Strategic Research on Governance, Equity and Health, Kenya

Enhancing governance for improved access to tuberculosis services in Western Kenya

Located in Kenya’s western region, Nyanza province has the highest HIV/AIDS prevalence in the country. It also has the highest incidence of HIV/AIDS co-infection, with up to 50% of TB cases in Kenya thought to be HIV-associated. In an attempt to address this situation, the Kenyan government adopted the internationally-approved Directly Observed Treatment Short Course for TB (DOTS), but faced various challenges in its implementation.

This study attempted to understand how health services delivery governance structures influence improved access to Tuberculosis Services in the districts of Nyando, Kisumu, Siaya, Bondo and Suba districts in Nyanza province. Specifically, the research explored the following:

  • the role of community social networks in DOTS implementation, to identify, mobilize and build capacity for appropriate community social networks in DOTS implementation in order to enhance equity in access to quality TB services;
  • how community participation in the set-up and operations of the health management boards can improve equity in access to TB services through effective flow of TB information;
  • how health workers’ support for community involvement in TB management can influence access to quality TB services; and
  • how traditional community health care providers can influence access to quality TB services through enhanced DOTS implementation.

The results of this intervention study underline the need to involve members of the communities in the fight against diseases such as TB. It shows that existing social networks within the communities need to be empowered with relevant knowledge to help in the fight against TB and also in making the health delivery system responsive and capable of providing equitable access to health services for the most needy.
This community empowerment can be done through capacity building of social networks to prepare them to play a role in the management of diseases such as TB and others that affect the community.

The study also shows that the change of attitude by health providers and agents of health promotion at the community level has a positive outcome for health service delivery. This change of attitude can be sustained in low-income settings if the structures of governance for health delivery recognize that the health delivery system is relational. An important aspect of this relational aspect is the morale of the health workers and the agents of health promotion such as TB ambassadors at the village level, which this study has shown has the potential to boost the patient-provider trust in health care delivery.

Workshops played a role in building trust between TB ambassadors and health workers, which had a trickle-down effect to the communities and patients, hence increasing demand for TB services.

Project description

Programme: Strategic Research on Governance, Equity and Health

Research title: Enhancing governance for improved access to tuberculosis services in Western Kenya

Thematic Research Area: Evidence to Policy

Grantee Country: Kenya

Grantee Institution: Department of Sociology and Anthropology, Maseno University

Program Coordinator/Principle Investigator: Erick Otieno Nyambedha

Start date: June 2007

Status of grant: Completed in August 2009