In 2018, Kenya’s Ministry of Health (MOH) spearheaded the development of national guidelines for the prevention and management of cardiovascular disease (CVD) to provide a standardized way of managing heart health in the country. With the support of Access Accelerated and the World Heart Federation, the Kenya Cardiac Society (KCS) joined forces with the MOH to disseminate the guidelines to healthcare facilities across Kenya. Lilian Mbau, CEO, explains how the project has developed over time and catalyzed action on the ground.

Peer-to-Peer Learning

The National CVD Guidelines are a key resource to improving health outcomes and equipping health workers at all levels to prevent and manage heart health. Shortly after the guidelines were developed, however, it became apparent that we needed to do more to get the information out there, so we set about disseminating them further and creating greater awareness. The roll-out phase consisted of distributing the guidelines in six of the 47 counties across Kenya. This also included a training component through which we trained health providers who then shared their learnings with other colleagues in their facilities.

Fast-forward a few years and we are now in phase two of the project, which sees us branching out and carrying out activities in four new counties. We have integrated new components, including a robust monitoring and evaluation process through which we will be able to demonstrate the outcomes of the work we have been carrying out. I think this is a crucial part of what we do, as not only will it allow us to spot areas of improvement, but it also goes to show just how much we have achieved.

One thing we’ve learned is that it’s always better to train the healthcare providers in each specific county and let them disseminate the information there. Each county has its own needs, and the healthcare providers know their own local context the best, so this makes the most sense.

Decision makers and policymakers can make a lot of assumptions. That’s why it’s so important to go to facility level and interact with the health workers.

Taking our efforts further afield

Even though we have done really well so far, we still have a lot more work to do. The Kenya Cardiac Society is the only organization on the ground disseminating the guidelines and training the health workers, so we’re still only a quarter of the way to reaching all counties across Kenya. We see that the demand is there, but we’re not able to scale up our efforts given resource constraints on the one hand, and the shortage of health workers on the other.

We’re also conscious of the fact that health workers are often already stretched with their day-to-day roles: trying to provide quality care while contending with often inconsistent access to medication and supply. This lack of essential medical supplies and equipment is a huge challenge to ensuring that the CVD guidelines are followed.

It isn’t just a case of training the health workers but also talking to the county leadership, because they are the ones that provide the supplies and medication. To counter that and in a bid to extend awareness among county leadership, we’re using the bottom-up approach by urging health workers to push leaders directly within the county. I’m pleased to say we are beginning to see the fruits of our labor. Recently, we were invited to sit in on a multistate forum during their revisions of the essential medicine list. And we were able to push for medication to be accessed by the lowest level facilities, such as health centers.

Looking forward 

Fundamentally, we’re really proud of the project and happy to see the guidelines being shared across the country. Yes, we can do more, and we will. Interacting with health workers and people living with CVD has been a real eye-opener to understand what is needed and what needs to be done. Decision makers and policymakers don’t always have all the information.

That’s why it’s so important to go to the facility level, interact with the health workers and really understand what they need in terms of delivering quality cardiovascular care.

Read more interviews in the Access Accelerated report: Key Lessons in Advancing Access to NCD care