Transforming Lung Health in Kenya: Integrated Care for Asthma, COPD and TB

How the Integrated Program for Asthma COPD and TB (iPACT) will reshape lung health care in Kenya

Integrated Program on Asthma, COPD, and TB (iPACT)

The Integrated Program on Asthma, COPD, and TB (iPACT) is a transformative initiative aimed at addressing the burden of respiratory diseases in Kenya through an integrated approach to diagnosis, treatment and management. The program focuses on improving health outcomes for asthma, Chronic Obstructive Pulmonary Disease (COPD), and tuberculosis (TB), which collectively account for a significant portion of the disease burden in the country.

iPACT is a collaborative effort involving the Ministry of Health (MoH), Clinton Health Access Initiative (CHAI) funded by GlaxoSmithKline (GSK) and the Bill and Melinda Gates Foundation (BMGF), leveraging cutting-edge technologies and data-driven insights to revolutionize lung health care in Kenya.

Current Status of Services

a)     Missed cases

o  Sub optimal screening of TB among the respiratory conditions reported at 81% in 2022.

o  Siloed screening: gaps in screening algorithm that only focuses on TB and misses other chronic lung conditions.

o  Lack of sensitive screening tools; missing asymptomatic cases. In addition, systematic screening for high-risk population is inherently weak

b)     Suboptimal presumptive case investigation leading to missed opportunities for TB diagnosis. In 2022, only 60% of TB presumptive cases were investigated for TB leading to more than 40% clinically (symptomatically) diagnosed. These are majorly due to supply chain and equipment distribution issues.

c)     Suboptimal or complete lack of access to appropriate diagnostic tools which has led to:

o  Low DRTB surveillance which is currently at 60%-In the case of DS-TB or MDR-TB, the resistance pattern may not be correctly identified leading to starting a client on the wrong TB regimen.

o  Missing atypical TB cases in addition to comorbidities with TB resulting in prolonged time to diagnosis (if ever) resulting in greater community spread of TB.

d)     Sub optimal differential diagnosis for Chronic Lung Disease leading to misdiagnosis.

e)     Data insufficiency: The true burden of Lung Health conditions is not well established.

o Lack of integrated reporting tools for chronic lung health conditions.

f)       Suboptimal treatment for TB and other lung health conditions due to:

o Limited, inconsistent, and high cost of asthma and COPD treatment across the country.

o Gaps in supply chain management leading to limited understanding of the country’s annual procurement needs for Asthma and COPD

g)     Service delivery gaps:

o  Low technical capacity in the holistic management of chronic lung diseases

o  The lack of a structured system for referral or linkage of patients with other co-morbidities conditions for evaluation and specialized care is a disincentive for entertaining alternative or additional diagnoses.

o  Although some inhaler products are on the essential medicine list (EML) and relatively inexpensive, provider and patient education on effective use of these medicines is limited.

 Activities to be implemented under iPACT

1.  The project aims to establish a baseline on lung health burden, service availability, and facility readiness to adopt an integrated lung health model in 18 counties. To support MoH in assessing the burden of COPD, asthma, and post-TB lung disease while evaluating the capacity of healthcare facilities to provide integrated lung health services. Key activities include engaging the Ministry of MoH and stakeholders for buy-in, conducting comprehensive facility assessments, and establishing baseline data to inform programming. Additionally, the project will review and disseminate policies, guidelines, and job aids to enhance clinical practice and integrate asthma and COPD into existing TB monitoring and evaluation systems for a more cohesive lung health response.

2. Screening and Diagnosis

• Expand screening efforts beyond tuberculosis to include the detection of chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). This ensures early identification of non-communicable lung conditions that are often overlooked.
• Deploy advanced diagnostic tools across healthcare facilities, including digital X-rays with Computer-Aided Detection (CAD) technology, spirometry for lung function testing, and molecular TB tests. These tools enhance the accuracy of diagnoses and enable differentiated management of lung diseases.
• Optimize screening and diagnostic algorithms to streamline the identification of various lung conditions, improving efficiency and reducing the chances of misdiagnosis. This involves integrating symptom-based approaches with advanced diagnostic techniques for precise evaluation.

