Layering and scaling up chronic non-communicable disease care on existing HIV care systems and acute care settings in Kenya: a cost and budget impact analysis

Like many countries in sub-Saharan Africa, Kenya is experiencing a rapid rise in the burden of non-communicable diseases (NCDs): NCDs now contribute to over 50% of inpatient admissions and 40% of hospital deaths in the country. The Academic Model Providing Access to Healthcare (AMPATH) Chronic Disease Management (CDM) programme builds on lessons and capacity of HIV care to deliver chronic NCD care layered into both HIV and primary care platforms to over 24,000 patients across 69 health facilities in western Kenya. We conducted a cost and budget impact analysis of scaling up the AMPATH CDM programme in western Kenya using the International Society for Pharmacoeconomics and Outcomes Research guidelines.; Costs of the CDM programme for the health system were measured retrospectively for 69 AMPATH clinics from 2014 to 2018 using programmatic records and clinic schedules to assign per clinic monthly costs. We quantified the additional costs to provide NCD care above those associated with existing HIV or acute care services, including clinician, staff, training, travel and equipment costs, but do not include drugs or consumables as they would be paid by the patient. We projected the budget impact of increasing CDM coverage to 50% of the eligible population from 2021 to 2025, and compared it with the county budgets from 2019.; The per visit cost of providing CDM care was $10.42 (SD$2.26), with costs at facilities added to HIV clinics $1.00 (95$2:11 to $0.11) lower than at primary care facilities. The budget impact of adding 26,765 patients from 2021 to 2025 to the CDM programme was 3,088,928 under constant percent growth, and 3,451,732 under steady-state enrolment. Scaling up under the constant percent growth scenario resulted in 12% cost savings in the budget impact. The county programmatic CDM cost in 2025 was <1% of the county healthcare budgets from 2019.; The budget impact of scaling up AMPATH's CDM programme will be driven by annual growth scenarios, and facility/provider mix. By leveraging task shifting, referral systems and partnering with public and non-profit clinics without NCD services, AMPATH's CDM programme can provide critical NCD care to new, rural populations with minimal financial impact

The Heart of the World

Cardiovascular diseases (CVDs) are the leading cause of mortality globally. Of the 20.5 million CVD-related deaths in 2021, approximately 80% occurred in low- and middle-income countries. Using data from the Global Burden of Disease Study, NCD Risk Factor Collaboration, NCD Countdown initiative, WHO Global Health Observatory, and WHO Global Health Expenditure database, we present the burden of CVDs, associated risk factors, their association with national health expenditures, and an index of critical policy implementation. The Central Europe, Eastern Europe, and Central Asia region face the highest levels of CVD mortality globally. Although CVD mortality levels are generally lower in women than men, this is not true in almost 30% of countries in the North Africa and Middle East and Sub-Saharan regions. Raised blood pressure remains the leading global CVD risk factor, contributing to 10.8 million deaths in 2019. The regions with the highest proportion of countries achieving the maximum score for the WHF Policy Index were South Asia, Central Europe, Eastern Europe, and Central Asia, and the High-Income regions. The Sub-Saharan Africa region had the highest proportion of countries scoring two or less. Policymakers must assess their country’s risk factor profile to craft effective strategies for CVD prevention and management. Fundamental strategies such as the implementation of National Tobacco Control Programmes, ensuring the availability of CVD medications, and establishing specialised units within health ministries to tackle non-communicable diseases should be embraced in all countries. Adequate healthcare system funding is equally vital, ensuring reasonable access to care for all communities

Undergraduate Students’ Satisfaction Levels with Moodle Feedback Features in Selected Public Universities in Kenya

The essence of this study was to establish student’s experiences on Moodle feedback features used in supporting teaching and learning activities in public universities Kenya offering online learning through Moodle system platform. The objectives of the study were: To find out popular Moodle feedback features by undergraduate students and secondly to establish student’s satisfaction levels with Moodle feedback features. The study targeted 17 out of 37 public universities using Moodle platform. A sample of three newly established and three oldest universities were randomly picked. A total of 14,322 second year undergraduate students were targeted since they had completed at least four unit courses online through Moodle system. A stratified sample size of 1,969 participants comprising students and eLearning administrators were involved in data collection exercise which employed questionnaire, interviews and focused group discussion. Descriptive research design approach was used in this study. Data analysis comprised of descriptive and inferential statistics. The study established that there is no significant relationship between Moodle feedback features and student’s satisfaction levels, approximately 62.4 % of students received timely feedback from their instructors, over 93% of learners highly satisfied with databases feedback ,over 50 % of learners are not contented with feedback features found in Moodle system ,eLearning administrators responds to student’s inquiries in time, database response is the most popular Moodle feedback features among undergraduate students in public universities in Kenya and finally course instructors in public universities in Kenya are not keen in providing feedback to learners in time. The study recommends all learning institutions using Moodle system should set up controls to monitor and reward instructors actively involved in feedback activities. Keywords: Moodle, student’s satisfaction, Moodle feedback features, online learning, learning management system, public universities, Kenya. DOI: 10.7176/JEP/14-5-03 Publication date: February 28th 202

testing among diabetic patients in a Kenyan

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Cost and affordability of non-communicable disease screening, diagnosis and treatment in Kenya: Patient payments in the private and public sectors.

The prevalence of non-communicable diseases (NCDs) is rising in low- and middle-income countries, including Kenya, disproportionately to the rest of the world. Our objective was to quantify patient payments to obtain NCD screening, diagnosis, and treatment services in the public and private sector in Kenya and evaluate patients' ability to pay for the services.We collected payment data on cardiovascular diseases, diabetes, breast and cervical cancer, and respiratory diseases from Kenyatta National Hospital, the main tertiary public hospital, and the Kibera South Health Center-a public outpatient facility, and private sector practitioners and hospitals. We developed detailed treatment frameworks for each NCD and used an itemization cost approach to estimate payments. Patient affordability metrics were derived from Kenyan government surveys and national datasets. Results compare public and private costs in U.S. dollars. NCD screening costs ranged from $4 to$36, while diagnostic procedures, particularly for breast and cervical cancer, were substantially more expensive. Annual hypertension medication costs ranged from $26 to$234 and $418 to$987 in public and private facilities, respectively. Stroke admissions ($1,874 versus$16,711) and dialysis for chronic kidney disease ($5,338 versus$11,024) were among the most expensive treatments. Cervical and breast cancer treatment cost for stage III (curative approach) was about $1,500 in public facilities and more than$7,500 in the private facilities. A large proportion of Kenyans aged 15 to 49 years do not have health insurance, which makes NCD services unaffordable for most people given the overall high cost of services relative to income (average household expenditure per adult is $413 per annum).There is substantial variation in patient costs between the public and private sectors. Most NCD diagnosis and treatment costs, even in the public sector, represent a substantial economic burden that can result in catastrophic expenditures

Patient costs of managing complications of hypertension and diabetes (2017 US dollars).

<p>Patient costs of managing complications of hypertension and diabetes (2017 US dollars).</p

Patient costs for hypertension, diabetes, asthma and COPD management (2017 US dollars).

<p>Patient costs for hypertension, diabetes, asthma and COPD management (2017 US dollars).</p

Patient costs of managing complications of hypertension and diabetes (2017 US dollars).

<p>Patient costs of managing complications of hypertension and diabetes (2017 US dollars).</p