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Kishindo M, Kamano J, Mwangi A, Andale T, Mwaura GW, Limo O, Too K, Mugo R, Maree E, Aruasa W. Are outpatient costs for hypertension and diabetes care affordable? Evidence from Western Kenya. Afr J Prim Health Care Fam Med 2023; 15:e1-e9. [PMID: 37916717 PMCID: PMC10546227 DOI: 10.4102/phcfm.v15i1.3889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Diabetes and hypertension pose a significant socio-economic burden in developing countries such as Kenya, where financial risk-protection mechanisms remain inadequate. This proves to be a great barrier towards achieving universal health care in such settings unless mechanisms are put in place to ensure greater access and affordability to non-communicable disease (NCD) management services. AIM This article aims to examine outpatient management services costs for patients with diabetes and hypertension attending public primary healthcare facilities. SETTING The study was conducted in Busia and Trans-Nzoia counties in Western Kenya in facilities supported by the PIC4C project, between August 2020 and December 2020. METHODS This cross-sectional survey included 719 adult participants. Structured interviewer-administered questionnaires were used to collect information on healthcare-seeking behaviour and associated costs. The annual direct and indirect costs borne by patients were computed by disease type and level of healthcare facility visited. RESULTS Patients with both diabetes and hypertension incurred higher annual costs (KES 13 149) compared to those with either diabetes (KES 8408) or hypertension (KES 7458). Patients attending dispensaries and other public healthcare facilities incurred less direct costs compared to those who visited private clinics. Furthermore, a higher proportionate catastrophic healthcare expenditure of 41.83% was noted among uninsured patients. CONCLUSION Despite this study being conducted in facilities that had an ongoing NCDs care project that increased access to subsidised medication, we still reported a substantially high cost of managing diabetes and hypertension among patients attending primary healthcare facilities in Western Kenya, with a greater burden among those with comorbidities.Contribution: Evidenced by the results that there is enormous financial burden borne by patients with chronic diseases such as hypertension and diabetes; we recommend that universal healthcare coverage that offers comprehensive care for NCDs be urgently rolled out alongside strengthening of lower-level public healthcare systems.
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Mujumdar V, Naanyu V, Kamano J, Cherono P, Koros H, Etyang L, Misoi L, Itsura P, Tonui P, Waqo E, Schneidman M, Aruasa W. A qualitative exploration of perceived causes of cervical cancer in Busia and Trans Nzoia, Western Kenya (416). Gynecol Oncol 2022. [DOI: 10.1016/s0090-8258(22)01638-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Karwa R, Miller ML, Schellhase E, Tran D, Manji I, Njuguna B, Fletcher S, Kanyi J, Maina M, Jakait B, Kigen G, Kipyegon V, Aruasa W, Crowe S, Pastakia SD. Evaluating the impact of a 15‐year academic partnership to promote sustainable engagement, education, and scholarship in global health. J Am Coll Clin Pharm 2020. [DOI: 10.1002/jac5.1249] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Rakhi Karwa
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Monica L. Miller
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Ellen Schellhase
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Dan Tran
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital Eldoret Kenya
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | | | - Sara Fletcher
- Department of Drug Use Research and Management, Oregon State University College of Pharmacy Corvallis Oregon USA
| | - John Kanyi
- Moi Teaching and Referral Hospital Eldoret Kenya
| | - Mercy Maina
- Moi Teaching and Referral Hospital Eldoret Kenya
| | | | - Gabriel Kigen
- Department of Pharmacology & Therapeutics, Moi University College of Health Sciences Eldoret Kenya
| | | | - Wilson Aruasa
- Moi Teaching and Referral Hospital Eldoret Kenya
- Academic Model Providing Access to Healthcare Eldoret Kenya
| | - Susie Crowe
- Department of Pharmacy Practice, Bill Gatton College of Pharmacy East Tennessee State University Johnson Tennessee USA
| | - Sonak D. Pastakia
- Department of Pharmacy Practice, Purdue University College of Pharmacy West Lafayette Indiana United States
- Academic Model Providing Access to Healthcare Eldoret Kenya
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Pastakia SD, Tran DN, Manji I, Schellhase E, Karwa R, Miller ML, Aruasa W, Khan ZM. Framework and case study for establishing impactful global health programs through academia - biopharmaceutical industry partnerships. Res Social Adm Pharm 2020; 16:1519-1525. [PMID: 32792324 DOI: 10.1016/j.sapharm.2020.07.