Asiki Gershim, Shao Shuai, Wainana Carol, Khayeka-Wandabwa Christopher, Haregu Tilahun N, Juma Pamela A, Mohammed Shukri, Wambui David, Gong Enying, Yan Lijing L, Kyobutungi Catherine
African Population and Health Research Center, P.O Box 10787-00100, Nairobi, Kenya.
Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden.
BMC Health Serv Res. 2018 May 9;18(1):344. doi: 10.1186/s12913-018-3152-4.
In Kenya, cardiovascular diseases (CVDs) accounted for more than 10% of total deaths and 4% of total Disability-Adjusted Life Years (DALYs) in 2015 with a steady increase over the past decade. The main objective of this paper was to review the existing policies and their content in relation to prevention, control and management of CVDs at primary health care (PHC) level in Kenya.
A targeted document search in Google engine using keywords "Kenya national policy on cardiovascular diseases" and "Kenya national policy on non-communicable diseases (NCDs)" was conducted in addition to key informant interviews with Kenyan policy makers. Relevant regional and international policy documents were also included. The contents of documents identified were reviewed to assess how well they aligned with global health policies on CVD prevention, control and management. Thematic content analysis of the key informant interviews was also conducted to supplement the document reviews.
A total of 17 documents were reviewed and three key informants interviewed. Besides the Tobacco Control Act (2007), all policy documents for CVD prevention, control and management were developed after 2013. The national policies were preceded by global initiatives and guidelines and were similar in content with the global policies. The Kenya health policy (2014-2030), The Kenya Health Sector Strategic and Investment Plan (2014-2018) and the Kenya National Strategy for the Prevention and Control of Non-communicable diseases (2015-2020) had strategies on NCDs including CVDs. Other policy documents for behavioral risk factors (The Tobacco Control Act 2007, Alcoholic Drinks Control (Licensing) Regulations (2010)) were available. The National Nutrition Action Plan (2012-2017) was available as a draft. Although Kenya has a tiered health care system comprising primary healthcare, integration of CVD prevention and control at PHC level was not explicitly mentioned in the policy documents.
This review revealed important gaps in the policy environment for prevention, control and management of CVDs in PHC settings in Kenya. There is need to continuously engage the ministry of health and other sectors to prioritize inclusion of CVD services in PHC.
在肯尼亚，2015年心血管疾病（CVDs）占总死亡人数的10%以上，占伤残调整生命年（DALYs）总数的4%，且在过去十年中呈稳步上升趋势。本文的主要目的是回顾肯尼亚初级卫生保健（PHC）层面与心血管疾病预防、控制和管理相关的现有政策及其内容。
除了对肯尼亚政策制定者进行关键信息访谈外，还在谷歌引擎中使用关键词“肯尼亚国家心血管疾病政策”和“肯尼亚国家非传染性疾病（NCDs）政策”进行了有针对性的文献检索。还纳入了相关的区域和国际政策文件。对所确定文件的内容进行审查，以评估它们与全球心血管疾病预防、控制和管理卫生政策的契合程度。还对关键信息访谈进行了主题内容分析，以补充文献审查。
共审查了17份文件，并采访了3名关键信息提供者。除了《烟草控制法》（2007年）外，所有心血管疾病预防、控制和管理的政策文件均在2013年后制定。国家政策先于全球倡议和指南出台，且内容与全球政策相似。《肯尼亚卫生政策》（2014 - 2030年）、《肯尼亚卫生部门战略和投资计划》（2014 - 2018年）以及《肯尼亚国家非传染性疾病预防和控制战略》（2015 - 2020年）都有关于包括心血管疾病在内的非传染性疾病的战略。还有其他关于行为危险因素的政策文件（《2007年烟草控制法》、《酒精饮料控制（许可）条例》（2010年））。《国家营养行动计划》（2012 - 2017年）有草案版本。尽管肯尼亚有一个包括初级卫生保健的分级医疗系统，但政策文件中未明确提及在初级卫生保健层面整合心血管疾病的预防和控制。
本次审查揭示了肯尼亚初级卫生保健环境中心血管疾病预防、控制和管理政策环境存在的重要差距。有必要持续促使卫生部和其他部门将心血管疾病服务纳入初级卫生保健的优先事项中。
