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 organisational 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%.[30]
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 six year 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 five 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 five year
grant with the Stop TB Partnership that saw 4 million pounds go
into global TB control (2008-11).
9. In addition to these recent commitments,
the UK Government has made a long-term commitment of £1 billion
(2007-15) to the Global Fund to fight AIDS, Tuberculosis and Malaria
and a 20-year commitment to the international drugs purchase facility
UNITAID (2006-26), 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 prioritisation
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 prioritise 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.
30 Kenya AIDS Indicator Survey (KAIS) preliminary report
2007. Back
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