Scaling up the primary health integrated care project for chronic conditions in Kenya: study protocol for an implementation research project

Abstract

IntroductionAmid the rising number of people with non-communicable diseases (NCDs), Kenya has invested in strengthening primary care and in efforts to expand existing service delivery platforms to integrate NCD care. One such approach is the AMPATH (Academic Model Providing Access to Healthcare) model in western Kenya, which provides the platform for the Primary Health Integrated Care Project for Chronic Conditions (PIC4C), launched in 2018 to further strengthen primary care services for the prevention and control of hypertension, diabetes, breast and cervical cancer. This study seeks to understand how well PIC4C delivers on its intended aims and to inform and support scale up of the PIC4C model for integrated care for people with NCDs in Kenya.Methods and analysisThe study is guided by a conceptual framework on implementing, sustaining and spreading innovation in health service delivery. We use a multimethod design combining qualitative and quantitative approaches, involving: (1) in-depth interviews with health workers and decision-makers to explore experiences of delivering PIC4C; (2) a cross-sectional survey of patients with diabetes or hypertension and in-depth interviews to understand how well PIC4C meets patients’ needs; (3) a cohort study with an interrupted time series analysis to evaluate the degree to which PIC4C leads to health benefits such as improved management of hypertension or diabetes; and (4) a cohort study of households to examine the extent to which the national hospital insurance chronic care package provides financial risk protection to people with hypertension or diabetes within PIC4C.Ethics and disseminationThe study has received approvals from Moi University Institutional Research and Ethics Committee (FAN:0003586) and the London School of Hygiene & Tropical Medicine (17940). Workshops with key stakeholders at local, county, national and international levels will ensure early and wide dissemination of our findings to inform scale up of this model of care. We will also publish findings in peer-reviewed journals.

Understanding the treatment burden of people with chronic conditions in Kenya: A cross-sectional analysis using the Patient Experience with Treatment and Self-Management (PETS) questionnaire

“…About half of our respondents reported a monthly income of less than KShs 3,000, which is lower than the national poverty line of KShs 3,252 for rural populations as defined by the Kenyan National Bureau of Statistics [42], although similar to poverty levels reported for Busia and Trans Nzoia counties, at 61% and 50%, respectively (2018) [20]. However, it is important to note that household income data were self-reported and not comprehensively captured by the survey; more than half of respondents were farmers (56%), whose household income is difficult to estimate with considerable monthly fluctuation.…”

“…This study was set in the context of a wider implementation study that sought to understand the impact and scalability of a novel approach to integrate promotive, preventive, and curative care for diabetes, hypertension, cervical and breast cancer at the primary health care level (Primary Health Integrated Care Project for Chronic Conditions, PIC4C) within the Academic Model Providing Access to Healthcare (AMPATH) programme in Western Kenya [20]. PIC4C was launched in 2018 by the Kenyan Ministry of Health in partnership with AMPATH/Moi, Access Accelerated and the World Bank.…”

“…The overall study was set in Busia and Trans Nzoia counties in Western Kenya, where the PIC4C model of care was implemented across a total of 73 facilities (public dispensaries, health centres and county referral hospitals) [20]. We sought to capture a wide range of people with hypertension and/or diabetes in terms of age, gender and broad socio-demographic status and who were registered with PIC4C facilities.…”

Examining the Responsiveness of the National Health Insurance Fund (NHIF) to People Living with Hypertension and Diabetes in Kenya: A qualitative study

“…This study is part of a larger study that seeks to inform and support the scale-up of the Primary Health Integrated Care Project for Chronic Conditions (PIC4C) model for integrated management of people with hypertension, diabetes, and breast and cervical cancers in Kenya [36]. Alongside other work packages in the larger study, our work package has three overarching aims: i) to measure the effectiveness of the NHIF national scheme benefit package to provide financial risk protection to individuals with chronic diseases; ii) to examine the extent to which the NHIF national scheme benefit package is responsive to the needs of individuals with and hypertension;…”

“…We conducted four focus group discussions (FGDs) with NCD patients in Busia (1 rural and 1 urban) and Trans Nzoia (1 rural and 1 urban) counties who were enrolled in the NHIF national scheme. FGD participants were selected from an existing PIC4-C scale-up study database (matched cohort wave 2) [36]. FGD participants were eligible if 1) they were actively enrolled in NHIF at the time of recruitment, 2) they had either diabetes or hypertension or comorbid (both diabetes and hypertension), 3) were more than 18 years of age, and 4) if they consented to participate in the study.…”