Challenges in policy reforms for non-communicable diseases: the case of diabetes in Kenya

Abstract

Background: The 2011 UN declaration on non-communicable diseases (NCDs) recognized their importance as a global health issue, particularly for low-and middle-income countries. The extent to which these countries address policy implementation gaps in the face of resource limitations and competing priorities remains largely unexplored. Objective: This qualitative study presents Kenya's experience of translating the UN declaration to national policies for diabetes prevention and control. Methods: Policy documents published between 2006 and 2016 were analyzed. Thirty-two documents were included in the analysis. Interviews with six purposively selected policy stakeholders at multiple levels of decision-making were conducted. Emerging themes were deconstructed into a policy analysis triangle. Results: Diabetes-specific policies already existed in Kenya before 2011, suggesting successful advocacy work by diabetes interest groups. The 2011 UN declaration subsequently coincided with a period of political transition in Kenya, opening policy windows that the diabetes community leveraged to trigger political drive against prevailing challenges. The postdeclaration period reflected a transition from diabetes-specific policies to a wider NCD agenda. Most of the documents and national strategies aligned strongly with international documents, however, were based on scant local evidence. The implementation process was largely health-sector driven. The non-health sector remained largely uninvolved, contrary to global recommendations. This, in addition to fragmented health governance and weak monitoring systems, continues to undermine existing gains and efforts to fight diabetes and NCDs on a wider scale. Conclusions: In Kenya, a major gap remains between how diabetes is addressed within the NCD policy agenda and tackling diabetes in reality, with respect to local implementation processes. More emphasis on population-wide prevention and inclusion of the non-health sector could help to cascade national efforts to the grassroots level. A concerted effort from the highest political level is needed to address overarching NCD drivers while maintaining health system improvement strategies.

Noncommunicable Disease (NCD) strategic plans in low- and lower-middle income Sub-Saharan Africa: framing and policy response

“…With the growing visibility of NCDs, the last decade has seen a dramatic expansion in the number of countries developing NCD strategic plans in Africa [8]. Prior case studies have documented a heavy reliance on global policies including the WHO's Global Action Plan for the Prevention and Control of NCDs, which may account for our findings [31,35,36]. While global guidance has been credited with the expansion in national plans, it does not guarantee success.…”

“…Researchers have documented weak political will and limited technical capacity of local NCD units as challenges in engaging and coordinating stakeholders from outside of the health sector in national NCD response efforts [ 32 ]. Limited engagement in both formulation and implementation, in turn, has been linked to delays or failures of the resulting policies [ 35 ].…”

“…Researchers elsewhere have argued that this slow progress reflects a failure to adequately localize the national response, due to gaps in local data and limited involvement of stakeholders outside of the health sector [ 32 , 35 , 39 , 40 ]. Others have identified a poor alignment between NCD-specific and sector-wide plans in terms of goals, financial resource allocation, and implementation details [ 8 ].…”

Examination of Mortality Due to Diabetes and Assessment of Diabetes-Related Healthcare Services in Rural Western Kenya

“…To combat these trends Kenya has developed guidelines to standardize diabetes diagnosis and care (Table 1) [12]. However, the country has had di culties in implementing the policies at the clinical practice level due to limited resources and lapses in health care governance [13]. Continue lifestyle modi cations with medications.…”

War on Diabetes in Singapore: A Policy Analysis

“…This study thus aims to contribute towards addressing this knowledge gap by using the policy triangle framework, articulated by Walt and Gilson (10), to analyse the WoD policy response. The policy triangle framework has been widely applied to a variety of health policy concerns, including health sector reforms and public health and in many different countries (11,12). It focuses on the content of the policy, the actors involved in the policy change, the processes on developing and implementing change, and the context within which the policy is developed (10).…”