Sigma Medical Centre is one of the leading private health facilities in the sprawling Kianyaga market located on the outskirts of Kerugoya town, central Kenya. According to the facility administrator, Milkah Waithaka, the facility which attends to an average of 25 clients per day, was set up in 2017.
“We offer both outpatient and inpatient services where we screen and treat all the common tropical ailments and refer difficult cases. Until August 2020, TB was among the difficult diseases we referred. This, however, is no longer the case,” Milkah shares.
In August 2020, the management of Sigma Medical Centre was among private health facilities representatives in Kirinyaga County that attended the TB Public Private Mix (PPM) engagement county entry meeting. The meeting which was supported by Centre for Health Solutions – Kenya USAID funded Tuberculosis Accelerated Response and Care II (TB ARC II) in collaboration with the Ministry of Health National TB Program and Kirinyaga county department of health aimed at identifying various mechanisms for capacity building the private facilities in screening and treating TB.
“A few days after the meeting, the Kianyaga sub-county TB coordinator and the TB ARC II Kirinyaga County PPM Assistant visited our facility and sensitised all the health care workers on TB active case finding, treatment, and management. We began offering TB services from that day, and we have never looked back,” Milkah says.
Additional intensive one-week training was provided to the facility clinician, Christine Muthoni.
“The training was an eye-opener as it provided me with a practical experience on how to screen, diagnose, treat and manage TB. It has changed much from what we went through in medical college. I was able to learn the importance of recording TB data and the use of this data for decision making,” Christine says.
Back at the facility, Christine began utilising the knowledge and skills acquired as well as cascading the same to her fellow health workers.
“The training awakened in me the urge to fight TB. It made me realise I had a role to play in ending TB and I was capable of doing so. I became very vigilant and began screening every client I attended for TB. I even went further and recalled some of the clients with TB symptoms I had attended to before the training for screening to ascertain their status,” Christine recalls.
She adds, “To onboard everybody in the facility in this fight against TB, I went further to share the knowledge and skills with them through internal continuous medical education. As days went by, this was complemented by the on-the-job training and support supervision we have been receiving from the sub-county TB coordinator and the PPM assistant coordinator. We are proud to be offering TB services by among others actively finding cases and providing quality of care to our patients”
Prisca Wangui considers herself one of the biggest beneficiaries of this engagement. After struggling with her ailing four-year-old daughter for almost a year while visiting various health facilities to no avail, the breakthrough came when she visited Sigma Health Centre.
“Before coming to Sigma Health Centre, my daughter had become frail. She had a persistent cough and night sweats prompting us to visit various facilities where she was mostly treated for pneumonia and bacterial infection,” Prisca shares.
“It was at Sigma, her diagnosis was made after they took an X-ray that confirmed she had TB. Though at first, I was hesitant in believing that indeed she had TB, when they initiated her on treatment and she began improving one week into treatment, I was glad to see my daughter regain back her health and begin to thrive as were her age mates,” Prisca adds.
Prisca’s entire household including her husband was also screened and tested for TB. Prisca and her 8-year-old daughter turned positive and were also initiated on treatment.
“We have all since completed our TB treatment and are completely cured. I am a very happy mother as my children are growing well with no health complications and attending school. I am very grateful to the health workers at Sigma for diagnosing what was ailing us and supporting us in our treatment journey. I also remain indebted to the Ministry of Health National TB Program and its partners for ensuring that we got treatment free of charge. If it were not for the support received, maybe my family would have been wiped out now as TB is a killer disease if not treated,” Prisca concludes.
Sigma Medical Centre is among the 45 Private health facilities in Kirinyaga County engaged in the successful implementation of the PPM engagement model. The model which is a collaboration between the Ministry of Health National TB Program, Kirinyaga county department of health, and CHS through the USAID funded TB ARC II activity is aimed at onboarding private facilities in providing TB services.
Peter Muchiri, TB ARC II Kirinyaga County PPM assistant notes he is glad to see the successful implementation of the PPM model in the county.
“As a PPM Assistant, I work closely with the Ministry of Health National TB Program County and Sub County TB Coordinators in the implementation of the PPM model in the county. I assist in identifying the private health facilities to be engaged in TB activities, capacity building of health care workers, strengthen linkages to diagnosis and treatment, provide continuous support supervision and mentorship to health facilities, and ensure a steady supply of commodities e.g., falcon tubes, recording, and reporting tools as well as ensure availability of anti-TB medicines among others.
Ann Masese, a Senior Technical Officer – Strategic Initiatives in the TB ARC II activity adds that Muchiri is among the five PPM Assistants supporting PPM activities. This initiative is being implemented in 5 counties namely Kirinyaga, Meru, Nyeri, Kilifi, and Mombasa. The PPM assistants are very instrumental because they have dedicated 100% of their time and effort to providing timely support to the private facilities to implement TB activities. This complements the duties carried out by the county and sub-county TB coordinators whom the assistants work with closely.
“Additionally, the PPM assistants also support facilities to develop and implement quality improvement plans towards improved quality of TB services. TB ARC II also supports the training of HCWs through continuous medical education and on-the-job training. The health facilities are also provided with simple equipment e.g. cooler boxes to support sample transportation. IEC materials have also been provided to increase demand for TB in the health facilities as well as chemists and laboratories,” Ann says.
Kirinyaga County TB Coordinator, Franklin Mwenda is grateful for the impact the PPM engagement has had on TB control in the county. The county has adopted novel approaches to strengthen engagement and increase TB notification from the private sector to ensure sustained continuity of the engagement.
“Engagement of private providers in our county has enabled responsiveness to our local needs in reaching everyone where they seek care. Values have been identified among private providers in offering TB services and it is slowly influencing TB outcomes. We are glad this initiative was launched. We have been able to launch a sustainable sample networking mechanism that is supported by the County government of Kirinyaga,” Mwenda says.
According to Nkirote Mwirigi, National TB Program PPM Lead, engaging all care providers in TB control is critical in attaining the global and national targets.
“The WHO recognises PPM as a strategic initiative that needs to be scaled up to End TB. Despite the large private sector in Kenya, there is a notable gap between coverage and the number of TB patients notified by the private sector. NTP has incorporated the PPM model in the national TB strategic plan 2019-2023 and began its implementation by engaging facilities like Sigma in providing TB services,” Nkirote shares.
Recently the National TB Program launched the PPM action plan. According to the National TB Program Acting Head Dr Caroline Asin, engaging all health care providers through PPM approaches is essential to reach all people with TB who miss out on access to care due to either under-reporting or under diagnosis.
“The private sector plays a big role in delivering key services for the fight against TB as well as strengthening health systems in Kenya. It is important to build on the PPM Action Plan 2021-2023 to strengthen and expand meaningful engagement and participation of the private sector in the fight against TB,” Dr Asin advises.