Assessing the Readiness to Provide Integrated Management of Cardiovascular Diseases and Type 2 Diabetes in Kenya: Results from a National Survey

Peter Otieno; Charles Agyemang; Welcome Wami; Calistus Wilunda; Richard E Sanya; Gershim Asiki

doi:10.5334/gh.1213

Assessing the Readiness to Provide Integrated Management of Cardiovascular Diseases and Type 2 Diabetes in Kenya: Results from a National Survey

Glob Heart. 2023 Jun 15;18(1):32. doi: 10.5334/gh.1213. eCollection 2023.

Authors

Peter Otieno^{1

2

3}, Charles Agyemang², Welcome Wami³, Calistus Wilunda², Richard E Sanya², Gershim Asiki^{2

4}

Affiliations

¹ Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
² African Population and Health Research Center P.O. Box: 10787-00100, Nairobi, Kenya.
³ Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Tower C4, The Netherlands.
⁴ Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.

Abstract

Introduction: Integrated chronic disease management is the desired core function of a responsive healthcare system. However, many challenges surround its implementation in Sub-Saharan Africa. The current study assessed the readiness of healthcare facilities to provide integrated management of cardiovascular diseases (CVDs) and type 2 diabetes in Kenya.

Methods: We used data from a nationally representative cross-sectional survey of 258 public and private health facilities conducted in Kenya between 2019 and 2020. Data were collected using a standardised facility assessment questionnaire and observation checklists modified from the World Health Organization Package of Essential Non-communicable Diseases. The primary outcome was the readiness to provide integrated care for CVDs and diabetes-defined as the mean availability of tracer items comprising trained staff and clinical guidelines, diagnostic equipment, essential medicines, diagnosis, treatment and follow-up. A cut-off threshold of ≥70% was used to classify facilities as 'ready'. Gardner-Altman plots and modified Poisson regression were used to examine the facility characteristics associated with care integration readiness.

Results: Of the surveyed facilities, only a quarter (24.1%) were ready to provide integrated care for CVDs and type 2 diabetes. Care integration readiness was lower in public versus private facilities [aPR = 0.6; 95% CI 0.4 to 0.9], and primary healthcare facilities were less likely to be ready compared to hospitals [aPR = 0.2; 95% CI 0.1 to 0.4]. Facilities located in Central Kenya [aPR = 0.3; 95% CI 0.1 to 0.9], and the Rift Valley region [aPR = 0.4; 95% CI 0.1 to 0.9], were less likely to be ready compared to the capital Nairobi.

Conclusions: There are gaps in the readiness of healthcare facilities particularly primary healthcare facilities in Kenya to provide integrated care services for CVDs and diabetes. Our findings inform the review of current supply-side interventions for integrated management of CVDs and type 2 diabetes, especially in lower-level public health facilities in Kenya.

Keywords: cardiovascular diseases; integrated care; readiness assessment; type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiovascular Diseases* / epidemiology
Cardiovascular Diseases* / therapy
Cross-Sectional Studies
Delivery of Health Care
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / therapy
Health Services Accessibility
Humans
Kenya / epidemiology

Grants and funding

The Joep Lange Institute and the Dutch Ministry of Foreign Affairs funded the original health service provision assessment in Kenya. The funders had no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.