Rethinking chronic care: how blended patient-centered care delivery and innovative financing models can contribute to achieving universal health coverage-a case study of an integrated approach in Kenya

Abstract

Universal Health Coverage (UHC) aims to ensure all individuals have access to essential health services without financial hardship. Chronic diseases, like hypertension and diabetes, play a critical role in achieving UHC due to their lifelong management needs. This paper examines the implementation of a digital and mobile-based, patient-centered care model aimed at improving care for hypertensive and diabetic patients in Kenya. Between 2018 and 2019, 1626 patients from nine clinics in Nairobi, Kiambu, Nyeri and Vihiga counties were enrolled in an integrated non-communicable disease (NCD) care model including self-management devices for home monitoring, a digital health wallet (M-TIBA) for co-payment and facility-based peer support groups. Follow-up data was collected November-December 2020. Results indicated significantly improved patient outcomes, with 50% of hypertensive and 74% of diabetic patients achieving disease control, compared to 42% and 52% at baseline. Additionally, peer group participation increased adherence to self-monitoring and lifestyle modifications, contributing to better health outcomes. Despite these successes, challenges such as accessing medications and technical issues with digital tools were identified. Financial sustainability and scalability remain critical concerns, particularly in under-resourced settings. The case study highlights the potential of digital health solutions to enhance chronic care and support UHC by improving accessibility and reducing costs. A multifaceted approach, combining digital tools with face-to-face support and addressing structural barriers in healthcare systems, is essential for long-term success. The findings contribute to the broader discourse on integrated care models for NCDs in low-resource settings, underscoring the importance of sustainable financing and innovative care delivery mechanisms.

Keywords: diabetes; digital financing; digital health; home-monitoring; hypertension; low-middle income countries (LMIC); non-communicable disease (NCD); self-management; universal health coverage (UHC).

Figure 1

Integrated NCD management throughout a patient journey.

Figure 2

Reasons reported for unmet need to obtain primary care services in the last 6 months (% of respondents reporting this reason, based on qualitative categorization of responses).

Figure 3

Frequency of BP measurements (top) and BG measurements (bottom) at home (self-reported versus actual entries in Afya pap, %).

Figure 4

Proportion of spending on visit consultations, laboratory investigations and medicines (% by disease/risk factor type).