Gendered Gaps To TB Prevention And Care In Kenya: A Political Economy Analysis Study.

BackgroundTuberculosis (TB) remains a public health concern despite the massive global efforts towards ending TB. Kenya is among the high burdened countries globally with the TB prevention and care efforts hampered by poor health systems, resource limitations and other socio-political contexts that inform policy and implementation. Notably, TB cases are much higher in men than women, and therefore, the political economy analysis study provides in-depth contexts and understanding of the gender gaps to access and successful treatment for TB infection. MethodsThe Political Economy Analysis (PEA) adopted a qualitative in-depth approach that targeted 16 Key Informant Interviews (KIIs). The Key Informant Interviews (KIIs) were distributed among government entities, academia, non-state actors, and community TB groups. ResultsThe themes identified were mapped onto the applied PEA analysis framework domains. The contextual and institutional issues included gender concerns related to the disconnect between TB policies and gender inclusion aspects, such as low prioritization for TB programs, limited use of evidence to inform decisions and poor health system structures. The broad barriers influencing the social contexts for TB programs were social stigma and cultural norms such as traditional interventions that negatively impact health-seeking behaviors. The themes around the economic situation were poverty and unemployment, food insecurity, and malnutrition. The political context centered around the systemic and governance gaps in the health system from the national and devolved health functions. ConclusionOverall, broad contextual factors identified from the political economy analysis widens the disparity in targeted gender efforts toward men. Following the development of effective TB policies and strategies, it is important to have well-planned gendered responsive interventions with a clear implementation plan and monitoring system to enhance access to TB prevention and care. Strength and limitationsThe study provides insights into the political, economic, and social contexts influencing TB prevention and care efforts. Additionally, to the best of our knowledge, this will be the first PEA to evaluate the TB program from a gendered perspective. As a limitation, the study is missing the voices and lived experiences of men leaving with TB as this was not part of the study scope. As such, we do not have their perspectives as they may better articulate some barriers faced with access and uptake of TB prevention and management programs.