Access to Medicines for Non-Communicable Diseases (NCDS) during COVID-19 in Kenya: A Descriptive Commentary

Kiragu, Zana Wangari; Gathecha, Gladwell; Mwangi, Martin; Ndegwa, Zachary; Pastakia, Sonak D.; Nyagah, Daniel; Cizungu, Richard N; Mutwiri, Mariana Takah; Ndolo, Meshack; Wirtz, Veronika J.

doi:10.1080/23288604.2021.1984865

Cited by 9 publications

(11 citation statements)

References 8 publications

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“…The included studies were conducted in six LMICs: Peru [ 35 ], Brazil [ 36 ], India [ 37 - 44 ], Kenya [ 45 ], Bosnia and Herzegovina [ 46 ], and Mexico [ 47 ]. The highest number of studies were from India (n = 9) and Brazil (n = 2), while the rest were from one country study each.…”

Section: Resultsmentioning

confidence: 99%

“…Most studies employed a prospective cohort [ 35 , 36 , 39 - 41 , 47 , 48 ] or cross-sectional design [ 37 , 42 , 46 ]. Two studies used a qualitative design [ 44 , 45 ] and the rest were clinical audits/review [ 38 ] and a field-based report [ 43 ]. Table 2 summarizes the included reports’ characteristics.…”

Section: Resultsmentioning

confidence: 99%

“…We identified four different health systems adaptations and reconfiguration to improve access to NCDs: telemedicine or teleconsultation strategies [ 35 - 38 , 40 , 41 , 43 , 44 , 46 - 48 ], NCD medicines drop-off points [ 45 ], decentralization of hypertension follow-up services and provision of free medication to peripheral health centers [ 39 ], and diabetic retinopathy (DR) screening with a handheld smartphone-based retinal camera [ 36 ]. Telemedicine was the most introduced intervention among the four.…”

Section: Resultsmentioning

confidence: 99%

“…Six studies reported on mental health disorders [ 38 , 41 , 43 , 44 , 46 , 48 ], four focused on people living with diabetes [ 35 , 36 , 45 , 47 ], and the rest were related to cancer [ 37 ], hypertension [ 39 , 45 ], and Parkinson disease [ 40 ]. For diabetes care, most of the adaptations were telemedicine strategies [ 35 , 36 , 47 ], while others comprised NCD medicines drop-off points [ 45 ] and DR screening with a handheld device [ 36 ]. Telepsychiatry was also used to address the needs of people with psychiatry and mental health disorders [ 38 , 41 , 43 , 44 , 46 , 48 ].…”

Section: Resultsmentioning

confidence: 99%

“…One study reported on the use of telemedicine to follow up on patients with Parkinson disease [ 40 ]. Two different interventions focused on providing care for people with hypertension namely the use of NCD medicine drop-off points [ 45 ], and decentralization of hypertension follow-up services from major health care delivery points to peripheral health centers [ 39 ]. One study reported on health systems adaptations to improve cancer care.…”

Section: Resultsmentioning

confidence: 99%

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Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review

et al. 2023

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Background During the COVID-19 pandemic, access to health care for people living with non-communicable diseases (NCDs) has been significantly disrupted. Calls have been made to adapt health systems and innovate service delivery models to improve access to care. We identified and summarized the health systems adaptions and interventions implemented to improve NCD care and their potential impact on low- and middle-income countries (LMICs). Methods We comprehensively searched Medline/PubMed, Embase, CINAHL, Global Health, PsycINFO, Global Literature on coronavirus disease, and Web of Science for relevant literature published between January 2020 and December 2021. While we targeted articles written in English, we also included papers published in French with abstracts written in English. Results After screening 1313 records, we included 14 papers from six countries. We identified four unique health systems adaptations/interventions for restoring, maintaining, and ensuring continuity of care for people living with NCDs: telemedicine or teleconsultation strategies, NCD medicine drop-off points, decentralization of hypertension follow-up services and provision of free medication to peripheral health centers, and diabetic retinopathy screening with a handheld smartphone-based retinal camera. We found that the adaptations/interventions enhanced continuity of NCD care during the pandemic and helped bring health care closer to patients using technology and easing access to medicines and routine visits. Telephonic aftercare services appear to have saved a significant amount of patients’ time and funds. Hypertensive patients recorded better blood pressure controls over the follow-up period. Conclusions Although the identified measures and interventions for adapting health systems resulted in potential improvements in access to NCD care and better clinical outcomes, further exploration is needed to establish the feasibility of these adaptations/interventions in different settings given the importance of context in their successful implementation. Insights from such implementation studies are critical for ongoing health systems strengthening efforts to mitigate the impact of COVID-19 and future global health security threats for people living with NCDs.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review

et al. 2023

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Policies for type 2 diabetes and non-communicable disease management during the COVID-19 pandemic in Kenya and Tanzania: a desk review and views of decision-makers

