Addressing TB and malaria

Healthcare workers in Kenya have reported a 70% decrease in the number of people coming to facilities for TB testing, and 50% of people living with TB have reported difficulties in getting to facilities. In Ethiopia, emerging data have shown that the COVID-19 pandemic has resulted in a 66% reduction in TB case detection in both Addis Ababa and Dere Dawa City.

The programme aims to sustainably strengthen health systems in both countries. It will run for 20 months in Kenya (in six counties: Bungoma, Busia, Kakamega; Siaya, Homabay and Migori) and 12 months in Ethiopia (in 25 woredas across two regions, Afar and Somali), where it will build on an existing initiative. The programme will take a diagonal approach, addressing challenges at all levels of each country’s health systems: building the capacity of frontline health workers and health managers, enhancing community health systems strengthening, and strengthening TB and malaria surveillance to inform decision-making.

Our Impact in Kenya

In the first year of the programme:

• Start-up activities included a co-creation workshop, county project launches and an online event hosted by Devex, as well as a baseline assessment.
• The baseline findings were presented at a nursing conference in Tanzania.
• TB and malaria curricula content was revised and adapted for digital training. This was used to provide refresher training for 82 ToTs, train 360 healthcare workers (HCWs) and conduct continuing medical education (CMEs) for 1,816 HCWs.
• At county level, to support leadership and governance of management teams, 327 people were trained in leadership, management, and governance (LMG), 80 people on effective commodity management, and supported annual performance reviews for TB/malaria indicators. The project also supported the development of a Human Resources for Health (HRH) strategic plan in Homabay County and a Community Health Services (CHS) policy in Kakamega county.
• At community level, 120 health facilities and 96 Community Health Units received supportive supervision.
• A total of 1,199 community health volunteers (CHVs) enrolled onto digital malaria case management training and 129 community health extension workers (CHEWs) were trained on areas related to improving community participation.
• An awareness raising event was held on World Mosquito Day in Homabay County.
• To improve data for decision-making, a data quality audit (DQA) was carried out in Busia County, 18 ToTs were trained on data analytics, and CHV data reporting tools were digitised.

Our Impact in Ethiopia

Note: The conflict in Ethiopia has had an impact on 13 Amref-run projects across the Afar and Amhara Regions, both of which border Tigray. An estimated 2.2 million people living in Afar and Amhara have been affected by the conflict. 1,500 health facilities are non-functional due to destruction and looting, and many health professionals have been displaced, resulting in a significant disruption to services. Amref’s priorities are to ensure continuity of service delivery where possible and to support Public Health Emergency Management efforts as the situation evolves.

Despite these challenges, in 2021:

• The project commenced with Ministry of Health (MoH) registration and launch events in the two regions.
• 201 health workers were trained in malaria and 120 health workers received advanced TB training.
• A total of 120 health facility managers were trained as ToTs on Primary Health Care clinical guidelines, which is being cascaded to health facilities.
• 88 lab technicians were trained on lab quality management systems, 55 health facilities participated in External Quality Assurance (EQA) and 101 community health posts participated in on-site assessments for malaria rapid diagnostic tests (RDTs).
• At community level, mobile van TB services screened 311 people in Afar and 134 community volunteers were orientated in Somali on community-based activities in order to mobilise their respective communities.
• Finally, operations research was conducted in Somali to allow lessons to be drawn from integrating disease-specific activities into maternal and child health services.