Cardiovascular Journal of Africa: Vol 32 No 3 (MAY/JUNE 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 3, May/June 2021

AFRICA

163

However, no system to measure the quality of care provided to

people who have suffered acute cardiac events has been noted.

Essential medicines and interventions

Most of the essential medicines were generally available in

primary-care facilities except for warfarin and clopidogrel.

2015, total cholesterol measurement was generally available at

the primary healthcare level, while CVD risk stratification or

secondary prevention of rheumatic fever and RHD were not

prioritised at this level.

However, in the new NCD strategic plan

2021–25, CVD risk stratification has been prioritised and should

be available later in 2021.

Secondary prevention and management

The STEP survey revealed that 7% of hypertensive persons

received medical treatment in 2015,

whereas no data were

available on high-risk patients with AF being treated with oral

anticoagulants or those with a history of CVD who were taking

aspirin, statin and at least one antihypertensive agent.

Part D: Cardiovascular disease governance

Kenya does not have a national strategy or plan that specifically

addresses CVD and their risk factors or RHD prevention and

control as a priority. However, there is one that focuses on

non-communicable diseases (NCDs) and related risk factors.

6,19

A national surveillance system that includes CVD and their risk

factors has been set up.

8,20

A national tobacco-control strategic plan and a multi-sectoral

co-ordination mechanism have respectively been launched and

implemented.

21,22

Collaborative projects for NCD interventions,

including CVD, have been implemented between the MoH and

non-health ministries and civil societies in Kenya.

23,24

In a report by the World Bank Group and MoH, the benefits

of CVD prevention and control for population health and

the economy have been modelled using the United Nation’s

interagency OneHealth Tool. This software-based health-

modelling tool is used to assess the costs and health benefits of

interventions.

Assessment of policy response

There is no legislation mandating health financing for CVD,

essential CVD medicines at affordable prices or any court

orders protecting patients’ rights and mandating improved CVD

interventions, facilities, health-system procedures or resources.

Legislation is employed in areas where smoking is banned, as

are visible warnings on tobacco packs, advertising, and measures

to protect tobacco control policies from tobacco industry

interference.

Through the solatium fund, that is from taxation

of tobacco or other ‘sin’ products, sustainable funding for CVD

is partially available.

Policies that ensure equitable nationwide access to healthcare

professionals and facilities are also present.

Furthermore, policy

interventions that promote a diet that reduces CVD risk are

available.

Kenya’s Health Act of 2017 mandates implementing

policies to reduce NCDs, including CVD.

No other legislation

is available or in place.

Stakeholder action

Non-governmental organisation advocacy for CVD policies

and programmes,

along with active involvement of patients’

organisations in advocacy for CVD/NCD prevention and

management, are in place.

Advocacy champions along with

patient engagement groups for RHD have been implemented.

Civil society is involved in thedevelopment and implementation

of a national tobacco-control plan.

There is a technical working

group that draws multi-sectoral participation for NCDs/CVD.

24,29

These societies include the Kenya Association for Prevention

of Tuberculosis and Lung Diseases, KCS, Kenya Diabetes

Association, Kenya Society for Haemato-Oncology and the

Non-Communicable Disease Alliance, Kenya.

Specific activities by cardiology professional associations

aimed at 25% reduction in premature CVD mortality by 2025

have been developed,

while no hypertension screening by

businesses at workplaces was reported.

Forthcoming from these data, we summarise Kenya’s strengths,

weaknesses, threats and priorities.

Strengths

National guidelines for most CVD and NCD risk factors have

been developed.

15,17

Through Kenya’s national NCD strategic

plan 2015–20 (the NCD strategic plan 2021–25 will be launched

by May/June 2021), the MoH has envisioned to:

•

establish mechanisms to integrate NCD prevention and

control at national and county level into policies across all

government sectors

•

formulate and strengthen legislations, policies and plans for

preventing and controlling NCDs at county and national

government level

•

promote healthy lifestyles and implement interventions to

reduce the modifiable risk factors for NCDs, which include

unhealthy diets, physical inactivity, harmful use of alcohol,

tobacco use and exposure to tobacco smoke

•

promote and conduct research and surveillance for the

prevention and control of NCDs, which include CVD

•

promote sustainable local and international partnerships for

preventing and controlling NCDs

•

establish and strengthen effective monitoring and evaluation

systems for NCDs and their determinants

•

strengthen health systems for NCD prevention and control

across all levels of the health sector

•

promote and strengthen advocacy, communication and social

mobilisation for NCD prevention and control.

The Kenya Health Policy 2014–30

outlines the direction the

health sector has taken to ensure that the overall status of

health is not only in line with the Constitution of Kenya 2010

but is also significantly improved.

Furthermore, the policy

identifies key areas of focus, which include reducing the burden

of NCDs through strengthening primary healthcare, among

other strategies.

Kenya reported having a nutritional strategy

to control unhealthy diets, by promoting healthy diets.

Since

2013, free maternity services have been introduced, leading the

way for increased access to healthcare by reducing household

expenditure on health