Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya

Abstract

Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings.

Keywords: cardiovascular disease; global health partnership; limited resources; sub-Saharan Africa.

Central Illustration. Developing Sustainable Cardiovascular Services at Public Hospitals in Kenya.

Figure 1. Map of Kenya Showing Cities with Cardiology Expertise

In 2009, most cardiologists in Kenya were located in and around the capitol (Nairobi) or on the coast in Mombasa. There were no adult cardiologists in Eldoret, the 5^th largest city, serving 25 million people.

Figure 2. Critical Milestones in Development of the Cardiovascular Center of Excellence and the Cardiac Unit

ACLS = advanced cardiac life support; BLS = basic life support; CCU = cardiac intensive care unit; CQI = continuous quality improvement; Duke = Duke University; ECG = electrocardiogram; echo = echocardiography; ICU = intensive care unit; Moi = Moi University; MOU = memorandum of understanding; MTRH = Moi Teaching and Referral Hospital; NHIF = National Hospital Insurance Fund; NHLBI = National Heart Lung and Blood Institute; PACS = picture archiving and communication system; RFP = revolving fund pharmacy; SOP = standard operating procedures

Figure 3. MTRH Cardiac Unit Organizational Structure as Outlined in a Memorandum of Understanding between Duke and Moi Universities

MTRH and AMPATH Leadership administer the MTRH Cardiac Unit, with Duke as lead collaborator and adviser. The Cardiac Unit includes a pediatric and adult outpatient clinic, noninvasive cardiac diagnostic unit, inpatient consult service, and cardiac care unit. Expansion goals include electrophysiology, interventional, and invasive diagnostic services. AMPATH = Academic Model Providing Access to Healthcare; CV = cardiovascular; MTRH = Moi Teaching and Referral Hospital

Figure 4. RFP Concept

After the provision of seed funding, patient revenue is reinvested in the RFP to replenish medications and to expand the formulary, ensuring a continuous supply of vital medications. RFP = revolving fund pharmacy.

Figure 5. Trends in Cardiac Outpatient Clinic Volume

Three-month running average for the adult and pediatric cardiac outpatient clinics from January 2011 to January 2015. Clinic volumes decreased seasonally in December and January.