World Health Organisation lists Kenya among the 30 high TB burden countries globally. According to the Kenya TB Prevalence Survey 2016 findings, Kenya is estimated to lose at least 60 persons to TB every day. One contributor to this is, three quarters of the people with TB symptoms miss out on TB diagnosis and treatment even after presenting themselves to health facilities.
Since 2016, Centre for Health Solutions – Kenya (CHS) with funding from United States Agency for International Development (USAID) through the Tuberculosis Accelerated Response and Care activity (TB ARC) and its successor Tuberculosis Accelerated Response and Care II (TB ARC II) activity in collaboration with the National Tuberculosis, Leprosy and Lung Disease Program (NTLD-P) and the International Union against Tuberculosis and Lung Disease (The Union) has been working to change this trend. This is through a free TB online learning platform for health care workers known as Extension for Community Healthcare Outcomes Project (Project ECHO).
The goal of Project ECHO in Kenya, an innovation adapted from Mexico, is to increase access to specialist care countrywide by developing professional communities of learning and practice in Kenya. It aims to improve quality patient care; enhance access to technical expertise by peripheral facilities; improve surveillance of TB and drug resistant TB in both adults and pediatrics, and improve diagnostic and management skills in isoniazid preventive therapy, GeneXpert, pediatric diagnosis and a practical approach to lung health.
“Project ECHO’s tagline is education magnifier. It is a very simple approach where you bring healthcare professionals of all types into a virtual room with a specialty to discuss cases and have short didactics. The platform enables the transfer of knowledge of the specialist to other individuals in the field in a simple way around the questions they are seeing in their patients every day,” notes Dr Jane Carter, former president of The Union and one of Project ECHO lead trainers.
Project ECHO has a distinct setup with the main site called The Hub serving peripheral centres referred to as spokes. Kenya’s HUB is currently at the National TB program offices in Nairobi and the spokes are spread across the 47 counties in the county offices and at the health facilities. There is a connection that is set up which means one needs internet that TB ARC II is currently supporting bundling of monthly.
“The good thing about ECHO is that you don’t need fancy equipment. All you need is a hand held device; a phone, a tablet or a laptop. One also needs internet connection to link to the spoke through live stream. It is almost like face to face communication. At The HUB level we give log in link to the spoke through live stream. It is almost like face to face communication. We ensure that there is a facilitator who is facilitating the sessions and though sometimes we have situations where the facilitator is not at The HUB, we loop him/her to The HUB and they are able to facilitate from wherever they,” says Dr Brenda Mungai, Director of TB and Lung Health, CHS.
The ECHO project sessions are conducted twice weekly; every Monday and Tuesday 8:00am – 9:00am. The sessions begin with a training followed by questions and comments to ensure that the teams understand what is being spoken about or talked about during that time.
“We are proud as a country to be among the first adopters of the ECHO innovation. In the year 2019 alone, we have been able to train over 2800 healthcare workers. From these trainings, there has been a decrease in the knowledge gap among the health care workers. The trainings have provided health care workers with addition training on TB and other related topics,” says Dr Paul Wekesa, Chief Executive Officer, CHS.
Dr Paul adds, “ECHO has provided a platform for TB data4action trainings, supported the initiation and monitoring of patients on new molecules such as Bedaquiline and Delaminid, demonstration on hand-on skills necessary in pediatric diagnosis like practicum sessions on nasopharyngeal aspirate, gastric aspirate and the tuberculin skin test and aided the dissemination of new policies by the National TB Program.”
His sentiments resonate with those of Elizabeth Mueni, Nairobi County TB Coordinator, who notes, “Through the ECHO platform we are seeing an increase in childhood TB diagnosis which was a challenge before. Healthcare workers were not comfortable diagnosing childhood TB or even doing nasopharyngeal aspirate, but through ECHO they have learnt how to get a good sample from children and also understand how childhood TB presents.”
Mueni adds that through case presentation in the ECHO sessions, healthcare workers have been able to learn how to manage difficult TB cases and now they are comfortable managing TB patients.
According to her, the ECHO project has assisted the private health sector healthcare workers majority of whom are not able to leave their facilities to attend a three to five-day trainings to get updates of TB and lung health.
Eric Omache, a clinician at Administration Police Training School Health Centre Embakasi, Nairobi shares, “Through the ECHO platform we have been able to liaise with other team players in the TB industry. We have been able to discuss issues regarding TB diagnosis, the use of TB Lipoarabinomannan (TB LAM), TB management and current regimen of paediatric TB. We have also been able to learn and bench mark with others on the use of data tools.”
His sentiments are echoed by his counterpart Peter Gathii, Pharmacist, Embakasi Health Centre who urges his fellow healthcare workers to join in the weekly sessions as the platform has helped him and his fellow colleagues to improve TB services in the facility which include finding the missing TB patients, treating them, and ensuring high quality care from presumptive to completion of TB treatment.
Kenya is currently planning to introduce injection free regimen, and the TB ECHO platform will be an important tool to effectively reach out to everyone as was proved in the sensitisation and faster adoption of the drug resistant TB management short term regimen.