Non-communicable diseases (NCDs) in Kenya represent a third of deaths, half of hospital admissions and have considerable economic consequences. Hypertension, cancer and diabetes are among the most prevalent NCDs. Although there are cost-effective management strategies for these NCDs, in Kenya, a large knowledge practice gap remains. This is due to a health system which emphasizes specialist services and lacks integration, and also due to existing financial barriers to access to care.
Based on the learning form the AMPATH (Academic Model Providing Access to Health Care) HIV care model a partnership between AMPATH, the Ministry of Health (MOH), the World Bank (WB) and the Access Accelerated Initiative (AAI) has been established for the development and piloting of the Primary Health Integrated Care Project for Chronic Conditions (PIC4C). The PIC4C model includes (i) early case finding of people with hypertension, diabetes, cervical/ breast cancer at service level 1; (ii) structured referral to service providers at level 2 for confirmation of diagnosis and treatment initiation or referral to level 3 or 4 using structured protocols; (iii) initiation of treatment using structured treatment protocols and decision support tools at levels 2, 3 and 4; (iv) retention of patients in care supported by ongoing training of health workers at all care levels; (v) monitoring and evaluation supported by a health information system; and (vi) linking patients in care with a voluntary chronic care benefit package operated by the NHIF (National Hospital Insurance Fund) for sustainable health financing.
From October 2018 (funded by the WB and AAI) the PIC4C model is being implemented in 2 counties in western Kenya. Working in partnership with the WB and MOH we aim to support scale up of the PIC4C model. Our specific objectives include: 1) to understand the implementation process; 2) to understand the experiences of patients; 3) to assess the health benefits (and potential unintended consequences), and 4) to evaluate the effectiveness of the NHIF chronic care benefit package. To achieve our objectives we will use mixed methods: objective 1: in-depth interviews with health workers and decision makers, objective 2: a cross-sectional survey of patients newly diagnosed with diabetes and/or hypertension and in-depth interviews with a sub-sample of patients, objective 3: a cohort study with interrupted time series component for patients with hypertension, diabetes, and/or HIV/AIDS, and objective 4: a matched cohort study (including households with members with the selected NCDs with and without NHIF chronic care package benefit enrollment) and in-depth interviews/focus groups with decision makers and patients with NCDs.
We will also conduct workshops and policy dialogues with key stakeholder to reflect on key factors to allow for the potential adaptation and wider scale up of the PIC4C model beyond the pilot counties.
- Pablo Perel London School of Hygiene & Tropical Medicine
- Jemima Kamamo MOI University
- Edwine Barasa KEMRI-Wellcome Trust Research Programme
- Ellen Nolte London School of Hygiene & Tropical Medicine
- Kara Hanson London School of Hygiene & Tropical Medicine
- Antonio Gasparrini London School of Hygiene & Tropical Medicine
- Adrianna Murphy London School of Hygiene & Tropical Medicine
- Anthony Etyang KEMRI-Wellcome Trust Research Programme
- Violet Naanyu MOI University
- Jane Chuma World Bank
- Loise Nyanjau Ndonga Ministry of Health
- Nicholas Kirui Moi Teaching & Referral Hospital
- Joseph Kibachio Ministry of Health
- Medical Research Council, United Kingdom