Urgency to address NCDs in Kenya must remain top-of-mind: How can digital health solutions support patients during and post-pandemic?

Urgency to address NCDs in Kenya must remain top-of-mind: How can digital health solutions support patients during and post-pandemic?

A patient is reviewed by a medical officer at Mukuyuni Sub-County Hospital, Kenya. Photo credit: Urbanus Musyoki

In the midst of the global COVID-19 pandemic, it is hard to think of anything else. And yet, the burden of Non-Communicable Diseases (NCDs) — such as diabetes and hypertension — remains and continues to grow across low- and middle-income countries. Each year, NCDs kill 41 million people, equivalent to 71% of all deaths globally.

In Kenya, over half a million adults were living with diabetes in 2019, and 40% of them were unaware of their condition. Nearly half of hospital admissions and an estimated 55% of deaths in Kenya are associated with an NCD.

Recently, a World Health Organization survey, completed by 155 countries in May 2020, confirmed serious disruptions in prevention and treatment services for NCDs due to the COVID-19 pandemic, noting that low-income countries are most affected. These trends raise great concern, as people living with an NCD are heavily represented among serious cases of the virus. 

Saving lives and improving the health of people living with an NCD calls for integrated, locally-led solutions. In 2019, the Kenyan Ministry of Health began working with Novartis Global Health & Corporate Responsibility, Medtronic Labs, and Management Sciences for Health (MSH) to create Afya Dumu (“lasting health” in Swahili). This unique initiative is aimed at strengthening local health systems to improve community awareness around NCDs, screening and linkage to care, and diagnosis and longitudinal care management for Kenyans living with an NCD.

[(left) A community health volunteer visits with a patient in Makueni County, Kenya. (right) An Afya Dumu team member speaks about the importance of NCD care at a community awareness event. Photo credit: Urbanus Musyoki, Medtronic Labs.](left) A community health volunteer visits with a patient in Makueni County, Kenya. (right) An Afya Dumu team member speaks about the importance of NCD care at a community awareness event. Photo credit: Urbanus Musyoki, Medtronic Labs.

In collaboration with the Ministry of Health’s NCD unit and county health teams in Makueni, Nyeri, and Kakamega, Afya Dumu is building the capacity of health workers and volunteers to carry out facility and community-based interventions that build awareness and encourage patient adherence to NCD care plans. “Our projection is to initiate and manage treatment for more than 30,000 Kenyans living with hypertension and diabetes in the next two years,” says  Dr. Nathan Mulure, Head of Public Affairs, Novartis SSA.

The chronic nature of hypertension and diabetes calls for proper monitoring and ongoing health worker education. “The Afya Dumu trainings for health care workers have provided the impetus and platform to execute continuous medical education targeting hypertension and diabetes,” explains Eric Wanyama, NCD officer for Kakamega County. “Over 300 health care workers were recently employed in our county. These systems will be tremendously helpful as we work to train and mentor more health workers in NCD care and management.”

Alongside refresher clinical training for physicians and other health workers on how to best manage NCDs in line with national treatment guidelines, Afya Dumu has introduced a digital health system for longitudinal and end-to-end care. The system, Medtronic Labs’ Empower Health, consists of an automated blood pressure monitor, glucometer, smartphone or tablet, and accompanying software application used at healthcare facilities or by community health volunteers.

From the app, patients are provided a tailored hypertension and/or diabetes management plan. Patients do not need to own a smartphone or the diagnostic equipment themselves, and can access regular blood pressure and blood glucose checks through the community health worker network or support groups and receive real-time feedback on their measurements. Providers can view patient’s longitudinal data, provide direct patient feedback on their condition via SMS, and write electronic prescriptions — accessible through participating hospital pharmacies. To close the loop, Afya Dumu tele-counselors using the Empower Health system provide support to patients via calls to educate them on NCDs and address adherence challenges.

[A health care worker in Kakamega County, Kenya measures and records a patient’s blood pressure using a digital health system introduced by Afya Dumu. Photo credit: Richard Nyakundi, Medtronic Labs]A health care worker in Kakamega County, Kenya measures and records a patient’s blood pressure using a digital health system introduced by Afya Dumu. Photo credit: Richard Nyakundi, Medtronic Labs

“Prior to the COVID-19 pandemic, access to care and treatment for NCDs in Kenya was challenging and often fragmented, especially for the poor,” says Dr. Ndinda Kusu, MSH Project Director. “The current global crisis further demonstrates the urgent need to strengthen health systems to adequately address the growing burden of chronic illnesses while still meeting unexpected population health needs, such as coronavirus.”

Initiatives such as Afya Dumu are crucial to ensuring that no one falls through the gaps and that patients with hypertension and diabetes remain a priority during the current pandemic. “COVID-19 and related restrictions have compromised activities of trained community health volunteers,” says Wanyama. “We are eager for this outreach to resume. Household screening for NCDs and encouraging people with diabetes, for example, to form support groups as they receive care and information are important opportunities to improve patient health and treatment outcomes.”

Many patients are shying away from health facilities due to the fear of contracting COVID-19. Digitization of health services shifts the care from brick and mortar hospitals to the communities. Digitization also reduces crowding at facilities as patients come at the appointed times only. This has greatly enhanced patient care and customer service efficiency at the facility level.

“While telehealth is not new to Kenya, innovative solutions are needed more than ever,” explains Chemu Lang’at, Medtronic Labs’ Regional Head of Africa. “Afya Dumu directly addresses barriers to care for NCD patients, even more so during the pandemic, where access to essential chronic condition care is key. The ability to utilize Afya Dumu’s digital health, tele-counseling, and virtual support group during the pandemic demonstrate the potential to bolster the health system in Kenya for the long term.”