Kenya landscape analysis for neglected tropical diseases (NTDs), WASH and behaviour change 2019 Kenya Landscape Analysis | March–July 2019 Foreward The Kenya landscape analysis for Neglected Tropical disease (NTDs), WASH and behavior change is aligned to SDG 3 and 6 which states that by 2030, countries should end epidemics of AIDS, Tuberculosis, Malaria, and Neglected tropical diseases and combat hepatitis, waterborne diseases and other communicable diseases and ensure access to water and sanitation for all. It is also aligned to the 2nd Kenya National Strategic Plan for control of NTDs 2016- 2020, and the Kenya Breaking Transmission Strategic Plan 2019-2023 which recommends control and elimination of the 4-PC NTDs namely, Schistosomiasis, Soil transmitted helminthiasis, Trachoma and lymphatic filariasis within 5 years. The six strategic objectives of the National Breaking Transmission strategy 2019- 2023 are, to increase MDA coverage in all endemic sub-counties, expand NTDs related WASH interventions, mainstream BCC interventions, intensify advocacy, coordination and partnerships in NTDs control and elimination, strengthen systems for monitoring, evaluation, surveillance and research, resource mobilization, and financial sustainability of the program. This document outlines key findings on endemicity of the 4 PC-NTDs and key opportunities to utilize government planning and coordination mechanisms to develop joint integrated WASH and NTD plans and accountability systems. It seeks to present the broad national perspective on the current WASH and behavior change programming taking place in Kenya related to NTD care and control. The landscape analysis addresses 4 issues that underpins disease prevalence and programming in Kenya as prioritized by Universal Health Care; one of the big four agenda over the 5-year period of 2017-2020 which are treatment, care, and social inclusion. i Kenya Landscape Analysis | 2019 Acknowledgements The Kenya Landscape Analysis for Neglected Tropical Diseases (NTDs), Wash and behavior change has been developed through an elaborate and consultative process involving stakeholders, development and implementing partners, government ministries, and County health teams. MOH would like to appreciate the Director General for Health, Dr. Patrick Amoth, Dr. Francis Kuria, the Director of Public Health Directorate and Dr. Sultani Matendechero, head Division of Vector borne and Neglected Tropical Diseases for providing stewardship. Special thanks go to Dr Sultani Matendechero, Wycliff Omondi, Agnes Kithinji from DVB and NTDs, Earnest Barasa of Opthalmic Services Unit, Samuel Cheburet of health information systems and Elias Nyaga of Kenya National Bureau of Statistics, County NTD coordinators Mr Letoiya, Kintalel, Halake, Kibiego, Otiende, Sironka, Rutto, Sinoti and Kimanthi who provided the much needed information for the development of the Landscape Analysis. The landscape analysis received technical support from Sightsavers through the consultant Mr. Benjamin Murkomen who was assisted by research assistants Mr. Francis Wandegu, Neville Okwaro and Betty Kinya, of MOH- Wash-hub who worked tirelessly to research, compile and develop this document. Much appreciation goes to this team for their efforts and contributions, Lastly the Ministry of Health is greatly indebted to all our stakeholders and development partners who are hereby recognized for their contributions towards the development of the landscape analysis and of special mention are Sightsavers, UNICEF Kenya, World bank, AMREF Health Africa, Ministry of Water and Sanitation, Ministry of Education, Ministry of Health-Wash Hub and DVB and NTD, the County governments of Kajiado, Turkana, West Pokot, Narok, Baringo, Samburu, Meru, and Marsabit . ii Kenya Landscape Analysis | 2019 Figure 1: Geographical map of Kenya and counties iii Kenya Landscape Analysis | 2019 Contents Foreward ...................................................................................................................................... i Acknowledgements ................................................................................................................... ii Contents .................................................................................................................................... iv List of figures and tables .......................................................................................................... ix Definitions ................................................................................................................................. xi Acronyms ................................................................................................................................. xv Executive summary ................................................................................................................... 1 Purpose………. ........................................................................................................................ 1 Methods…….. .......................................................................................................................... 1 Key findings ............................................................................................................................. 2 Further research .................................................................................................................... 16 Key opportunities ................................................................................................................... 17 Recommendations ................................................................................................................. 17 1 Background information ............................................................................................... 19 1.1 The analysis team .................................................................................................. 20 1.2 Key stakeholders involved ...................................................................................... 20 1.3 Information collection ............................................................................................. 20 2 Demographic information ............................................................................................. 21 2.1 NTD-endemic counties with demographic distribution12 ......................................... 21 2.2 NTD-endemic counties and sub-counties in Kenya13, 14 ......................................... 21 2.3 Number of school-age children ............................................................................... 22 2.4 Adult literacy rate .................................................................................................... 22 2.5 Population mobility ................................................................................................. 24 2.6 Areas experiencing waterborne disease outbreaks in recent years ....................... 24 2.7 Specific farming practices that raise transmission risk ........................................... 24 3 Disease information ...................................................................................................... 25 3.1 NTD history ............................................................................................................ 25 3.2 Prevalence of disease for which mass drug administration programmes are being delivered ................................................................................................................. 27 3.3 Relevant NTD interventions .................................................................................... 27 3.4 Neglected tropical diseases in Kenya ..................................................................... 27 iv Kenya Landscape Analysis | March–July 2019 3.5 Programme information on endemic NTDs ............................................................ 37 3.6 Community and facility-based morbidity management ........................................... 38 3.7 Non-MDA interventions for NTDs ........................................................................... 41 3.8 MDA interventions for NTDs ................................................................................... 43 3.9 NTD data collection within health system of Kenya ................................................ 43 3.10 National-level health information monitoring ........................................................... 44 3.11 County-level reporting structure ............................................................................. 46 3.12 Sub-county level ..................................................................................................... 47 3.13 Health facility level .................................................................................................. 48 3.14 Community level ..................................................................................................... 49 3.15 Organisations/ministries carrying out NTD-related activities in Kenya ................... 49 4 Water supply, sanitation and hygiene ......................................................................... 51 4.1 Water sector overview in Kenya ............................................................................. 51 4.2 Water institutions in the Ministry of Water and Sanitation ...................................... 51 4.3 Key Ministry of Water and Sanitation development partners .................................. 53 4.4 Monitoring and evaluation .....................................................................................