3.Capacity Building

• Provide comprehensive training programs for healthcare workers to strengthen their capacity to deliver integrated lung health services. Training should cover the diagnosis, treatment, and management of TB, asthma, COPD, and other respiratory conditions.
• Develop, review, and disseminate user-friendly guidelines, policies, and job aids to standardize care practices. These resources will serve as quick-reference tools for healthcare workers, promoting adherence to evidence-based practices

4.Supply Chain Management:

• Revise existing logistics management systems to include essential medications and consumables for asthma, COPD, and emerging respiratory conditions such as COVID-19. This ensures a steady and consistent supply of lung health commodities at all levels of care.
• Strengthen forecasting and procurement processes to meet the demands of lung health programs. This includes conducting annual quantifications and aligning procurement with anticipated service delivery needs to avoid stockouts.

5.Data and Policy Integration:

• Expand health monitoring and evaluation tools to capture data on lung health conditions comprehensively. Incorporate indicators for asthma, COPD, and other chronic lung diseases into existing reporting systems like the Kenya Health Information System (KHIS).
• Conduct implementation science studies to generate evidence on effective lung health interventions. These studies will guide the formulation of policies and practices tailored to the local context, ensuring impactful and sustainable improvements in lung health service delivery

Programmatic Scope and Recommendations

o  Expand diagnostic and treatment access for both infectious (TB, HIV-related) and non-infectious lung conditions (COPD, asthma).

o  Incorporate AI tools for diagnostics and patient management.

o  Improve data collection for burden estimation and develop clear metrics to measure success. Address gaps in referral systems, community-level engagement, and nutritional interventions​

Achievements made to date

1.     Stakeholders Inception Meeting on Lung Health

The stakeholder engagement focused on strengthening collaboration and coordination for integrated lung health services. CHAI participated in the annual joint work planning workshop with MoH and partners, ensuring iPACT activities were included in the FY 2024/25 work plan and aligning interventions with key performance indicators. CHAI also introduced the iPACT project to MoH leadership, securing buy-in and developing a joint activity timeline. A lung health stakeholders’ forum was held with MoH, county officials, and key partners to develop a lung health implementation roadmap, map stakeholders, and define programmatic priorities. Follow-up meetings were planned to enhance coordination among implementing partners. Additionally, CHAI engaged with TB Reach Wave 11 recipients to understand their lung health initiatives. Key projects included FIND Kenya’s digital screening algorithm using AI and spirometry in Machakos and Mombasa, CHS’s community-based TB and respiratory disease management in Kiambu targeting over 231,000 people, and Ogra Foundation’s community-led screening and referral program in Kisumu. These engagements are critical in fostering collaboration, reducing duplication, and enhancing lung health service delivery in Kenya.

Objective 1: To establish the availability of Asthma, COPD and other lung health services and determine the readiness and capacity of facilities to provide integrated lung health services

2.     Service Availability and Readiness Assessment

CHAI, in collaboration with MoH, developed a comprehensive SARA assessment tool to evaluate lung health service availability, facility readiness, and capacity for integrated care. Key activities included drafting a Lung Health SARA concept note, gaining MoH and stakeholder approval, designing facility assessment and key informant questionnaires, and developing a data analysis plan. Facility mapping ensured regional representation, the assessment covered seven counties (Murang’a, Nairobi, Nakuru, Turkana, Migori, Bungoma, and Kilifi), with 199 facilities assessed. Training was conducted for national supervisors, county TB and leprosy coordinators (CTLCs), and sub-county TB coordinators (SC-CTLCs), who collected data. Data cleaning, analysis, and report writing in January 2025 provided insights into service gaps, investment priorities, and partner involvement in lung health services.

A secondary literature review complemented the assessment, identifying policy, financing, and implementation gaps. Next steps include disseminating findings, publishing a detailed roadmap, printing the SARA report, and developing policy briefs and scientific publications to inform integrated lung health service delivery in Kenya.

