When the Order of Malta began programmes in Nairobi in 2002, cases of tuberculosis had increased to alarming levels and it took almost a month for diagnosis following testing. There were only two locations in Nairobi carrying out the tests, and as the diagnosis requires a sputum sample on 3 consecutive mornings transport and work implications meant that testing was beyond the means of the average Kenyan.
The Order of Malta brought testing, diagnosis and treatment to the people by identifying 10 Ministry of Health clinics spread around the slums of Nairobi and equipped each of these with a tuberculosis laboratory and lab technician. This meant that test results could be given within 24 hours, and we were able to reach a catchment area of over 3 million people. All of the clinics are located in the poorest areas, making the service accessible to those most affected and in need.
The World Health Organisation (WHO) set benchmarks for TB control and the Order of Malta has met or exceeded these in all their clinics:
- TB treatment success rate of 95% (WHO benchmark – 85%)
- TB treatment case detection rate of 70% (WHO benchmark – 70%)
- TB cases tested for HIV is now 95% (WHO benchmark – 90%)
- TB treatment defaulter rate is less than 5%
The diagnosis and treatment, the training of local staff in the health centres, the set up of laboratories and the education of slum residents are all essential parts of the programme.
The Order of Malta puts special emphasis on continuous training and retraining of health care personnel. This work is very successful. In December 2007, the diagnosis and treatment centre in Riruta in the slums of Nairobi, won the national award as the best tuberculosis facility for the years 2006 and 2007.
From the outset it was understood that as soon as they were able the Ministry of Health would take over the running of the TB clinics, employing the staff and continuing the programmes. Initially it was hoped that this would take a couple of years, but has actually taken almost 10 years.
At the end of 2010 an agreement was reached between the Ministry of Health and the Order of Malta that all of the Malteser International supported Health Centres would be handed over to the Ministry of Health in the first half of 2011.
This includes all staff payments, running costs (stationary), services (X-rays, CD4 count, baseline, etc.), supplies (food, microscopes, etc.).
All of the Malteser International staff have the possibility to be taken over by Ministry of Health through an increase of permanent staffing that was issued recently by Ministry of Health.
The concern is that the Ministry of Health is not able to take over the Community Health Worker component at the moment. This is a worry on two fronts:
- 1. The Community Health Workers will be left unemployed
- 2. The success of the TB programme is under threat, as without the Community Health Worker component it will be very difficult to ensure the continued and successful treatment of the tuberculosis patients.
The key to the success of the tuberculosis programme has been the Community Health Workers. These are a team of 60 who live within the slum communities and provide home-based care to the patients. Several have been involved since 2002.
The primary role of a Community Health Worker is:
- Regular health education on TB/HIV in the community
- Referral of chronic coughers to the health clinics
- Medication defaulter tracing
- Contact tracing
- Home based care for very sick patients
- Nutrition support for very sick patients
- Linking project activities with other partners