title: Engaging the Entire Care Cascade in Western Kenya: A Model to Achieve the Cardiovascular Disease Secondary Prevention Roadmap Goals.
abstract: Cardiovascular disease (CVD) is the leading cause of death in the world, with a substantial health and economic burden confronted by low- and middle-income countries. In low-income countries such as Kenya, there exists a double burden of communicable and noncommunicable diseases, and the CVD profile includes many nonatherosclerotic entities. Socio-politico-economic realities present challenges to CVD prevention in Kenya, including poverty, low national spending on health, significant out-of-pocket health expenditures, and limited outpatient health insurance. In addition, the health infrastructure is characterized by insufficient human resources for health, medication stock-outs, and lack of facilities and equipment. Within this socio-politico-economic reality, contextually appropriate programs for CVD prevention need to be developed. We describe our experience from western Kenya, where we have engaged the entire care cascade across all levels of the health system, in order to improve access to high-quality, comprehensive, coordinated, and sustainable care for CVD and CVD risk factors. We report on several initiatives: 1) population-wide screening for hypertension and diabetes; 2) engagement of community resources and governance structures; 3) geographic decentralization of care services; 4) task redistribution to more efficiently use of available human resources for health; 5) ensuring a consistent supply of essential medicines; 6) improving physical infrastructure of rural health facilities; 7) developing an integrated health record; and 8) mobile health (mHealth) initiatives to provide clinical decision support and record-keeping functions. Although several challenges remain, there currently exists a critical window of opportunity to establish systems of care and prevention that can alter the trajectory of CVD in low-resource settings.
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: rajesh.vedanthan@mssm.edu.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: Jemima H
authors.initials: JH
authors.lastname: Kamano
authors.affiliation: Duke Global Health Institute, Duke Clinical Research Institute, and Duke University School of Medicine, Durham, NC, USA.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Bloomfield
authors.affiliation: Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: Imran
authors.initials: I
authors.lastname: Manji
authors.affiliation: Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya; Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, IN, USA.
authors.forename: Sonak
authors.initials: S
authors.lastname: Pastakia
authors.affiliation: Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya.
authors.forename: Sylvester N
authors.initials: SN
authors.lastname: Kimaiyo
mesh_terms: D000553:Ambulatory Care; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D017281:Cost of Illness; D003695:Delivery of Health Care / Q000458:organization & administration; D006040:Goals; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008507:Medically Underserved Area; D055502:Secondary Prevention / Q000458:organization & administration*