The Problem

Approximately, 39% of all deaths in the country are caused by non-communicable diseases (NCDs) up from 27% in 2014 and projected to rise to 47% by 2030 without any intervention. Cardiovascular diseases (CVDs) and Diabetes are the top killers and contribute to 42% of NCD deaths.

Diabetes

More than 8,700 diabetes-related deaths were registered in Kenya in 2015, and the deaths will continue increasing given that the prevalence of diabetes is projected to rise from 3.1% in 2019 to 4.4% by 2035.

Hypertension

Additionally, the prevalence of hypertension has increased over the last decade with an estimate that 1 in 4 Kenyans are hypertensive and more than half of those above 40 years

Goals

Reduce mortality and morbidity caused by the diabetes and hypertension.

Categories of intervention

1.     Patients unaware and undiagnosed.

2.     Patients aware and not on treatment.

3.     Patients on treatment and not achieving control

4.     Lack of data systems

Diabetes

Diagnosis

•     Type 1 & Type 2 - Blood sugar

Treatment

•     Type 1- Insulin

•     Type 2- OGLAs & insulin

Hypertension

Diagnosis

•     Blood pressure

Treatment

•     Based on the patients indications and co-morbidities

Gaps on the continuum of care

Service delivery:

Screening and Diagnosis

·        Weak patient triaging, screening & identification

·        Lack of screening and diagnostic equipment and consumables

·        Weak Linkage within the facility-referral systems

·        Limited opportunities for community screening

·        Patient awareness and education

·        Not enough personnel at facility service points

·        Low Index of suspicion at triage/screening especially for T1 DM

·        Delayed diagnosis pathway

Treatment and Monitoring

·        Treatment protocol and guideline are not standardized, harmonized and clear

·        Multi-disciplinary Teams not constituted in the management of NCDs in facilities

·        Treatment and care is not decentralized to PHC level

·        Lack of Knowledge and skills based on NCD patient care and management

·        Shortage of drugs at the facility level

·        Suboptimal drugs- Unavailability of FDC for optimal Tx at facility level,

·        Costly optimal treatment options e.g LAAIs

·        Inadequate self-monitoring equipment and consumables for patient with T1 & advanced T2

·        DM & HTN care is not integrated at different service delivery points with weak referral systems affecting longitudinal care and tracking of patient.

Supply Chain

·        Gaps in NCD (DM/HTN) commodities forecasting at national and county level.

·        Stock outs

·        Unclear national and county procurement timelines and process.

Data systems

·        Lack of recording and reporting tools with optimal utilizations

·        Reporting gaps at KHIS

·        Inefficient utilization of appointment and follow-up tools

·        Unavailability of data for decision making

Finance

·        Lack of visibility into county allocation budget set for health

·        Fewer individuals on insurance cover (increase package of diabetes commodities and care)

Interventions Framework

Service delivery:

·        Mainstream screening at all service points.

·        Review of the clinical guidelines and treatment protocols and ensure MOH ownership.

·        Ensure the revised guidelines, protocols & algorithms are disseminated to health workers.

·        Establish 5 centers of excellence for management of DM & HTN

·        Develop a decentralization framework for the management of DM and HTN services (diagnosis, treatment initiation, monitoring of stable patients, commodity provision) to PHC level.

·        Develop & roll-out health worker training and continuous education

·         on diabetes/HTN management, in line with revised guidelines and protocol.

·        Ensure mentoring, monitoring and supportive supervision

·        Leverage on community health strategy for awareness and prevention

Supply Chain

·        Establish structures in forecasting and Quantification at national and county level

·        Address key supply chain bottleneck

·        Ensure for low-cost suppliers to participate in tenders process.

Data systems

·        Ensure reporting tools are available at the facilities.

·        Capacity build HCW’s to improve reporting and utilization of data.

·        Develop a feedback mechanism on data management systems between county and national level

Finance

·        Leverage GF application to increase resource available for commodity, reagent and equipment.

·        Support MoH to advocate for increased investment in DM & HTN management

·        Advocate for increased insurance coverage for full package of DM & HTN commodities and care.