Summary of SARA Secondary Literature Review Findings

The literature review revealed that Kenya faces significant challenges in delivering integrated lung health services:

• Service Delivery: While policies exist, they are poorly implemented due to limited awareness among healthcare workers and a lack of essential diagnostic tools like spirometers. Public facilities are under-resourced, particularly at the primary level​.
• Human Resources: There is a shortage of trained personnel for managing chronic respiratory diseases. Skills in diagnosing and treating lung health conditions are limited, and training opportunities are insufficient​.
• Health Information Systems: The data on lung health conditions is fragmented, with most health information systems focusing on TB. Indicators for conditions like asthma and COPD are not well-integrated into national monitoring systems​.
• Health Products and Technologies: Many essential commodities for lung health are unavailable in public facilities. Items like nebulizers and oxygen concentrators are scarce, particularly in lower level facilities​.
• Governance: Despite political commitment, structural gaps exist, including insufficient funding and weak integration of lung health into broader health strategies​.

Summary of SARA Primary Data Collection Findings

 Service Availability & Readiness

• Respiratory emergency services are provided across all health facility levels, though limited at Level 2 (72%) and Level 3 (90%).
• Only 9% of facilities offer spirometry, mainly concentrated in Nairobi, with costs ranging from KES 300 to 15,000.
• Palliative care, pulmonary rehabilitation, and pleural procedures are mostly available at Level 4-6 facilities.
• 87% of facilities have integrated TB guidelines, but asthma and pediatric TB guidelines are less widely available.
• Limited training on lung health guidelines—51% of health workers trained in asthma guidelines compared to 68% in TB guidelines.

Diagnostic & Laboratory Capacity:

• X-ray machines are available in 38% of health facilities, with 89% being functional.
• Digital X-rays with AI software are available in select Level 3-6 facilities, but digital result transmission is low.
• Sputum cytology and advanced diagnostic tests are mainly available at Level 6 facilities.

 Health Workforce Challenges:

• Lung health services are provided mainly by general healthcare workers; there is a shortage of specialized personnel.
• Nurses form the majority of the workforce (53%), followed by Clinical Officers (9%) and Medical Officers (8%).
• Some counties, such as Turkana and Bungoma, have lower numbers of trained lung health professionals.

Health Information Systems & Data Management:

• Many facilities (46.7%) still rely on manual record-keeping, with 20% using electronic medical records (EMR).
• TB-specific reporting tools (e.g., TIBU Lite) are in use, but there is limited data capture on other lung diseases.

Health Products & Technologies:

• Essential antibiotics (e.g., Amoxicillin, Ciprofloxacin) are available in over 65% of facilities, but asthma inhalers (39%) and nebulization services are limited.
• Only 16 spirometers are available nationwide, with 10 in private facilities and just 3 in public and faith-based facilities each.
• Tobacco cessation services are available in only 11% of service delivery points.

 Health Financing & Resource Allocation:

• While lung health is prioritized in strategic plans, there is no dedicated national budget for its implementation.
• 77.4% of facilities receive partner support, mostly focused on TB, with limited funding for other lung conditions.
• Counties procure medicines independently, leading to disparities in availability.

 Infrastructure & Infection Prevention Control (IPC):

• Oxygen availability stands at 74%, but gaps exist in rural areas.
• 75% of facilities have piped water, while 76% have internet connectivity.
• PPE shortages persist, with gloves, masks, and aprons available in less than 20% of facilities.

 Community-Based Services & Outreach:

• 72% of facilities have linkages with functional Community Health Units (CHUs).
• Community outreach programs exist but focus mainly on TB rather than integrated lung health services.
• Only 9% of Community Health Promoters (CHPs) are trained in asthma, 5% in COPD, and 3% in smoking cessation.

Objective 2: Determining the Burden of Chronic Lung Conditions in Kenya

A review of existing publications and national reporting systems, including EMR and KHIS, was conducted to assess the available data on TB, asthma, COPD, and post-TB lung disease (sequelae). This secondary literature review provided insights into the current estimates of lung disease burden at national and county levels. The next steps involve establishing a technical working group, led by a consultant, to develop and validate a burden estimation model for a more accurate understanding of chronic lung conditions in Kenya.

