Kenya

INTRODUCTION Kenya has a population of 28,679,000 (1999 census). Some 20 million Kenyans are currently regularly exposed to malaria, which remains the country's leading cause of morbidity and death. Clinic attendance and admission to hospitals shows a proportional malaria morbidity of 30% (outpatient departments), out of which 19% are admitted. Malaria mortality among under-5s is estimated at 26,000 deaths a year while over 145,000 children aged 0-4 years require hospitalization. Malaria case fatality rate is around 6% in health care facilities. It is estimated that 170 million working days are lost annually in Kenya due to malaria. Estimated duration of malaria transmission (in months) in Kenya (see www.mara.org.za)

STATE OF THE MOVEMENT
RBM action is spearheaded by the National Malaria Coordinating Committee, chaired by the Director of Medical Services. Membership includes MOH (all heads of MOH departments are members), external partners, local NGOs and the private sector. The committee meets quarterly and functions as an executive board supervising the National Malaria Control Programme. This allows the MOH and partners to jointly manage national malaria action. A monthly partners' meeting is also held to discuss issues before they go to the NMCC.

Restructuring and enhancing the capacity of the National Malaria Control Unit led to its elevation to MOH division status as the new Division of Malaria Control. New offices have been constructed with DFID support and new staff appointed.

The country's ten-year strategy is complete and was endorsed by partners at a Round Table meeting in April, 2001 during which resources were pledged by partners. The strategy was launched nationally by the Minister of Health in April 2001.

Early RBM achievements include: zero-rating of VAT on mosquito nets; new guidelines on epidemic preparedness and response; training health personnel in epidemic-prone districts; drug policy has been reviewed and SP adopted as the first-line drug; the Health Sector Strategic Plan (HSSP) for 1999-2004 gives malaria the highest priority; the Interim Poverty Reduction Strategy paper commits the government to effective implementation of its malaria control action plan.

Active partners in RBM in Kenya include MERLIN in Kisii district, CARE in Siaya district, AMREF in Transmara district, and MSF-F in Homa Bay District. ADB, WHO, UNICEF and DFID.

GOAL
The goal of the National Malaria Strategy is to reduce morbidity and mortality caused by malaria by 30% among Kenya's population by the year 2006 and maintain this progress through to 2010.

STRATEGIC COMPONENTS:
The plan has been developed through consensus building approaches which have collectively involved over 200 stakeholders from the government, private, mission, and NGO sectors at central, provincial and district levels. The strategy also draws upon previous MoH proposals, plans of action and a review of the institutional framework carried out in October 2000.

STRATEGIC COMPONENTS
Four Strategic Approaches

• Guaranteeing access to rapid and effective treatment.
• Providing malaria prevention and treatment to pregnant women.
• Ensuring the use of ITNs by at-risk communities.
• Improving malaria epidemic preparedness and response. Supporting structures for strategic approaches
• Information, Education and Communication (IEC).
• Monitoring, evaluation and research.

MAIN IMPLEMENTATION STRATEGIES

• Fostering awareness among client communities and promoting confident and correct use of appropriate drugs and services by the community.
• Improved case management by service providers.
  (Guidelines for health workers, in-service and pre-service training, supervision and continuing training, collaboration with IMCI and Safe-Motherhood programmes, collaboration with national public health laboratories, etc.).
• Drug registration, legislation and quality. (Appropriate formulations, packing and dosing, enabling access to first-line therapeutics through informal drug sellers and monitoring drug efficacy.)
• Provision of prophylactic iron, folate and Preventive Intermittent Treatment to pregnant women through collaboration with reproductive health programmes.
• Creation of an enabling environment to foster private sector growth in the provision of unsubsidized, affordable ITN services which complement alternative approaches offered by non-profit, social marketing organizations, NGOs and the public sector. (Demand creation, waiver of taxes and tariffs, strictly targeted subsidies).
• Effective epidemic preparedness and response. (Creating of Disease Outbreaks Management Units, use of indoor residual spraying, and innovative drug management schemes).
• Targeted IEC (use of workshops, mass media, website and resource centres, school health and Africa Malaria Day celebrations, etc.)
• Measuring target indicators of the national malaria strategy and impact assessment.

MANAGEMENT ARRANGEMENTS
In order to take forward the National Malaria Strategy the principals and structures articulated in the National Health Sector Strategic Plan will be adopted throughout the country. Malaria is one of the six essential packages of the HSSP and complete harmonisation between the National Malaria Strategy and the National Health Sector Strategic Plan will guarantee RBM success in Kenya.

The National Malaria Coordinating Committee (NMCC) will provide a forum for partners in the National Malaria Strategy to exchange information, coordinate malaria control plans and activities, and measure progress against objectives. The NMCC will report to the Ministers of Health.

Development partners will be represented on the NMCC but may also need to meet separately. Twice-yearly donor meetings may therefore be appropriate to provide input to annual plans and review mid-year financial positions. These will be convened through the WHO Country Office.

Detailed planning and monitoring of activities will be the role of the DOMC, which will function as the movement's secretariat, with support provided, where appropriate, from technical working groups.

MAJOR EXPECTED OUTCOMES BY 2005

• 80% of all antimalarial drugs, provided through formal and informal sectors, are of internationally acceptable pharmacological standards.
• 60% of malaria cases are appropriately managed at home by family members or caretakers.
• 80% of first-line therapeutic failures and cases of severe, complicated malaria are correctly managed by health personnel in appropriate facilities.
• 60% of pregnant women have two PIT sessions (in their second and third trimesters).
• 80% of febrile or anaemia episodes are appropriately managed at ANC services.
• 60% of pregnant women sleep under an ITN.
• 60% of the at-risk population sleep under nets.
• 60% of epidemics are effectively contained through appropriate use of interventions, including community mobilization, effective case management, ITNs and/or IRS.