of Governance in Kenya A Wairia 1 , J Njenga 1 , E Masini 2 , F Ngari 2 , B Mungai1, M Maina 3 Correspondence: [email protected] 1 Centre for Health Solutions- Kenya (CHS); 2 National TB, Leprosy and Lung Disease Program, Ministry of Health, Kenya 3 United states Agency for International Development - Kenya Key words: Devolution, co-ordination, counties, TB control, clusters • Kenya adopted a new constitution in 2013 • As a result, all aspects of health care services including TB control activities were devolved to the 47 newly created semi-autonomous counties • One of the consequences of devolution in TB control in Kenya was lack of coordination of control activities leading to severe shortage of TB drugs experienced in 2014 • During that year, neither the counties nor the national government budgeted for procurement of the drugs • The country was forced to get drugs from Malawi • To ensure proper coordination of TB control activities under devolved system, there was need for the national TB control program to realign with the system Background Methods • Efforts made by NTLD-Program to align TB control to the devolved system have borne fruits. • There is clear coordination of service delivery and little disruption of services • NTLD-Program has continued to engage county leaders on matters related to TB control • All counties have agreed all TB commodities to be procured centrally and distributed through KEMSA • Both levels of government agreed to work together in: o Joint strategic planning o Resource mobilization o Joint monitoring and evaluation o Provision of targeted high impact interventions o Targeted capacity building of county health teams by national government • The NTLD-Program also continuously engaged the counties to ensure deployment of qualified officers as county and sub county TB coordinators • Electronic surveillance system was modified to be able to provide data both at the national and county levels • County pharmacists, initially not playing major role in TB control, were brought on board through sensitisation and engagement in all management of TB commodities Conclusion • In 2014, two consultative meetings were held between National TB, Leprosy and Lung Disease Program (NTLD- Program) and County Health Managers from all the 47 counties County Health Directors and County TB Coordinators at the Consensus Building Meeting in Nairobi, 2014 Quarterly meetings Developed and printed with the support of the United States Agency for International Development (USAID) through the Tuberculosis Accelerated Response and Care (TB ARC) Activity Centre for Health Solutions - Kenya, Kasuku Road off Lenana Road, CVS Building, 4 th floor, North Wing P. O. Box 23248 - 00100, Nairobi, Kenya Tel: +254 (0) 271 0077 www.chskenya.org Results • As at February 2016, all the 47 counties had appointed County TB and Leprosy Coordinators (CTLCs) • Number of TB control zone coordinators rose from 257 in 2013 to current 289 • Counties have been organized into 17 clusters for ease of coordination and facilitation of quarterly data review meetings based on county proximity to each other and similarities in TB burden • Each of the 17 clusters have held independently 8 quarterly meetings with technical assistance from NTLD- Program • NTLD-Program has conducted 4 technical assistance missions jointly with county health officials • Two data quality assessment missions • Counties have access to their specific TB data • Few counties have set aside money for TB control activities in their annual budgets • However, there are still aspects that counties need to take up including facilitating sub county coordinators to conduct routine support supervision, provision of tools, and support of the electronic surveillance system Quarterly meetings