Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya

Background: Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services. Aim: This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities. Setting: The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020. Methods: This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients were computed by disease type and level of healthcare facility visited. Results: Patients with both diabetes and hypertension incurred higher annual costs (KES 13 149) compared to those with either diabetes (KES 8408) or hypertension (KES 7458). Patients attending dispensaries and other public healthcare facilities incurred less direct costs compared to those who visited private clinics. Furthermore, a higher proportionate catastrophic healthcare expenditure of 41.83% was noted among uninsured patients. Conclusion: Despite this study being conducted in facilities that had an ongoing NCDs care project that increased access to subsidised medication, we still reported a substantially high cost of managing diabetes and hypertension among patients attending primary healthcare facilities in Western Kenya, with a greater burden among those with comorbidities. Contribution: Evidenced by the results that there is enormous financial burden borne by patients with chronic diseases such as hypertension and diabetes; we recommend that universal healthcare coverage that offers comprehensive care for NCDs be urgently rolled out alongside strengthening of lower-level public healthcare systems

Awareness and factors associated with NHIF uptake in four counties in Western Kenya

Background: Kenya is in the process of implementing universal health care whose success and sustainability will be determined by its funding mechanism and by uptake of National Hospital Insurance Fund (NHIF) by its populace. Unfortunately, NHIF enrollment is currently voluntary with a higher uptake among formally employed individuals who represent only 16.4% of the population. To improve the voluntary uptake rate of the scheme, it is important to have increased awareness as well as implement strategies that address barriers to NHIF uptake. Methods: This was a cross sectional community-based survey conducted in Busia, Trans Nzoia, Vihiga and Siaya counties between October 2018 and September 2019.It utilized multistage stratified sampling technique. Interviewer assisted questionnaires were used to collect socio-demographic, socio-economic, Non-Communicable Diseases (NCD) knowledge, NHIF awareness and uptake data. Descriptive and multiple logistic regression statistical analysis were conducted using STATA version 15. Results: From a representative sample of 3597 participants interviewed, NHIF awareness was noted to be 81.5%, with low uptake rate of 21-25% in the four selected counties. Being older than 69 years, having a low level of education and income status as well as lower health risk were significant barriers to NHIF uptake. Conclusion: Despite high rates of NHIF awareness noted in this study, there is still low uptake of this scheme in rural western Kenya especially among those with low socioeconomic status, advanced age and at risk of chronic illnesses. There is need for further qualitative studies to explore contextual factors affecting NHIF uptake in Western Kenya