Addressing priority gaps in access and quality of NCD services in primary care settings in Rural Kenya: a participatory approach to intervention development

Abstract

Background: Non-communicable diseases (NCDs), particularly diabetes mellitus (DM) and hypertension (HTN), are projected to surpass communicable diseases as the leading causes of mortality in Africa by 2030. Kenya remains off track to achieving the 25x25 global targets for reducing premature NCD mortality, underscoring the need to strengthen prevention, early detection, and management at the primary healthcare (PHC) level. This study aimed to: (i) conduct a joint analysis of facility-level baseline data to identify gaps in PHC service delivery for DM and HTN, and (ii) collaboratively identify and co-design tailored improvement interventions to enhance access to quality DM and HTN services. Methods: A participatory research (PAR) approach was applied using a five-step procedures: (1) situation analysis; (2) stakeholder engagement to identify service delivery gaps; (3) prioritization of interventions; (4) implementation planning informed by contextual factors; and (5) monitoring and evaluation. Two multistakeholder workshops were conducted involving health management teams, PHC workers, community health promoters, patients, and researchers. Stakeholders were identified using purposive and snowball sampling. Data analysis included quantitative scoring in Excel and qualitative synthesis in Dedoose software. Results: Key gaps identified included limited pre-service training on DM and HTN, insufficient disease-specific knowledge among PHC workers, suboptimal patient care pathways characterized by long waiting times and weak follow-up, and the absence of standardized care packages. Priority interventions co-designed through the participatory approach included targeted PHC worker training, improved access to clinical guidelines, structured mentorship and supervision, strengthened community outreach, and improved availability of diagnostic tools and essential medicines. Conclusion: Participatory approaches to intervention development (PAID) facilitate stakeholder ownership and contextually appropriate solutions, offering a pragmatic pathway to strengthening DM and HTN care at the PHC level.