Strategies for Effective Stakeholder Engagement in Strengthening Referral Networks for Management of Hypertension Across Health Systems in Kenya

Abstract

Background: Ineffective referral networks in low-and middle-income countries hinders access to evidencebased therapies by hypertensive patients, leading to high cardiovascular mortality and morbidity. The STRENGTHS (Strengthening Referral Networks for Management of Hypertension Across Health Systems) study evaluates strategies to improve referral processes utilizing the International Association of Public Participation framework to engage stakeholders. Objectives: This study sought to identify and engage key stakeholders involved in referral of patients in the Ministry of Health, western Kenya. Methods: Key stakeholders involved in policy formulation, provision, or consumption of public health care service were mapped out and contacted by phone, letters, and emissaries to schedule meetings, explain research objectives, and obtain feedback. Results: Key stakeholders identified were the Ministry of Health, the Academic Model Providing Access to Healthcare, health professionals, communities and their leadership, and patients. Engaging them resulted in permission to contact research in their areas of jurisdiction and enabled collaboration in updating care protocols with emphasis on timely and appropriate referrals. Conclusions: Early stakeholder identification and engagement using the International Association of Public Participation model eased explanation of research objectives, building consensus, and shaping the interventions to improve the referral process.

Magnitude and determinants of self-referrals among women seeking skilled birth attendance services: a cross-sectional hospital-based study in Marsabit County, Kenya

“…5,6 In Kenya's health system, community level primary health care facilities, which are often run by trained nurses/midwives or clinical officers, are supposed to offer skilled birth services and appropriately refer women with childbirth related complications to hospitals categorized as referral hospitals. 7 This targets to improve efficiency and as a result, health service coverage expansion in systems that experiences health workforce and resource shortages. 8 Despite the low levels of health spending, through universal health coverage, there is a strong focus on improved accessibility to services through the government enacting policies to reduce financial barriers to access to basic health services.…”

Effect of Nurse-Based Management of Hypertension in Rural Western Kenya

“…A central principle of this program was leveraging the existing infrastructure and task redistribution strategy implemented by AMPATH for the treatment and prevention of HIV [ 14 ]. In addition to task redistribution, the AMPATH Chronic Disease Management Program involves a multicomponent care package that includes clinical decision support using health information technology [ 34 ], consistent and secure medication supply [ 22 ], linkage and retention activities [ 23 ], community and stakeholder engagement [ 35 ], and social support for patients. This multicomponent package aligns with all of the World Health Organization health system building blocks: service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance [ 36 ].…”

Human-Centered Implementation Research: A New Approach to Develop and Evaluate Implementation Strategies for Strengthening Referral Networks for Hypertension in western Kenya

“…In collaboration with the Kenyan Ministry of Health, AMPATH has established a Chronic Disease Management (CDM) Program, which has enrolled over 40,000 patients with hypertension at over 70 health facilities spanning all levels of the health system (20,21). The multicomponent CDM care delivery package includes task redistribution (22), clinical decision support using HIT (23), consistent and secure medication supply (24), linkage and retention activities (25), community and stakeholder engagement (26), and social support for patients.…”