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

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

Peter Otieno  1   2   3 , Charles Agyemang  2 , Welcome Wami  3 , Calistus Wilunda  2 , Richard E Sanya  2 , Gershim Asiki  2   4
Affiliations

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

Peter Otieno et al. Glob Heart. .

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.

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Conflict of interest statement

The authors have no competing interests to declare.

Figures

A map of Kenya showing the counties included in the health facility survey
Figure 1
A map of Kenya showing the counties included in the health facility survey. 1 = Kisumu, 2 = Nairobi, 3 = Nyamira, 4 = Mombasa, 5 = Kiambu, 6 = Kirinyaga, 7 = Embu, 8 = Baringo, 9 = Kitui, 10 = Narok, 11 = Wajir. Blank map retrieved and adapted from: https://d-maps.com/ [Accessed: 16 May 2022].
Healthcare services availability for management of CVD and type 2 diabetes
Figure 2
Healthcare services availability for management of CVD and type 2 diabetes.
Care integration readiness for management CVD and type 2 diabetes
Figure 3
Care integration readiness for management CVD and type 2 diabetes.
Gardner-Altman comparisons plots of care integration readiness scores and facility characteristics
Figure 4
Gardner-Altman comparisons plots of care integration readiness scores and facility characteristics.
Facility characteristics associated with CVDs and type 2 diabetes care integration readiness
Figure 5
Facility characteristics associated with CVDs and type 2 diabetes care integration readiness.
See this image and copyright information in PMC

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