Innovating to increase access to diabetes care in Kenya: an evaluation of Novo Nordisk’s base of the pyramid project

ABSTRACT

Background: The Base of the Pyramid (BoP) project is a public–private partnership initiated by Novo Nordisk that aims to facilitate access to diabetes care for people at the base of the economic pyramid in low- and middle-income countries (LMICs). In Kenya, the BoP, through a partnership model, aims to strengthen five pillars of diabetes care: increased awareness of diabetes; early diagnosis of diabetes; access to quality care by trained professionals; stable and affordable insulin supply; and improved self-management through patient education.

Objectives: This study evaluates the extent to which BoP Kenya is scalable and sustainable, whether stakeholders share in its value, and whether BoP Kenya has improved access to diabetes care.

Method: The Rapid Assessment Protocol for Insulin Access (RAPIA), an approach developed to provide a broad situational analysis of diabetes care, was used to examine health infrastructure and diabetes care pathways in Kenya. At the national level, the RAPIA was applied in a SWOT analysis of the BoP through in-depth interviews with key stakeholders. At individual and county health system levels, RAPIA was adapted to explore the impact of the BoP on access to diabetes care through a comparison of an intervention and control county.

Results: The BoP was implemented in 28 of 47 counties in Kenya. Meru, a county where BoP was implemented, had 35 of 62 facilities (56%) participating in the BoP. Of the five pillars of the BoP, most notable progress was made in achieving the fourth (stable and affordable insulin supply). A price ceiling of 500KSh (US$5) per vial of insulin was established in the intervention county, with greater fluctuation and stock-outs in the non-intervention county. Despite reduced insulin costs, many patients with diabetes could not afford the additive expenses of monitoring, medicines, and travel. Less progress was made over the other pillars, which also faced challenges to sustainability and scalability.

Conclusion: In the context of the rising prevalence of non-communicable diseases in LMICs, cross-sector approaches to improving access to care are increasingly needed. Public–private partnerships such as the BoP are necessary but not sufficient to ensure access to health care for people with diabetes at the base of the economic pyramid in Kenya.

KEYWORDS:

• Diabetes
• insulin
• access
• health systems
• service delivery

Responsible Editor Stig Wall, Umeå University, Sweden

Responsible Editor Stig Wall, Umeå University, Sweden

Acknowledgments

This research was an independent evaluation, funded by Novo Nordisk. We would also like to extend our sincere gratitude to the informants and research participants who helped shape our project.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approval for the research was granted by the UCL Research Ethics Committee (5406/002) and the Maseno University Ethics Committee (00334/16).

Paper context

With rising NCD prevalence in LMICs, cross-sector approaches to improving access to diabetes care are needed. We adapted the Rapid Assessment Protocol for Insulin Access (RAPIA) to evaluate the impact of the BoP, a public–private partnership that aims to facilitate access to diabetes care in Kenya. The BoP engaged stakeholders at a national level to ensure structural change but needs to invest more in local approaches to overcoming barriers to care.

Additional information

Funding

This research was an independent evaluation, funded by Novo Nordisk.

Notes on contributors

Geordan D. Shannon

GS, JS, and HHB conceptualised the paper. GS and WC performed data collection and analysis. GS drafted the paper with input from JS, HHB, WC, and JK.