In May 2011, the World Health Assembly (WHA) recognized the re-emergence of cholera as a significant global public health problem and adopted resolution WHA 64.15, calling for the implementation of an integrated and comprehensive global approach to cholera control.
Globally, the number of deaths from cholera rose from 4948 in 2009 to 7543 in 2010, an increase of 52% with an overall case fatality rate (CFR) of 2.38%. Of the 32 countries that reported deaths from cholera, 20 were on the African continent and accounted for 3397 deaths and 45% of the global total.
In Kenya, cholera incidence has been on the increase since 2006, and outbreaks have been increasing in numbers since 2007. In 2009, cholera was reported in 52 districts in all the provinces of Kenya with more than 11,679 cases and with an overall case fatality rate of 2.3%.
More profound effects of the outbreaks were felt in the arid and semi-arid areas of the country along Lake Turkana, Nyanza and Coast provinces as well as in prisons and the urban slums of Nairobi. Cholera has also been reported in refugee camps in Kenya.
The Ministry of health had developed a cholera response plan in 2008, 2009 and 2010. However, cholera incidence and case fatality continued to increase. It is with this realization that it was deemed necessary for fighting cholera to adopt a multi-sector approach with well-coordinated roles and functions of different partners.
The process of developing this Multi-sectoral Cholera Prevention and Control Plan 2011-2016 involved a consultative workshop with different local stakeholders and partners in 2010 which was followed by a second workshop which involved both local and International partners in April 2011. The plan identifies and strengthens the linkages among government departments, multi and bi lateral development partners, Non-Governmental Organizations (NGOs), whose activities contribute to the reduction of risk of cholera and prevention at local and national levels, and regional initiatives such as the East African Community Health sector coordination and the East African Public Health laboratories. Faith Based Organizations (FBOs) and the private sector are also included in the coordination mechanism.
This plan intends to fight cholera in Kenya through a well-coordinated multi-sectoral approach that
emphasizes a continuous prevention effort rather than the traditional focus on outbreak response only. Efforts will focus on cholera high risk areas that include those commonly affected by floods and drought, low income urban areas, refugee camps, and cross border interventions.
The plan is structured in the following technical thematic areas:
Advocacy, Resource Mobilization, and Coordination
Laboratory , Risk Assessment, and Surveillance
Water , Sanitation, and Hygiene (WASH)
Disease Prevention and Health Promotion
Disease Outbreak Preparedness and Response
In order to overcome dependence on a central management system, the plan emphasizes the strengthening of capacity at the district level to diagnose, manage, control and prevent cholera.
The fecal-oral route of cholera transmission is of primary concern and results in the secondary cases and subsequent spread of the disease. Proper disposal of children’s feaces often a neglected area in sanitation is also addressed. Ensuring safe water supply at the point of use, improving sanitation, promoting hand-washing with soap and food hygiene are critical for both preventing and controlling the disease. Increasing access to water, sanitation and hygiene (WASH) in high risk areas is an important component of the plan, as well as an emphasis on community-based service delivery.
As part of long term prevention, both the Kenyan community strategy with its disease surveillance component and the sanitation strategy are taken into account in the plan. The Ministry of Public Health and Sanitation has endorsed a variety of approaches to ensure safe disposal of feces, including Community-led Total Sanitation (CLTS) and Open-Defecation Free (ODF). Creation of demand for sanitation will be accompanied by efforts to ensure appropriate necessary supplies that are feasible, desirable and affordable.
In addition to working with the Ministry of Water and Irrigation (MOWI) at the national level, the plan identifies and engages the water service companies through the water boards at the local level. The pollution and quality control department of MOWI will ensure access to safe water supplies especially for high risk populations.
It is estimated that 8.5million children are currently enrolled in Kenya’s primary schools in different parts of the country. Improving access to water, sanitation and hygiene in schools and sensitizing children and teachers on basic hygiene, including hand-washing with soap, are key components of the plan as well as the participation in the international days including global hand washing day and world toilet day.
National stakeholders with mandates to undertake research are considered in the plan to generate data and inform evidence based strategies and interventions in diagnosis, emergency preparedness, management and prevention of cholera. The inclusion of the meteorological department as a stakeholder in the plan is to facilitate and the sharing of climate data to enhance better understanding of disease patterns for purpose of mitigating predictable weather related disease outbreaks.
The detailed implementation plan prioritizes the activities under the above mentioned thematic areas into short and long actions. The budget estimation for this five year plan is about Kshs. 1,196,400,000 (USD$ 12,614,600)
A monitoring and evaluation framework has also been structured into the plan where each thematic area can be continuously monitored and evaluated. The budget estimation for Monitoring and Evaluation is about Kshs. 94,700,000 (USD$ 998,700)