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

肯尼亚有越来越多的人患有慢性疾病，如高血压、高血糖和癌症。这些疾病占所有死亡人数的很大比例，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（公共诊所或保健中心）对这些慢性病患者进行管理非常重要。然而，肯尼亚目前的重点仍然是医院和专科服务。肯尼亚在初级保健中有慢性病综合管理的良好做法的例子，例如“提供获得保健的学术模式”，为艾滋病毒感染者（这是一种慢性病）提供综合护理。目前，卫生部和世界银行正在推广这一模式的经验，在布西亚县和特恩佐亚县试行一项“慢性病初级卫生综合保健项目”。该项目旨在查明社区中患有高血压、糖尿病、宫颈癌和/或乳腺癌的人，并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），确保他们在适当的服务水平上得到及时转诊和管理，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）一揽子计划中的慢性病福利计划联系起来，以保护人们免受这些慢性病的费用。PIC4C将于2018年10月开始实施，我们与卫生部和世界银行合作，寻求支持将该模式推广到肯尼亚试点地区以外的地区。为了实现这一目标，我们的目标是更好地了解实施过程和在进行试点过程中遇到的挑战。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，以更好地了解试点的实施情况。具体而言，我们将了解参与试点的患者、卫生保健工作者和决策者的经验，我们还将评估健康影响（PIC4C试点中高血压、糖尿病或癌症患者的治疗情况），我们还将评估NHIF慢性护理福利包是否为这些慢性病患者提供经济保护，并提供高质量的护理。最后，也是最重要的是，我们正在与政府成员、卫生保健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在肯尼亚其他地方扩大PIC4C。

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.