Scaling up the Primary Health Integrated Care Project for Chronic Conditions in Kenya: an implementation research project

肯尼亚面临着越来越多的慢性病患者，如高血压（高血压）、高血糖（糖尿病）和癌症。这些疾病在肯尼亚所有死亡人数中占很大比例，并对肯尼亚的经济产生重要影响。此外，由于穷人无法支付这些疾病的治疗费用，他们特别容易受到伤害。在社区和初级保健（公共药房或保健中心）对这些慢性病患者进行管理非常重要。然而，目前在肯尼亚，重点仍然是医院和专科服务。肯尼亚有一些在初级保健中综合管理慢性病的良好做法的例子，如“提供保健机会的学术模式”，为艾滋病毒感染者（这是一种慢性病）提供综合护理。卫生部和世界银行目前正在借鉴这一模式的经验，在布西亚和恩佐亚海峡县试行“慢性病初级保健综合护理项目”。该项目旨在查明社区中的高血压、糖尿病、宫颈癌和/或乳腺癌患者，确保他们及时转诊并在适当的服务水平上得到管理，使用一系列工具和方法（例如治疗方案、决策支持工具、电子健康记录和卫生工作者培训），以确保患者得到高质量的护理。它还将患者与国家医院机构基金（NHIF）的慢性病福利包联系起来，以保护人们免受这些慢性病的费用。PIC 4C将于2018年10月开始实施，并与卫生部和世界银行合作，我们寻求支持该模型在肯尼亚试点地区之外的推广。为实现这一目标，我们的目标是更好地了解实施过程和在试点过程中发现的挑战。在我们的项目期间，我们将进行访谈，分析来自卫生设施和患有这些慢性病的家庭的数据，以更好地了解试点是如何实施的。具体来说，我们将了解参与试点的患者、医护人员和决策者的经验，我们还将评估健康影响（PIC 4C试点中的高血压、糖尿病或癌症患者的治疗情况），我们还将评估NHIF慢性病护理福利包是否为这些慢性病患者提供经济保护，并提供优质护理。最后，也是最重要的是，我们正在与政府成员、医疗机构管理人员和患者密切合作，以确保我们的研究课程能够帮助在试点研究之外的肯尼亚其他地方扩大PIC 4C。

Kenya faces an increasing number of people with chronic diseases such as high blood pressure (hypertension), high blood sugar (diabetes) and cancer. These diseases account for a large proportion of all deaths and have an important economic impact in Kenya. Also, because poor people cannot pay for the treatment of these diseases they are especially vulnerable. Management of people with these chronic diseases at the community and primary care(public dispensaries or health centres ) is very important. However,currently in Kenya the emphasis remains on hospitals and specialist services. There are examples of good practice of chronic disease integrated management at primary care in Kenya such as the 'Academic Model Providing Access to Health Care', to provide integrated care for people with HIV (which is a chronic disease). Experiences from this model are now being taken forward by the Ministry of Health (MOH) and the World Bank (WB) to pilot a 'Primary Health Integrated Care Project for Chronic Conditions'(PIC4C) in Busia and Trans Nzoia counties. This project aims to identify people with hypertension, diabetes, cervical and/or breast cancer in the community and ensure their timely referral and management at the appropriate service level, using a range tools and approaches (e.g. treatment protocols, decision support tools, electronic health records and training of health workers) to ensure that the care patients receive is of high quality. It also links patients with a chronic disease benefit package from the National HospitalInstitutional Fund (NHIF) package to protect people from the costs of these chronic diseases. PIC4C will be implemented from October 2018 and working in partnership with the MOH and the WB we seek to support the scale up of the model across Kenya beyond the pilot sites. To achieve this, we aim to better understand the implementation process and challenges found during the conduct of the pilot. During our project we will conduct interviews, analyse data from the health facilities and household with people with these chronic diseases to better understand how the pilot is implemented. Specifically, we will understand the experiences of patients, health care workers and decision makers involved in the pilot, we will also assess the health impact (how well the patients with high blood pressure, diabetes or cancer included in the PIC4C pilot are treated), and, we will also evaluate whether the NHIF chronic care benefit package protects financially to patients with these chronic diseases and also provides good quality care. Finally,and most importantly, we are working very closely with members of the government, health care facilities managers and patients to ensure that our study lessons can help to scale up the PIC4C in other places in Kenya beyond the pilot study.