Title : Addressing gaps in access and quality of NCD services in rural Kenya through a participatory approach
Abstract:
Background: Projections show non-communicable diseases (NCDs) such as heart disease, cancer, diabetes, and chronic respiratory diseases in Africa will cause more deaths by 2030 than communicable and perinatal diseases combined. However, most countries, including Kenya, are not on track to meeting the 25x25 global target for reducing premature mortality. This underscores the strategic emphasis on enhancing the prevention, early detection, and management of the priority NCDs, which account for a significant portion of global morbidity and mortality. Effective primary-level interventions can reduce the incidence of these diseases. At the same time, early detection increases the chances of successful management, thus contributing to better outcomes, survival rates, and quality of life. To enhance relevance, long-term acceptance, and effectiveness of primary health services for NCDs, this study employed a participatory research design to develop and implement interventions aimed at improving care delivery, specifically focusing on diabetes mellitus (DM) and hypertension (HTN) in primary healthcare (PHC) settings in Kisumu County, Western Kenya.
Methods: We used a participatory research design with a five-step procedure: (1) situation analysis; (2) establish a common vision by gathering stakeholder input to identify gaps and challenges in PHC service delivery for DM and HTN; (3) identify and select priority interventions; (4) plan and implement the identified interventions considering implementation factors; and (5) monitoring and evaluation—set up a system for data collection and analysis, create an action plan, and share findings with stakeholders. Two workshops were conducted with various stakeholders, including health management teams, PHC workers, community health promoters, patients, and researchers. The study was conducted in Seme Sub-County, Kisumu County, Kenya. Stakeholders were identified using purposive and snowball sampling. Data analysis included quantitative scoring in Excel and qualitative synthesis in Dedoose software.
Results: Four main gaps identified were: (1) insufficient college training for health workers in managing DM and HTN; (2) knowledge gaps regarding DM and HTN diseases; (3) inadequate patient care, characterized by long wait times and insufficient follow-up; and (4) a lack of standardized care packages for DM/HTN patients. The recommended priority interventions included: training PHC workers, improving access to treatment guidelines, providing mentorship and supervision, organizing community outreach, and ensuring the availability of diagnostics tools and essential medication. The main challenges identified include modifiable challenges such as non-need-based training, inconsistent support systems, and poor documentation, which can be addressed with little to moderate investments, alongside non-modifiable challenges like inadequate infrastructure, lack of medication and supplies which requires substantial long-term investments; recommendations include training PHC workers and operationalizing community outreach programs.
Conclusion: The study underscores the value of the participatory approach to intervention development (PAID), engaging stakeholders in identifying service needs, interventions, and local factors to enhance DM and HTN care.
Key words: primary healthcare, non-communicable diseases, diabetes, and hypertension.
