Task Shifting the Management of Non-Communicable Diseases to Nurses in Kibera, Kenya: Does It Work?

Abstract

BackgroundIn sub-Saharan Africa there is an increasing need to leverage available health care workers to provide care for non-communicable diseases (NCDs). This study was conducted to evaluate adherence to Médecins Sans Frontières clinical protocols when the care of five stable NCDs (hypertension, diabetes mellitus type 2, epilepsy, asthma, and sickle cell) was shifted from clinical officers to nurses.MethodsDescriptive, retrospective review of routinely collected clinic data from two integrated primary health care facilities within an urban informal settlement, Kibera, Nairobi, Kenya (May to August 2014).ResultsThere were 3,554 consultations (2025 patients); 733 (21%) were by nurses out of which 725 met the inclusion criteria among 616 patients. Hypertension (64%, 397/616) was the most frequent NCD followed by asthma (17%, 106/616) and diabetes mellitus (15%, 95/616). Adherence to screening questions ranged from 65% to 86%, with an average of 69%. Weight and blood pressure measurements were completed in 89% and 96% of those required. Laboratory results were reviewed in 91% of indicated visits. Laboratory testing per NCD protocols was higher in those with hypertension (88%) than diabetes mellitus (67%) upon review. Only 17 (2%) consultations were referred back to clinical officers.ConclusionNurses are able to adhere to protocols for managing stable NCD patients based on clear and standardized protocols and guidelines, thus paving the way towards task shifting of NCD care to nurses to help relieve the significant healthcare gap in developing countries.

Nurse‐Led Interventions for Hypertension: A Scoping Review With Implications for Evidence‐Based Practice

“…Six manuscripts met inclusion criteria, were of average or good quality, were retained for the scoping review, and provided the results of four nurse‐led hypertension intervention studies (Hareri, Abebe, & Asefaw, ; Katende, Groves, & Becker, ; Khabala et al., ; Kumar et al., ; Some et al., ; Vedanthan et al., ). The studies were conducted in outpatient settings in Kenya, Ethiopia, and Uganda.…”

“…() and Khabala et al. () appeared to have used data from the same set of clinic records because both were implemented in an “urban informal settlement in the Kibera area of Nairobi” (Some et al., ). Each article had 12 authors, eight of whom were authors on both studies.…”

“…Some et al. () used data from all NCD patients seen from May to August 2014, while Khabala et al. () used data from patients who participated in Medication Adherence Clubs (MACs) from August 2013 through August 2014.…”

“…Four of the six studies (66.7%) were conducted in Kenya (Khabala et al., ; Kumar et al, ; Some et al., ; Vedanthan et al., ). Half of the studies were retrospective and used clinic records as the data source (Khabala et al., ; Kumar et al, ; Some et al., ). Researchers for one study used focus groups to collect data (Vedanthan et al., ), and the remaining studies collected data from nurses participating in hypertension training.…”

Does the Structured Operational Research and Training Initiative (SORT IT) continue to influence health policy and/or practice?

“…In a project run by the MSF in Kibera, Kenya, a study by Some et al showed that nurses were able to adhere to protocols for managing stable non-communicable disease (NCD) patients based on a clear standardized protocol [14]. This contributed to a major revision in the Kibera project guidelines which changed the way NCD patients are managed in those facilities.…”