Mohamed,

Kisia,

Mashiashi

et al. 2024

BMJ Open

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BackgroundThe COVID-19 pandemic caused disruptions in care that adversely affected the management of non-communicable diseases (NCDs) globally. Countries have responded in various ways to support people with NCDs during the pandemic. This study aimed to identify policy gaps, if any, in the management of NCDs, particularly diabetes, during COVID-19 in Kenya and Tanzania to inform recommendations for priority actions for NCD management during any future similar crises.MethodsWe undertook a desk review of pre-existing and newly developed national frameworks, policy models and guidelines for addressing NCDs including type 2 diabetes. This was followed by 13 key informant interviews with stakeholders involved in NCD decision-making: six in Kenya and seven in Tanzania. Thematic analysis was used to analyse the documents.ResultsSeventeen guidance documents were identified (Kenya=10; Tanzania=7). These included pre-existing and/or updated policies/strategic plans, guidelines, a letter, a policy brief and a report. Neither country had comprehensive policies/guidelines to ensure continuity of NCD care before the COVID-19 pandemic. However, efforts were made to update pre-existing documents and several more were developed during the pandemic to guide NCD care. Some measures were put in place during the COVID-19 period to ensure continuity of care for patients with NCDs such as longer supply of medicines. Inadequate attention was given to monitoring and evaluation and implementation issues.ConclusionKenya and Tanzania developed and updated some policies/guidelines to include continuity of care in emergencies. However, there were gaps in the documents and between policy/guideline documents and practice. Health systems need to establish disaster preparedness plans that integrate attention to NCD care to enable them to better handle severe disruptions caused by emergencies such as pandemics. Such guidance needs to include contingency planning to enable adequate resources for NCD care and must also address evaluation of implementation effectiveness.

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Frontline health workers’ experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study

Baatiema,

de-Graft Aikins,

Koram

et al. 2024

BMJ Open

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BackgroundThe COVID-19 pandemic has significantly impacted frontline health workers. However, a neglected dimension of this discourse was the extent to which the pandemic impacted frontline healthcare workers providing non-communicable diseases (NCDs) care. This study aims to understand the experiences of healthcare workers with no prior exposure to pandemics who provided care to people living with NCDs (PLWNCDs).MethodsA qualitative study design was employed, using a face-to-face in-depth interviews. Interviews were conducted in primary healthcare facilities in three administrative regions of Ghana, representing the Northern, Southern and Middle Belts. Only frontline health workers with roles in providing care for PLWNCDs were included. Purposive snowballing and convenience sampling methods were employed to select frontline health workers. An open-ended interview guide was used to facilitate data collection, and thematic content analysis was used to analyse the data.ResultsA total of 47 frontline health workers were interviewed. Overall, these workers experienced diverse patient-driven and organisational challenges. Patient-level challenges included a decline in healthcare utilisation, non-adherence to treatment, a lack of continuity, fear and stigma. At the organisational levels, there was a lack of medical logistics, increased infection of workers and absenteeism, increased workload and burnout, limited motivational packages and inadequate guidelines and protocols. Workers coped and responded to the pandemic by postponing reviews and consultations, reducing inpatient and outpatient visits, changing their prescription practices, using teleconsultation and moving to long-shift systems.ConclusionThis study has brought to the fore the experiences that adversely affected frontline health workers and, in many ways, affected the care provided to PLWNCDs. Policymakers and health managers should take these experiences into account in plans to mitigate the impact of future pandemics.

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Access to Medicines for Non-Communicable Diseases (NCDS) during COVID-19 in Kenya: A Descriptive Commentary

Cited by 9 publications

References 8 publications

Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review

Health system adaptions to improve care for people living with non-communicable diseases during COVID-19 in low-middle income countries: A scoping review

Policies for type 2 diabetes and non-communicable disease management during the COVID-19 pandemic in Kenya and Tanzania: a desk review and views of decision-makers

Frontline health workers’ experiences of providing care for people living with non-communicable diseases during the COVID-19 pandemic in Ghana: a qualitative study

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