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The field of global health has grown with multiple different public and private stakeholders engaging in the effort to improve health outcomes for underserved populations around the world. There is, however, only limited published guidance on how to promote successful partnerships between academia and the biopharmaceutical industry. OBJECTIVE This analysis will provide a framework for developing successful partnerships around five central principles. This framework will then be applied to two representative pharmacy collaboration case studies focused on training and donations. FRAMEWORK DESCRIPTION AND CASE STUDY FINDINGS Within the Academic Model Providing Access to Healthcare (AMPATH), successful collaborations between the biopharmaceutical industry philanthropic entities and academic partners have consistently prioritized 1) contextualization, 2) collaboration, 3) local priorities, 4) institutional commitment, and 5) integration. In the first case study, the application of this framework to clinical pharmacy training activities sponsored by Celgene and implemented by the Purdue Kenya Partnership has helped the program transition from an entirely donor dependent training program to a revenue generating, locally administered program which is now recognized and accredited by the Kenyan government. In the second case study, medication donations from Eli Lilly and Company have been converted from a traditional donation program in one Kenyan health facility to a replicable and sustainable supply chain model which has been expanded to more than 70 public sector facilities across western Kenya. CONCLUSION Adherence to the five core principles of the proposed framework can help guide partnerships between academic institutions and the biopharmaceutical industry to advance healthcare services for underserved populations around the world. As large-scale government-based development agencies continue to primarily focus on specific disease states, biopharmaceutical industry-based collaborations can help initiate activities in underfunded therapeutic areas such as non-communicable diseases.
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Affiliation(s)
- Sonak D Pastakia
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya.
| | - Dan N Tran
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Imran Manji
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Ellen Schellhase
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Rakhi Karwa
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Moi University College of Health Sciences, Eldoret, Kenya; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Monica L Miller
- Purdue University College of Pharmacy, West Lafayette, IN, USA; Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | | | - Zeba M Khan
- Celgene (Now Part of Bristol Myers Squibb), USA
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Barasa FA, Vedanthan R, Pastakia SD, Crowe SJ, Aruasa W, Sugut WK, White R, Ogola ES, Bloomfield GS, Velazquez EJ. Approaches to Sustainable Capacity Building for Cardiovascular Disease Care in Kenya. Cardiol Clin 2016; 35:145-152. [PMID: 27886785 DOI: 10.1016/j.ccl.2016.08.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiovascular diseases are approaching epidemic levels in Kenya and other low- and middle-income countries without accompanying effective preventive and therapeutic strategies. This is happening in the background of residual and emerging infections and other diseases of poverty, and increasing physical injuries from traffic accidents and noncommunicable diseases. Investments to create a skilled workforce and health care infrastructure are needed. Improving diagnostic capacity, access to high-quality medications, health care, appropriate legislation, and proper coordination are key components to ensuring the reversal of the epidemic and a healthy citizenry. Strong partnerships with the developed countries also crucial.
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Affiliation(s)
| | - Rajesh Vedanthan
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Susie J Crowe
- Purdue University College of Pharmacy, West Lafayette, IN, USA
| | | | | | - Russ White
- Tenwek Mission Hospital, Bomet, Kenya; Alpert School of Medicine, Brown University, 2 Dudley Street, PO Box 39, Providence, RI 02905, USA
| | - Elijah S Ogola
- Department of Clinical Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Gerald S Bloomfield
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Eric J Velazquez
- Department of Medicine, Duke Clinical Research Institute, Duke Global Health Institute, Duke University, Durham, NC, USA
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Binanay CA, Akwanalo CO, Aruasa W, Barasa FA, Corey GR, Crowe S, Esamai F, Einterz R, Foster MC, Gardner A, Kibosia J, Kimaiyo S, Koech M, Korir B, Lawrence JE, Lukas S, Manji I, Maritim P, Ogaro F, Park P, Pastakia SD, Sugut W, Vedanthan R, Yanoh R, Velazquez EJ, Bloomfield GS. Building Sustainable Capacity for Cardiovascular Care at a Public Hospital in Western Kenya. J Am Coll Cardiol 2016; 66:2550-60. [PMID: 26653630 DOI: 10.1016/j.jacc.2015.09.086] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 09/06/2015] [Accepted: 09/28/2015] [Indexed: 10/22/2022]
Abstract
Cardiovascular disease deaths are increasing in low- and middle-income countries and are exacerbated by health care systems that are ill-equipped to manage chronic diseases. Global health partnerships, which have stemmed the tide of infectious diseases in low- and middle-income countries, can be similarly applied to address cardiovascular diseases. In this review, we present the experiences of an academic partnership between North American and Kenyan medical centers to improve cardiovascular health in a national public referral hospital. We highlight our stepwise approach to developing sustainable cardiovascular services using the health system strengthening World Health Organization Framework for Action. The building blocks of this framework (leadership and governance, health workforce, health service delivery, health financing, access to essential medicines, and health information system) guided our comprehensive and sustainable approach to delivering subspecialty care in a resource-limited setting. Our experiences may guide the development of similar collaborations in other settings.
