Tuberculosis remains one of Kenya’s most persistent public health challenges, ranking among the top five causes of death in the country. Despite notable progress in recent years, Kenya continues to be one of the 30 high TB burden countries worldwide and one of the 14 nations facing a triple burden of TB, TB/HIV co-infection, and drug-resistant TB (DR-TB).
Every year, an estimated 120,000 Kenyans fall ill with TB, yet thousands go undiagnosed or untreated mainly due to delayed health-seeking behaviour, limited access to diagnostics, stigma, and gaps in community awareness. The TB case detection rate is currently below the WHO target of 90%, meaning many people with TB continue to spread the infection within households, schools, and workplaces before receiving care.
Drug-resistant TB poses an extra threat, driven by treatment interruption, poor adherence, and weak follow-up systems. Among people living with HIV, TB remains the leading cause of death, highlighting the importance of integrated service delivery. Meanwhile, marginalised and mobile populations, such as those in informal settlements, border regions, and arid counties, face barriers related to distance, poverty, and under-resourced health systems.
Collectively, these challenges require a multi-sectoral, people-centred approach that strengthens both the health system and community structures to identify, treat, and prevent TB, while addressing the disease’s underlying social and economic factors.
Amref Health Africa in Kenya leads one of the most comprehensive national responses to Tuberculosis through the Global Fund TB Programme, serving as the non-state Principal Recipient (PR2) since 2011. In close collaboration with the Ministry of Health, County Governments, Civil Society Organisations, and affected communities, Amref delivers integrated interventions that combine prevention, early detection, treatment, and long-term management of TB and lung diseases across all 47 counties.
Amref’s TB response is aligned with Kenya’s Community Health Strategy, ensuring services reach households and underserved populations through local health systems. Working with the Division of Community Health, the programme empowers Community Health Promoters (CHPs) and Community Health Assistants (CHAs) to identify, refer, and follow up TB cases directly within communities. These frontline workers carry out active case finding, household contact tracing, and community-led monitoring, creating a link between communities and health facilities to deliver care to the last mile.
Capacity strengthening efforts focus on equipping healthcare workers across both public and private sectors with the skills and tools to deliver equitable, high-quality TB services. These include training in core TB management, laboratory diagnostics, drug-resistant TB care, and continuous quality improvement through the Kenya Quality Model for Health (KQMH) and Performance Quality Enhancement (PQE) frameworks. Through Public–Private Mix (PPM) approaches, the programme expands the reach of TB services beyond public facilities by integrating private and faith-based providers into national surveillance, reporting, and treatment-delivery systems.
Leveraging its strong digital health infrastructure, Amref supports the digitisation of TB service delivery, reporting, and surveillance. In collaboration with the National TB, Leprosy and Lung Disease Programme (NTLD-P), Amref has enhanced the TIBU electronic surveillance system by adding modules for CHPs and healthcare workers. Digital pilots, such as the Nakuru TB Model, have demonstrated the value of real-time data in improving diagnosis, tracking, and adherence, thereby enhancing decision-making at both facility and policy levels.
Recognising that stigma, misinformation, and limited awareness continue to hinder TB control, Amref implements comprehensive Social and Behaviour Change Communication (SBCC) strategies. These include national and community-level campaigns using radio, social media, and school-based health programmes to raise awareness, reduce stigma, and encourage timely health-seeking behaviour. Through Community-Led Monitoring (CLM), citizens actively give feedback on service quality via the i-Monitor platform, helping county health teams respond quickly to issues and reinforce accountability across the system.
Amref is a leader in developing and expanding innovative, evidence-based solutions to strengthen TB programmes. Through the Kenya Innovation Challenge TB Fund (KIC-TB), the organisation has tested advanced approaches, including automated TB screening in busy areas, outreach to mobile populations, school-based screening initiatives, and workplace health interventions. Successful models have influenced national policy and guided the growth of people-centred innovations.
To cultivate a culture of learning, Amref also invests in operational research through the Structured Operational Research Training Initiative (SORT IT) and community-led research programmes that promote local evidence and encourage adaptive solutions to TB control challenges.
Amref integrates TB programming into broader health system strengthening efforts through Resilient and Sustainable Systems for Health (RSSH) interventions. This includes reinforcing laboratory and supply chain systems, improving data management, and upgrading Kenya’s oxygen infrastructure to ensure preparedness for respiratory health emergencies. By embedding these improvements within public facilities, Amref helps to build stronger, more responsive systems that can support TB care and other vital health services.
Sustainability is a fundamental pillar of Amref’s TB response. The organisation collaborates with national and county governments to promote domestic resource mobilisation, ensure policy consistency, and integrate community health promoter stipends into public financing frameworks. Amref also supports the development of wellness and occupational health policies that incorporate TB, HIV, and non-communicable disease prevention in workplaces, such as the Kenya Police Service.
By embedding TB interventions within Kenya’s Primary Health Care (PHC) and Universal Health Coverage (UHC) frameworks, Amref ensures that national gains in TB control are institutionalised, locally owned, and sustained beyond donor cycles—contributing to a stronger, people-centred health system.
9. Catholic Diocese of Murang’a (CDM)
