Challenges in the Management of Chronic Comorbid Conditions (Diabetes and Hypertension) in Kenya

Abstract

Management of chronic conditions requires a comprehensive care provision to persons at risk and those affected by coexisting conditions. Comorbidity of non- communicable diseases pause a new global challenge to the health systems, especially those in resource limited settings. The efforts towards provision of health for all and meeting the global goal of universal health coverage and the big four government agenda requires inclusion of chronic comorbid conditions within the health care settings. This paper describes challenges in the management of chronic comorbid conditions (Diabetes and Hypertension) in primary health care settings in Kenya. The study adopted a constructivist, qualitative approach and a combination of focused ethnography and grounded theory research designs. Ethnography design was used during data collection through participant observation; structured interviews, document analysis and focus group discussion. The study used constant comparative method in the field to ensure rich data collection. The study was conducted in seven health facilities using 40 informants (patients, care providers and administrators) who were purposively selected in Nandi County, Kenya. Data was analyzed using the three phases Open, axial and selective coding as presented in Strauss and Corbin substantive model. The study identified accessibility to chronic care services, community participation and preparedness as the main challenges to self-management of chronic combined diabetes and hypertension. Limited knowledge on comorbid conditions, belief systems, cost implications, and provider-patient perceived factors were also highlighted. Results of this study form the basis for strategic planning towards improving chronic care and improving the quality of life for people living with multiple comorbid chronic conditions.