Abstract
Background: Integrated care is increasingly recognised as a key strategy for the management of multimorbidity. However, evidence on the factors associated with the implementation of integrated care models in low- and middle-income countries (LMICs) remains limited. We explored stakeholders' perceptions on existing challenges and recommendations for implementing integrated care at primary health care (PHC) level to tackle cardiometabolic multimorbidity in Kenya.
Approach: We conducted a qualitative study using key informant interviews (KIIs) with 16 key stakeholders involved in healthcare delivery, research, and policy on non-communicable diseases (NCDs) in Kenya. All interviews were audio recorded, transcribed verbatim; and the data analysed both inductively and deductively using qualitative data analysis software Nvivo. The analysis was guided by the Rainbow Model of Integrated Care (RMIC) framework. Data were collected between February and March 2024.
Results: Integrated care was perceived mainly from the clinical (holistic care provision), systems (guidelines and standards promoting comprehensive healthcare delivery), and professional (interdisciplinary coordination centred around the healthcare providers) dimensions of the RMIC framework. Key challenges identified included disparity between policy and practice, inadequate resources, donor-driven priorities, limited stakeholder collaboration, limited capacity and human resources, siloed mindset, poor advocacy and limited evidence. Stakeholders recommended developing clear guidelines, enhancing stakeholder engagement, adequate planning and budgeting, improving staff availability and capacity, adequate resources, improving advocacy, evidence, and deliberate configuration of the health system to facilitate integrated care implementation.
Conclusion: To address the barriers to facilitate effective integration of cardiometabolic diseases at PHC level in Kenya, there is a need for developing clear guidelines, aligning donor priorities to promote integrated care, engaging stakeholders, improving resource allocation, and building healthcare capacity for implementation.