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Affiliation(s)
- Cynthia A Binanay
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | | | | | | | - G Ralph Corey
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Susie Crowe
- Purdue University College of Pharmacy, West Lafayette, Indiana
| | - Fabian Esamai
- College of Health Sciences, Moi University, Eldoret, Kenya
| | | | | | | | - John Kibosia
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Sylvester Kimaiyo
- Moi Teaching and Referral Hospital, Eldoret, Kenya; College of Health Sciences, Moi University, Eldoret, Kenya
| | - Myra Koech
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Belinda Korir
- Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - John E Lawrence
- Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina
| | - Stephanie Lukas
- Purdue University College of Pharmacy, West Lafayette, Indiana
| | - Imran Manji
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | | | - Peter Park
- Hubert Yeargan Center for Global Health, Duke University, Durham, North Carolina; Indiana University, Indianapolis, Indiana
| | | | - Wilson Sugut
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Reuben Yanoh
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Eric J Velazquez
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University, Durham, North Carolina; Duke University Medical Center, Durham, North Carolina; Duke Global Health Institute, Duke University, Durham, North Carolina.
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Stone GS, Aruasa W, Tarus T, Shikanga M, Biwott B, Ngetich T, Andale T, Cheriro B. The relationship of weekend admission and mortality on the public medical wards at a Kenyan referral hospital. Int Health 2015; 7:433-7. [DOI: 10.1093/inthealth/ihu100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 09/29/2014] [Indexed: 11/14/2022] Open
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Stone GS, Tarus T, Shikanga M, Biwott B, Ngetich T, Andale T, Cheriro B, Aruasa W. The association between insurance status and in-hospital mortality on the public medical wards of a Kenyan referral hospital. Glob Health Action 2014; 7:23137. [PMID: 24560256 PMCID: PMC3925809 DOI: 10.3402/gha.v7.23137] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/07/2014] [Accepted: 01/20/2014] [Indexed: 11/25/2022] Open
Abstract
Background Observational data in the United States suggests that those without health insurance have a higher mortality and worse health outcomes. A linkage between insurance coverage and outcomes in hospitalized patients has yet to be demonstrated in resource-poor settings. Methods To determine whether uninsured patients admitted to the public medical wards at a Kenyan referral hospital have any difference in in-hospital mortality rates compared to patients with insurance, we performed a retrospective observational study of all inpatients discharged from the public medical wards at Moi Teaching and Referral Hospital in Eldoret, Kenya, over a 3-month study period from October through December 2012. The primary outcome of interest was in-hospital death, and the primary explanatory variable of interest was health insurance status. Results During the study period, 201 (21.3%) of 956 patients discharged had insurance. The National Hospital Insurance Fund was the only insurance scheme noted. Overall, 211 patients (22.1%) died. The proportion who died was greater among the uninsured compared to the insured (24.7% vs. 11.4%, Chi-square=15.6, p<0.001). This equates to an absolute risk reduction of 13.3% (95% CI 7.9–18.7%) and a relative risk reduction of 53.8% (95% CI 30.8–69.2%) of in-hospital mortality with insurance. After adjusting for comorbid illness, employment status, age, HIV status, and gender, the association between insurance status and mortality remained statistically significant (adjusted odds ratio (AOR)=0.40, 95% CI 0.24–0.66) and similar in magnitude to the association between HIV status and mortality (AOR=2.45, 95% CI 1.56–3.86). Conclusions Among adult patients hospitalized in a public referral hospital in Kenya, insurance coverage was associated with decreased in-hospital mortality. This association was comparable to the relationship between HIV and mortality. Extension of insurance coverage may yield substantial benefits for population health.
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Affiliation(s)
- Geren S Stone
- Department of Medicine, Center for Global Health, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA; Department of Medicine, Moi University, Eldoret, Kenya;
| | - Titus Tarus
- Moi Teaching and Referral Hospital, Eldoret, Kenya
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