Scaling up the Primary Health Integrated Care Project for Chronic Conditions in Kenya an implementation research project

Background

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).

Aims

Assess the key components of the implementation process of the PIC4C model;
Understand the experiences of patients to assess whether and how well the PIC4C model meets the needs of those affected by the selected NCDs;
Assess the health benefits (on hypertension and diabetes) and potential unintended consequences (on HIV viral suppression) of the implementation of the PIC4C pilot; and
Evaluate the effectiveness of the NHIF chronic care benefit package to provide financial risk protection and understand the degree to which it is responsive to the needs of individuals and influences equity, efficiency, and quality of care.

Project plan

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.

To achieve our objectives we used 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 also conducted 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.

Impact

The project provided evidence for the adoption of Community Health Promoters for screening and referral of people with hypertension and diabetes in Kenya. This has now been adopted as a key part of the roll out of Universal Health Coverage nationally.

Additionally evidence from this project informed the decision to include integration of NCD care into primary healthcare as a key pillar in Kenya’s NCD strategy for 2021-2025.

Publications and output

You may visit the project website for more information.