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

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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.