Why Kenya should tightly embrace the rights-based approach to TB response

By Pesa Okania

According to the World TB Report 2023, TB was in 2022 the world’s second leading cause of death from a single infectious agent, after coronavirus disease (Covid-19). At the same time, it caused almost twice as many deaths as HIV/AIDS. This is despite TB being a preventable and usually curable disease.

Kenya is one of the 30 high TB burden countries globally, with an estimated incidence of 133,000 cases in 2021. The Ministry of Health, through the National TB Programme, has in 2024 set out on an ambitious path to end TB in Kenya by 2030. This, according to the National Strategic Plan for Tuberculosis, Leprosy, and Lung Health 2023-2028, will be through ensuring provision of quality care and prevention services for everyone in Kenya.

To achieve this goal, the Ministry has committed, it’s National TB Programme Strategic Plan 2023-2028 to address human rights and gender-related barriers to reach the country’s goal of equitable, gender-transformative access to services, especially among marginalised and vulnerable groups.

We argue that the goal of ending TB by 2030 can only be achieved through adoption of a human rights-based approach – an approach to TB that articulates and upholds the rights of people affected by TB, including the rights to life, health, non-discrimination, privacy, informed consent, housing, food, and water. This approach is key to the TB response, given that human rights-related barriers (TB-related stigma and discrimination, harmful laws, policies and practices, gender inequality and gender-based violence) continue to keep people in need from gaining access to vital TB health services.

In Kenya, significant gaps remain in ensuring a rights-based approach to the TB response. A community-led monitoring initiative spearheaded by the Kenya Legal and Ethical Issues Network on HIV and AIDS (KELIN) has documented widespread stigma and discrimination faced by people with TB in accessing health services, in schools, and at workplaces in Kenya.

Further, the country has experienced a prolonged period of TB drugs and commodities stock-outs – increasing the risk of developing resistance to drugs as well as risk of transmission to the larger community.

Another documented challenge is limited information about TB, especially its mode of transmission, prevention methods and treatment, hence intensifying myths and misconceptions in the community.

Other established challenges include lack of motivation among healthcare providers who are supposed to provide care and support to people with TB; catastrophic costs incurred by people with TB in accessing services, further exacerbating the burden on affected individuals and communities; and deficiencies in healthcare facilities, including inadequate infrastructure and shortage of healthcare workers, leading to compromised services and enhanced stigma. There are also instances of scarcity of innovative TB treatments, exposing people with TB to older and more toxic treatments.

Addressing these gaps requires a multifaceted approach, including the dissemination and implementation of TB workplace policies, promoting benevolence and non-coercive approaches to treatment adherence, and addressing social determinants of health.

Furthermore, there is a need for comprehensive TB policies in institutions of learning, and robust monitoring mechanisms to ensure the protection of patients’ rights and privacy.

Efforts to enhance access to TB healthcare services must also consider the availability, accessibility, acceptability, and quality (AAAQ) of these services. Stock-outs of essential drugs, delays in diagnosis, and gaps in procurement planning, contribute to the inadequacy of healthcare provision. Ensuring sufficient healthcare providers, adequate drug supplies, and proper equipment, is essential to addressing these challenges.

Interventions must aim at promoting a rights-centred approach in TB programming, empowering communities to advocate for health justice, and holding the government accountable for the delivery of healthcare services.

Emphasising community-led monitoring efforts is crucial in ensuring the active participation of affected communities in decision-making processes and programme evaluation. It is imperative that vulnerable and marginalised communities have equitable access to quality healthcare services in line with principles of social justice and the protection of health-related rights.

In conclusion, while Kenya has made strides in enshrining the right to health in its legal framework, there is a pressing need for concerted efforts to bridge the gap between policy and practice. By upholding the principles of equity, non-discrimination, and patient-centred care, Kenya can strive towards achieving universal access to quality healthcare for all, particularly in the fight against tuberculosis.

As we commemorate World TB Day on March 24, it is imperative to renew our commitment to upholding the rights of TB patients and addressing the systemic challenges they face. This includes strengthening community-led monitoring efforts, promoting awareness and education to combat stigma and discrimination, and ensuring the availability of comprehensive healthcare services that are accessible and affordable to all.

Only through collective action and a rights-based approach can we effectively combat TB and achieve health justice for all Kenyans.

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Pesa Okania is the Programme Officer for HIV, TB and KAP, at Kenya Legal and Ethical Issues Network on HIV/AIDS (KELIN)

E-mail:  [email protected]