Objectives and approach
Still grappling with the control of infectious diseases like HIV, malaria and tuberculosis, the Kenyan health care system was not well equipped to handle the new epidemic of diabetes and other NCDs.
The general upward trend in the occurrence of NCDs has placed a huge burden on the country's health care system, which would still operate under constraints arising from limited capacity and inadequate training of health care workers.
In order to reverse the current state of diabetes management in Kenya WDF has been supporting the Ministry of Public Health and Sanitation (MoH Kenya) with the implementation of the national NCD response in order to reduce morbidity and premature mortality resulting from diabetes and other NCDs by mainstreaming comprehensive, multidisciplinary care in the national health care delivery system. The first phase of the WDF support (grant ref.WDF09-436) was partially based on lessons learnt through the structures laid out by previous WDF funded pilot-stage projects in Kenya (cf grant ref. WDF04-085
A second phase of WDF support was recently approved (cf grant ref.WDF16-1344; details are found below. Separate website page in preparation).
Mainstreaming comprehensive, multidisciplinary diabetes care in the national health care delivery system in Kenya as part of the national NCD response of MoH Kenya.
The Ministry of Public Health and Sanitation would lead the implementation and thus be responsible for the overall coordination of the project with support from the Kenya Diabetes Management and Information Centre (DMI), a leading civil society organisation within the diabetes/NCD field. However, for technical assistance and to ensure cost-effectiveness and sustainability of the project, the Ministry also collaborates with WHO, the Kenya Defeat Diabetes Association, the Kenya Diabetes Study Group and Kenya Diabetes Educators, and other local and national stakeholder groups.
The first phase of support to the MoH Kenya national NCD response programme mainly targeted the strengthening the health care system to address diabetes and other NCDs by building capacity for the health facilities and increasing community participation in health care delivery. Referral and provinicial level facilities and their surrounding communities were the first to be targeted, with district (and primary) level to follow.
The first phase also included the development and adaptation of national diabetes/NCD strategy and clinical guidelines, building institutional capacity at the MoH Kenya Division of Non-Communicable Diseases and the Kenya Diabetes Management and Information Centre, development of a monitoring and evaluation tool and a mobilisation of key stakeholders.
Subsequently, 100 health care providers from nine provincial hospitals were trained on the diabetes/NCD care and the trained health care providers from the provincial hospitals then acted as trainers (ToT model) in the training of 400 health care providers from district hospitals. After the training the health facilities represented by the 500 health care providers trained received various basic equipment as e.g. glucometers, blood pressure meters, weighing scales etc.
Furthermore, in order to strengthen nutrition counselling services, further 300 nutritionists and nurses were trained on various NCD prevention topics such as diet, physical activity, education etc.
Management of hyperglycemia/NCDs in pregnancy was improved through the training of 200 health care providers from 40 maternal and child health clinics. The training focused among other things on the detection, management and referral of hyperglycemia in pregnancy incl the antenatal profiles of all pregnant women attending the clinics. IEC materials was also developed to be used by both the health care providers and the pregnant women.
A number of activities also took place at community level. The preceding community health strategy did not address NCDs, and hence was it the aim of phase 1 of the national NCD response programme support (WDF09-436) to integrate further the community health strategy with the national diabetes/NCD strategy in order to improve community level interventions. This component included the training of 1,200 community health workers and sensitisation of local community committee members on NCDs, and advocacy and raising of awareness has been carried out at community level across Kenya. Another way of raising awareness outlined in phase 1 was the training of 400 teachers at primary and secondary schools. The teachers would then be expected to include healthy lifestyle/NCD education at schools and educate their communities in a longer term perspective.
Results upon completion of phase 1 (grant ref.WDF09-436):
- Development of a national diabetes/NCD strategy and guidelines completed
- Close to 100 diabetes/NCD care facilities established at existing clinics and hospitals
- More than 150,000 patients registered.
- 102 health care professionals from provincial hospitals trained
- 524 health care professionals from district hospitals trained
- 294 nutritionist trained
- 1,200 community health workers trained
- 188 health care professionals trained in GDM/NCDs and pregnancy; More than 3,000 pregnant women screened.
- 400 school teachers from 9 counties trained
- Close to 50,000 people screened for diabetes and other NCDs, 1,800 cases detected
- More than 100 awareness camps and other medica activities were conducted; More than 10 million people reached
Kenya National Diabetes/NCD Response Programme support phase 2 ( grant ref.WDF16-1344)
WDF grant: EUR 750,000
Grant period: 2017-2020
This grant phase will be built on successes and lessons learned during the first phase of collaboration and project implementation (through grant ref WDF09-436). The first phase focused at the national level on developing policy documents and guidelines, capacity building of provincial and district level hospitals to improve delivery of diabetes/NCD care services and strengthening the capacity of the community health structures to respond to the rising burden of diabetes and other NCDs in Kenya.
This second phase, fully aligned with and considered integral to the MoH Kenya National Policy Framework for Prevention and Control of NCDs, shall provide further support to the MoH Kenya national diabetes/NCD response programme and will focus on bringing diabetes/NCDs services closer to where people are living. i.e. through strengthening of primary care. This will be undertaken through capacity building at the level of recently established county governments (noting the recent administrative/decentralisation reform of Kenya) for these to be better prepared to handle the rising burden of diabetes and other NCDs. The project will also focus on generating improved data from health facilities for decision makers in order to inform policy and planning. Furthermore, it will also be geared towards integrating the management and prevention of diabetes combined with GDM/NCDs in pregnancy within the primary health care facilities and through the community intervention component.
By expanding prevention and treatment of diabetes and other related NCDs to primary health level in form of a basic comprehensive package of services a larger part of the population, and proportionally more disadvantaged people will be able to access services and be further included in community level and preventive interventions. This is of critical importance if NCDs including diabetes should be controlled in Kenya.
Results upon completion phase 2 (grant ref. WDF16-1344)
- 825 health care professionals, representing more than 200 primary health centres across Kenya, trained in diabetes/NCD care and prevention
- 825 health care professionals representing 30 county hospitals and more than 200 primary health centres across Kenya trained in GDM/NCDs in pregnancy care and prevention
- More than 600 health care professionals, representing 20 county hospitals (including 16 hospitals from phase 1 support WDF09-436), sensitised on diabetes/NCDs
- 47 county NCD focal person positions established.
- 134 county health management teams sensitised.
- Programme steering committee meetings held and monitoring/evaluation visits conducted
- More than 72,000 people screened for diabetes and other NCDs
- Pregnant women attending county hospital RCH clinics to be reached through newly established NCD/pregnancy services