Utilization of Cardiovascular-related Services at Public Primary Health Care Centers in Limited Resource Settings in Kenya | Duke Kunshan University

Utilization of Cardiovascular-related Services at Public Primary Health Care Centers in Limited Resource Settings in Kenya

Cardiovascular disease (CVD) is increasingly becoming a serious public health challenge in Kenya, contributing not only to mounting mortality, morbidity, and healthcare expenditure, but also widening health disparity and lost productivity, which in turn undermine the long-term development of the East African powerhouse.

Hypertension and diabetes are leading CVD risk factors presented at primary healthcare (PHC) centers in Kenya; however inadequate screening, underdiagnoses, and suboptimal control of these risk factors have been found evident in both national surveys and small contextual studies, especially in limited-resource settings. Public PHC centers in Kenya, providing subsidized healthcare at community levels, are uniquely positioned to curb the CVD epidemic through early prevention and ongoing management, especially for the underprivileged.

Despite a newly formed enabling policy environment focusing on tackling non-communicable disease with a primary-care approach, there is currently a paucity of literature on the role that primary care plays in the prevention and management of cardiovascular diseases in Kenya. Our study aims to fill such gap by understanding CVD patients’ utilization experience at public PHC centers, in order to form evidence-based policy recommendation for targeted health system strengthening.

This cross-sectional descriptive study aims to explore the PHC utilization experience of adults who suffered from at least one of the four conditions of hypertension, diabetes, heart diseases, and stroke.

Our study was conducted in five public health centers in urban slum settlements (Korogocho and Viwandani) in Nairobi County and five public health centers in the rural areas of Machackos County. A mixed method approach was adopted as we conducted face-to-face interviews with 105 patients who sought CVD-related care at the  10 facilities using a structured questionnaire and further in-depth interviews with 12 out of the 105 patients using a semi-structured interview guide. Data on accessibility (travel time and wait time), affordability (travel cost, Out-of-Pocket (OOP) expenditure, and ongoing medication cost), procedures received, medication use, emergency knowledge, and overall satisfaction was collected to gain a holistic view of the utilization experience of the primary health care for their CVD conditions.