1102Assessing variability among health care facilities in delivering chronic disease management in Kenya

Abstract

Abstract Background Non-communicable diseases (NCDs) account for an estimated 71% of global deaths. In Kenya, 31% of mortality is attributed to chronic illnesses and half of these are premature deaths. The study aimed to assess variation in the capacity of health facilities in Kenya in delivering NCDs diagnosis or management: diabetes, cardiovascular disease, chronic respiratory disease, and cervical cancer screening. Methods A cross-sectional survey of 258 facilities was conducted between June–December 2019. Service-specific indicators: basic equipment, diagnostics, trained staff and guidelines, and essential medicines were captured using a structured questionnaire and summarised as domain scores. All results were weighted to account for the national distribution of facilities. Results More than half of the facilities (60%; 95% CI: 51-70%) had all basic functioning equipment, and only 29% (95% CI: 25-33%) had trained staff and guidelines for diagnosis or management of mental illnesses. Despite this, 54% (95% CI: 46-53%) of all facilities had diagnostic capacity to detect these NCDs. Furthermore, 53% (95% CI: 49-56%) of the facilities across all levels of care had medicines for managing hypertension and diabetes. The overall readiness score for NCDs diagnosis or management was 47% (95% CI: 43–51%) and varied significantly across the levels of care. Conclusions A wide variation in basic resource capacity to diagnose or manage NCDs was noted between levels of care. A gap in the capacity of health facilities to manage chronic illnesses exists across all levels of care in Kenya. Key messages To meet the recommended chronic illnesses management targets, there is a need to strengthen the existing capacity of the health system and bridge the gap across levels of care.