NCDs and poverty: integrating people’s health and economic priorities in Kenya

Through the Healthcare Innovation Programme, Letshego and PCI are piloting innovative and sustainable healthcare approaches in Eastern and Southern Africa. In Western Kenya, PCI is partnering with AMPATH to test a model that addresses both non-communicable diseases (NCDs) and poverty, and the inter-relationships between them in a rural economy.

The key question we are asking is whether establishing a programme of community savings and loans groups and taking portable health clinics to those groups can improve patient outcomes for serious life-changing NCDs such as such as heart and kidney disease, stroke and diabetes. The way that the project works is to link together economic enhancement and health programmes including agri-business, Kenya’s National Health Insurance Fund and the Ministry of Health. Then patients diagnosed with NCDs can be supported to access funds, technology and insurance to both sustain their healthcare and grow their income levels. If successful, the model could be scaled up to other rural areas across Kenya.

This work could not be more timely. The Lancet Task Force on NCDs and Economics has just published research that ‘demonstrated the tight-knit connection between economic growth and controlling NCDs’.  The Taskforce papers show that poverty drives and is driven by NCDs, but that financial protection from high medical costs can break this cycle; …. and that investment in NCD control results in increased economic growth’.

The AMPATH team philosophy echoes this approach. The project has sought to set up a quality system for NCD screening, diagnosis and care through health worker training, regular clinics, patient education, a patient record system and access to affordable drugs and tests.  In a closely integrated way they are also working to enhance the local economy and increase people’s incomes by supporting a range of economic enhancement activities.

The integration of activities that address both the population’s economic priorities which are known and seen and the health priorities which are as yet unknown and unseen (eg uncontrolled high blood pressure) is building community members’ awareness of and capacity to seek: financial risk protection through savings; national health insurance; and early intervention healthcare.

The programme illustrates the multi-dimensional system change that is needed to deliver screening, monitoring and management of NCD care in rural Kenya over the long term.

Debbie Thompson, PCI’s Healthcare Innovation Programme Manager, has recently returned from Kenya and reports on the progress of our partnership in the western region Bungoma County.

“The recent Lancet findings were really brought to life through my three-day visit to the rural NCD programme set up by AMPATH in the Milo catchment of Bungoma county.  During my visit I attended community savings and loan group meetings where participants are each saving in the region of £1-4 per month. Health education, screening and NCD care are also delivered through these groups.  Patients receive support in managing their health, for example they are encouraged by health workers and peers to return regularly for blood pressure monitoring and advice. They are also able to access treatment by paying for their own medication and tests which are delivered to them locally (saving travel costs) through community-based outreach clinics.

It was exciting to see comprehensive NCD care system where none existed before. Already in the 18 months since the start of the project the team will have attended to about 200 cases of diagnosed hypertension or type 2 diabetes, and project data is already showing improved rates of linkage to care through this model.  This care is helping to delay or prevent serious disease such as stroke or heart attack. Thinking of the catastrophes that could be averted for the households of those patients renews our determination to see this project demonstrate proof-of-concept”.