Kenya is a country with a high tuberculosis (TB) burden: it is currently ranked fourth in Africa of countries with high TB incidences, only behind South Africa, Nigeria, and Ethiopia. In addition to this, the TB/HIV co-infection rate stands at 40%.

Early in 2014, Kenya reported a looming shortage of TB drugs, resulting from a lack of funding allocation for first-line TB drugs in fiscal year 2013/2014. As a result of this gap, the country used up all of the buffer TB stocks of first-line TB drugs, and by March there was an absolute stock-out of some of the drugs (like streptomycin, a key antibiotic used in TB treatments), while there was only a few months’ worth of stock of the rest of the drugs. As a short-term measure, the Government borrowed first-line TB drugs from Malawi.

The Ministry of Health also put a request in the supplementary budget of 2014, but the allocation was devolved to the districts with no guidelines on what to prioritise. The districts ended up utilising the funds for other needs and never prioritised purchasing TB drugs.

joyceAt the same time, the Ministry of Health reached out to the Global Drug Facility (GDF) for support in procuring one year’s supply of drugs to address the situation.  The GDF promised to procure for the country half of one year’s supply on the condition that the Government would put in the first half of the required amount (350 million Kenyan Shillings, roughly £2.5 million) to demonstrate its commitment to this course. The total amount required for one year’s supply is just short of £5 million.

With this kind of situation, if nothing was done urgently, the country was going to face an increase in new TB cases as those carrying the infection would not have been able to receive proper treatment and could thereby pass on the disease. There was also likely to be an increase in cases of  Multi-Drug Resistant (MDR) TB  due to a lack of adherence to the prescribed course of medication.

In response to this situation, KANCO adopted the responsibility of advocacy to ensure there was allocation and procurement of TB drugs across Kenya. Various advocacy strategies were employed, including:

  1. Petition letters: KANCO led other Civil Society Organisations (CSOs) in drafting petition letters to relevant Members of Parliament. Unfortunately, there was not a single response from Parliament.
  2. One-on-one meetings with MPs: KANCO again held several one-to-one meetings with MPs using the RESULTS model of advocacy. The outcome was a lengthy discussion in Parliament about the status of the TB drug stock out. However, once again no immediate action resulted from this.
  3. Letters from the infected and affected communities: The RESULTS model of advocacy was then employed, in this instance to mobilise affected communities to write letters to their MPs. One MP called back to ask for details, but the action did not result in any further intervention.
  4. Traditional and social media: Seeing that the problem was still persistent, KANCO held a press briefing with about 20 media outlets present. At the same time, a hashtag was developed and grassroots campaigners were encouraged to take to Twitter, tagging all the leaders, MPs and others whose handles were known. One MP picked up the tweets and responded with an expression of interest in taking on this issue. She provided her email and asked to be furnished with all the details of the stock out. She was emailed the detailed account of the situation and the efforts that had been put to try and address it. In response, this MP held a press conference charging the Parliamentary Health Committee to address the issue.

These advocacy actions finally resulted in success for KANCO, grassroots campaigners, and the Kenyan population. Within just a few weeks  the Government announced a £2 million allocation for TB drugs. Persistent advocacy and widespread support facilitated through social media meant that political will was fostered to combat the TB drug shortage, saving lives and improving the health of Kenya. Naturally there is still much work to do – the remainder of the money needs to be sourced, and a longer term commitment needs to be made. But this persistent action by civil society has now ensured that the issue is high on the agenda of legislators.

Article adapted from a Case Study presented by Joyce Matogo of KANCO Kenya.

 KANCO is a partner of RESULTS UK, the two organisations collaborate, with others, in the ACTION Global Health Partnership. 

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