02088nas a2200277   4500000000100000008004100001260001300042653003900055653003300094653002500127653002200152653002300174653001100197653001000208653001200218653001300230653001900243653001700262100001300279700001300292245015300305300001100458490000600469520132100475022001401796       2000                            d  c2000 Jul10aAcquired Immunodeficiency Syndrome10aCommunicable Disease Control10aDeveloping countries10aDisease Outbreaks10aHealth Care Reform10aHumans10aKenya10aleprosy10aPolitics10aPrivate Sector10aTuberculosis1 aHanson C1 aKibuga D00aEffective tuberculosis control and health sector reforms in Kenya: challenges of an increasing tuberculosis burden and opportunities through reform.  a627-320 v43 a<p>During the period from 1980 to 1997, the annual number of new tuberculosis cases increased four-fold in Kenya, and had reached approximately 50,000 cases by 1998. During the same time period, the government per capita expenditure on health dropped from US$9.5 to US$3.5. Since 1983, Kenya has been decentralising financial responsibility and decision-making power to the districts. In addition, the late 1980s saw the introduction of cost-sharing schemes for most health services, excluding tuberculosis (TB) treatment. In the midst of these changes, a dual epidemic of TB and HIV/AIDS emerged, and is presently over-burdening the traditional public health system. In response, the National Leprosy and Tuberculosis Control Programme (NLTP) is seeking a wider network of service providers and new approaches to the prevention and treatment of TB in the country. The history of health sector reform in Kenya is summarised and the role of the NLTP in these reforms assessed. Recent approaches taken by the NLTP to sustain effective TB control, which draw on the environment of a changing and flexible health system, are expressed. Participation of the NLTP in components of health sector reform, particularly decentralisation, integration, financing through cost-sharing and public/private mix, are highlighted.</p>  a1027-3719