Improved cholera control in Kenya: A retrospective analysis of 2017-2019 in Nairobi and Homabay.

Background: Kenya has recorded at least 38 678 cases and 695 deaths over the last decade, and costing on average $2.2 million annually. From 2014 to 2016, the country experienced one of the deadliest and largest outbreak. However, between 2017 and 2020, there was a decline in the number of reported cases and deaths. Aim: This study seeks to reveal the investments made post the 2014-2016 outbreak and highlight existing gaps that need to be addressed to stop the resurgence of cholera outbreaks in Kenya. Setting: The study was conducted in two counties: Homabay and Nairobi. Methods: We used an observational study. Data were collected from 20 health facilities (involved in cholera control, during the study), 9 key informant interviews (KII) and 6 focus group discussions (FGDs). Results: We found improvement such as: dissemination of standard operating procedures, aligned reporting system, field epidemiology programme, establishment of a public health emergency operating centre and improved partner coordination. On the other hand, 12 of the selected 20 (60%) facilities had no prior training before government financing and laboratory capacity was sub-optimal: 13 (65%) facilities had no prior training, 16 (20%) had no operational laboratory plan and 10 (50%) had inadequate laboratory test kits and reagents. Conclusion: This study highlights that Kenya has experienced an improvement in specific core capacities. Contribution: For Kenya to completely flatten the curve, there is need for more sustainable investment and government's commitment in health system strengthening.