Objective 3: Reviewing and Disseminating Policies, Guidelines, and Job Aids for Integrated Lung Health Response

To strengthen the integrated lung health response, CHAI in collaboration with MoH developed a draft screening and diagnostic algorithm for TB, asthma, and COPD, addressing gaps in the current care pathway. Two consultative meetings with key stakeholders, including experts from Kenyatta National Hospital, Aga Khan Hospital, and the National Program, were held to review and refine the algorithm. The final version will be validated and incorporated into the revised integrated lung health guidelines. Additionally, updates to TB management based on WHO recommendations have been integrated, with further revisions for asthma and COPD underway. Next steps include validating the patient pathway and management guidelines, developing training materials, and finalizing the design, printing, and launch of the integrated lung health guidelines.

Objective 4: Integrating Asthma, COPD, and Other Lung Diseases into the TB Program and M&E Systems

CHAI collaborated with MoH to develop draft Integrated Lung Health indicators for review and adoption, with updates to facility registers, summary tools, KHIS, and the TIBU system planned for early 2025. Additionally, CHAI supported the development of ten county-specific TB and Lung Health strategic frameworks, aligning them with the National Strategic Plan. These frameworks outline existing gaps, priority interventions, and costed activities for optimized implementation. Next steps include adopting integrated lung health indicators, restructuring EMRs to include asthma, COPD, and PTLD, designing M&E data tools, incorporating lung health indicators into KHIS, updating facility EMRs with screening questions, and printing reporting registers for use in healthcare facilities.

Objective 5: Increasing TB Case Detection by 20% and Expanding Treatment Coverage in Targeted Counties

CHAI initiated the iPACT project in Murang’a, Nakuru and Nairobi counties through inception meetings with county leadership to secure buy-in and assess existing lung health patient pathways. Discussions highlighted the need for a baseline assessment, development of a detailed lung health implementation roadmap, and leveraging Primary Care Networks (PCNs) to improve patient identification and referral. Facility visits across nine public, private, and faith-based facilities revealed key gaps, including the absence of structured pathways for asthma and COPD, reliance on patient history for diagnosis due to limited spirometry use, and lack of AI diagnostic integration into outpatient EMRs. These findings informed the refinement of screening algorithms to enhance early detection and care for lung diseases.

To strengthen diagnostic capacity, CHAI engaged potential suppliers for spirometers, chest X-rays, and peak flow meters, analysing cost, specifications, and compatibility with global guidelines. A detailed market analysis was conducted to support procurement decisions. Additionally, CHAI developed a national repository mapping the availability of chest X-rays and TB molecular devices by county to guide equitable placement of diagnostic tools. The next steps involve procuring and deploying diagnostic equipment in phase 1 counties, with discussions ongoing to determine optimal placement across all levels of care.

iPACT is a transformative project aimed at strengthening Kenya’s lung health services by addressing key gaps in service delivery, diagnosis, policy integration, and stakeholder coordination. Through inception meetings with county leadership and facility visits, CHAI has identified critical challenges, including the absence of structured patient pathways for asthma and COPD, limited spirometry use, and a lack of AI integration in diagnostic tools. To bridge these gaps, CHAI in collaboration with MoH spearheaded the development of a baseline assessment, an integrated lung health roadmap, and refined screening and diagnostic algorithms to enhance case detection and treatment initiation.

A major focus of the project is improving access to essential diagnostic tools. CHAI has conducted extensive market analysis and supplier engagement for spirometers, chest X-rays, and peak flow meters while mapping existing diagnostic equipment across counties to ensure equitable placement. Policy and M&E system integration efforts include revising national guidelines, incorporating lung health indicators into KHIS and TIBU, and developing county-specific TB and lung health strategic frameworks. Additionally, CHAI is facilitating the development of burden estimation models, strengthening technical working groups, and supporting the review and dissemination of policies, SOPs, and job aids. With the next phase focusing on the procurement and deployment of diagnostic tools, training healthcare workers, and integrating lung health services into existing TB programs, iPACT is set to drive long-term improvements in lung health management and service delivery across Kenya.