Two years ago, Ganjoni Hospital, a busy private health facility in Mombasa County, was not offering TB services. This was a result of, among other things, lack of a TB clinic and tools to screen clients for TB.
“Initially, we were not offering TB services. We referred our TB clients to other facilities for testing and treatment, “ says Ann Kamau, facility in-charge nurse, Ganjoni hospital.
This was the case until November 2020, when a team from Centre for Health Solutions – Kenya USAID funded Tuberculosis Accelerated Response and Care II (USAID TB ARC II) activity, the National TB Program, and Mombasa County Health Department visited the facility.
“They began by sensitising us on the importance of offering TB services. They later took us through the process of setting up a TB clinic and provided us with the TB recording and screening tools and testing kits, “ Ann says.
She adds, “Over time the team has been capacity building us through regular continuous medical education and on-job training on TB testing and treatment.
The hospital has also embraced TB active case finding by integrating TB services in all departments.
“Apart from regularly screening our staff for TB, we have gone ahead to sensitise them on TB active case finding. The watchman is now able to identify a coughing client as he welcomes him/her to the facility and quickly alert the nurse at triage so is a cleaner who is able to note a cougher in the consultation waiting queue and alert a clinician for quick attendance to avoid the risk of spreading the disease to other clients,” Ann explains.
Through this engagement, Ganjoni Hospital is now a TB testing and treatment centre. The hospital is helping to find and treat TB cases in Mombasa County, one of the five high burden TB counties in Kenya.
One of the hospital’s TB clinic beneficiaries is 14-year-old Joyce Orio shares how the hospital saved her life..
“Before visiting Ganjoni hospital, where I was treated and cured TB, I had been sick for a period of over nine months with the common symptoms being headaches and night sweats,’’ Joyce opens up.
For the period she was not feeling well, her mother took her to four hospitals where she was misdiagnosed and treated for malaria and anemia.
“I was losing it as my health deteriorated drastically during the months I was sick. I was brought in here very weak and unconscious,’ Joyce adds.
After hospital admission and stabilisation, several tests were conducted, among them a TB test that showed she had TB.
“It is this hospital that saved my daughter’s life. It was here that what was ailing her was discovered and treated free of charge. Now my daughter is well and back in school to pursue her dream of being a doctor. To everyone who made this possible, I am forever grateful,” Joy’s mother says joyfully.
Ganjoni Hospital is among the 24 private health facilities in Mombasa County that USIAD TB ARC II in collaboration with the National TB Program and Mombasa County Department, has supported to provide TB services through the public-private mix (PPM) engagement model. The facilities include seven chemists and two standalone laboratories.
“The TB services we are introducing in the private facilities flow across the TB cascade. They include screening, identification of TB cases, referring of the cases to the nearest GeneXpert site and offering treatment to the diagnostic sites,” notes Nancy Gacheri, USAID TB ARC II Mombasa County PPM assistant officer.
Cosmas Mwamburi, Mombasa County TB Coordinator urges other counties to embrace the PPM model in finding missing TB cases.
“ Every county should embrace the public-private mix engagement in finding the missing TB case as it is yielding fruits. In Mombasa County, we have been able to engage 16 private facilities to provide TB treatment services. These facilities were not offering TB services among them four chemists,’ says Mwamburi.
He adds, “ For the short period we have implemented the PPM model, we have been able to diagnose and initiate over 65 TB patients on treatment through the private facilities.”
Kenya is one of the high burden TB and TB/HIV countries. Patient Pathway Analysis in Kenya (2016) found that 42% of possible TB patients first sought care in private health facilities, yet majority of these facilities lack diagnostic and treatment capacity.
It is for this reason that USAID TB ARC II in collaboration with the National TB Program is supporting the implementation of the model in five counties through five PPM assistant officers who provide timely support to the private facilities to implement TB activities. Their key responsibilities include identifying facilities to be engaged in TB activities, capacity building of health care workers, strengthening linkages to diagnosis and treatment, providing continuous support supervision and mentorship in collaboration with county and sub-county teams, ensuring a steady supply of supplies e.g. falcon tubes, recording, and reporting tools and ensuring the availability of anti-TB medicines.
They also support facilities and providers to implement their quality improvement plans towards improved quality of TB services. Ultimately, their role is to ensure that private providers are engaged in TB activities and provide services according to National TB guidelines. This is increasing TB case finding as well as improving the quality of care for TB patients.
