Written evidence submitted by KANCO (The Kenyan AIDS NGOs Consortium)

About KANCO

1. Established in 1990, KANCO is a national network of NGOs, CBOs and Faith Based Organisations, the Private Sector, Research and Learning Institutions involved in HIV/AIDS and TB work in Kenya. KANCO is also the Linking Organisation to the International HIV/AIDS Alliance ( UK) in Kenya.

2. We have stated our vision to be a Kenyan society free of HIV & AIDS and TB. Our mission is to provide leadership, promote collaboration and enhance capacity among CSOs and other stakeholders to respond to HIV & AIDS and TB at the community level.

3. Our core values are;

· Integrity - We value truthfulness, fairness, honesty and transparency in our internal and external relationships, communication and transactions.

· Excellence - We value professionalism and timeliness, and seek credibility in all that we do. We are committed to the highest professional standards

· Collaboration - We value the collective wisdom that emerges when individuals work together as a team

· Innovation - We value and support innovation.  We encourage informed risk-taking that holds the promise of enhancing organizational learning

4. More information is available here: http://www.kanco.org/FW266/html/Index.html

DFID commitment to HIV/AIDS TB and Malaria programs in Kenya

1. Kenya is experiencing an increase in HIV prevalence with more than 1.4 million Kenyans living with HIV/AIDS and a national prevalence of 7.4%[1]. This translates to an increase in the number of people in need of treatment, care and support, and subsequently an increase in the number of OVCs. The TBHIV co-infection rate is currently estimated at 50-60%. Although TB continues to be the leading killer of people living with HIV in the country, it is yet to implement screening of PLHA for TB country wide as a way of enhancing TB support to PLHIV. TB case notification rate stands at 329 per 100 000 having risen from 54 per 100 000 in 1991. This signifies a six fold increase in the past 15 years. To get out of the HBC bracket the case notification rate needs to come down to less than 300 per 100 000 cases.

2. The World Health Organisation (WHO) estimates that only 80 % of the TB cases are detected in Kenya indicating that the rest 20% continue to transmit TB. Though Kenya has been acknowledged for achieving the WHO's target (85% treatment success rate, case detection rate 80%), much still needs to be done to reduce the rising incidence of TB in Kenya. Kenya's efforts in addressing TB have also been hampered further by the emergency of the Multi drug Resistant TB which is not only difficult to treat, but also expensive to manage. This thus requires extraordinary measures, in order not to negate the progress made in the fight against both TB and HIV. The first case of the Extensive Drug resistant TB (XDR-TB) has been reported in the country. Over 500 MDR-TB cases are recorded but the figures could be more. One way to achieve this is to ensure more bilateral and multi lateral support to TB and TBHIV programs.

3. The response to the two epidemics in Kenya is highly dependent on bilateral and multi lateral support. These include the PEPFAR, USAID GFATM and DFID. DFID does not provide general budget support to Kenya. Instead its funds are managed by financial management agents or through special government accounts, or are provided direct to civil society. Currently around 50% of DFID aid is allocated to health and HIV/AIDS , focusing on health systems, malaria, reproductive health and strengthening the delivery of essential health services.

4. By March 2009 DFID gave 59 million to run for over six years targeting malaria control. Additional DFID support is contributing to the roll-out of new anti-malarial combination therapies, improving the response to epidemics, and to the funding of net retreatment and communication programmes.

5. For HIV/AIDS, DFID gave a $10 million per year for a 6 years program which has concentrated on prevention and orphan support. Prevention activities have focused on high risk groups such as fishing communities and young adults, using innovative behaviour change interventions. To prevent new infection, DFID funded the social marketing of condoms since 2003, with the aim of distributing 172 million condoms by the end of 2009.

6. Funds that have benefited the civil society projects from DFID include: support to development of home-based care and HIV counseling and testing guidelines adopted nationally, access to home-based care, HIV testing and supporting to Post-rape counseling policy development. DFID also support ARV programs and with its support, 161,000 people had been provided with anti-retroviral drugs by March 2008.

7. More funds amounting to $40 million on HIV/AIDS programs to support the Total War against Aids (TOWA program) over a 5 year period were approved in April 2008. This fund was co-funded with the World Bank.

8. In 2008 after the Global leaders forum, the UK Government supported the principles in the "Call for Action on HIV/TB", including the need to scale-up efforts to deliver universal access to TB and HIV prevention, treatment, care and support services by 2015; the need to strengthen health systems and services; the integration of health services, including HIV and TB; and to increase investment and facilitate research to promote the development of better tools for prevention, diagnosis and treatment of TB. Later in the year DFID signed a 5 year grant with the Stop TB Partnership that saw 4 million pounds go into global TB control (2008- 2011) .

9. In addition to these recent commitments, the UK Government has made a long-term commitment of £1 billion (2007-2015) to the Global Fund to fight AIDS, Tuberculosis and Malaria and a 20-year commitment to the international drugs purchase facility UNITAID (2006-2026), which is helping to increase access to and affordability of HIV and TB drugs. Despite the global recognition of the growing TB and TBHIV burden, further actions are required at country level through DFID offices.

10. It is however worth noting that DFID does not have direct support for TB programs in Kenya. Reports from DFID Kenya indicate that DFID supports general Health Systems Strengthening in various national health sectors through Health systems strengthening initiatives. For example the National TB program benefited from $ 206 700 of the DFID funding in 2008 which supported budgets like the human resources, Health Management Information System and other related expenses. Despite this support, the National TB program still reports a funding gap in the national TB response. The lack of direct funding to TB initiatives makes it difficult to assess the direct impact of DFID's support to the TB situation in the country. There is however a proposal for integration of TB into their health programs due for discussions in November 2009. This however will largely depend on DFID's prioritization and the eventual approval of the same.

11. It is increasingly becoming clear that though DFID's is committed to "Achieving Universal Access", by investing £6 billion over seven years to 2015 to strengthen health systems and services, including the integration of HIV and TB services. Countries like Kenya with high TBHIV co-infection need to be supported more to achieve both universal acccess and MDG targets. This thus necessitates the need for DFID to translate global leadrship on TB into country support it is also important to note that effective HIV/AIDS programming that is likely to have real impact cannot fail to focus on the close existing interaction between HIV and TB. More targeted funding to focus on the TB initiatives will greatly impact on the war against HIV/AIDS. In this respect the civil society appeals to DFID to diversify its support and integrate specific TB and TB-HIV related interventions in its supported health programs as they greatly support health systems.

RECOMMENDATIONS:

- DFID should prioritize the integration of TB to the health programs, to be discussed November 2009

- Integrate specific TB and HIV interventions within Health System Strengthening in Kenya

- DFID should continue to increase support for HIV and HIV-TB services in Kenya.

 

 

 

 

 

 

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1. Kenya AIDS Indicator Survey ( KAIS) preliminary report 2007