Challenges in policy reforms for non-communicable diseases: the case of diabetes in Kenya

ABSTRACT

Background: The 2011 UN declaration on non-communicable diseases (NCDs) recognized their importance as a global health issue, particularly for low- and middle-income countries. The extent to which these countries address policy implementation gaps in the face of resource limitations and competing priorities remains largely unexplored.

Objective: This qualitative study presents Kenya’s experience of translating the UN declaration to national policies for diabetes prevention and control.

Methods: Policy documents published between 2006 and 2016 were analyzed. Thirty-two documents were included in the analysis. Interviews with six purposively selected policy stakeholders at multiple levels of decision-making were conducted. Emerging themes were deconstructed into a policy analysis triangle.

Results: Diabetes-specific policies already existed in Kenya before 2011, suggesting successful advocacy work by diabetes interest groups. The 2011 UN declaration subsequently coincided with a period of political transition in Kenya, opening policy windows that the diabetes community leveraged to trigger political drive against prevailing challenges. The post-declaration period reflected a transition from diabetes-specific policies to a wider NCD agenda. Most of the documents and national strategies aligned strongly with international documents, however, were based on scant local evidence. The implementation process was largely health-sector driven. The non-health sector remained largely uninvolved, contrary to global recommendations. This, in addition to fragmented health governance and weak monitoring systems, continues to undermine existing gains and efforts to fight diabetes and NCDs on a wider scale.

Conclusions: In Kenya, a major gap remains between how diabetes is addressed within the NCD policy agenda and tackling diabetes in reality, with respect to local implementation processes. More emphasis on population-wide prevention and inclusion of the non-health sector could help to cascade national efforts to the grassroots level. A concerted effort from the highest political level is needed to address overarching NCD drivers while maintaining health system improvement strategies.

KEYWORDS:

• Health policy
• LMIC
• qualitative study
• implementation
• monitoring
• citizen involvement
• prevention
• population-based

Responsible Editor Peter Byass, Umeå University, Sweden

Responsible Editor Peter Byass, Umeå University, Sweden

Acknowledgments

The authors acknowledge the support of Julia Chalinor in editing and proofreading the manuscript. We also acknowledge the financial support of the German Academic Exchange Service (DAAD) in facilitating the data collection process in Kenya.

Author contributions

All authors substantially contributed to the study and the manuscript: Florian Neuhann and Veronica Shiroya conceived and designed the study, advised by Andreas Deckert and Olaf Müller. Florian Neuhann and Veronica Shiroya organized the field work and the data collection. Veronica Shiroya conducted the interviews and collected all the relevant data and documents and performed the analysis, supervised by Florian Neuhann. Olaf Müller and Andreas Deckert substantially contributed to the interpretation and presentation of the results. Veronica Shiroya and Florian Neuhann drafted the paper, Andreas Deckert and Olaf Müller critically revised the structure and the content of the paper. All authors contributed in writing the manuscript and read and approved the final version.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical consent to conduct the study was obtained from the local ethics committee in Heidelberg and from the Ministry of Health – Kenya. Written informed consent was sought from key informants. Confidentiality and anonymity in the data processing was assured. The findings of the study were disseminated to the stakeholders who took part in the interviews.

Paper context

NCDs are an important health problem in Kenya. We present Kenya’s challenges and milestones in translating international NCD declarations in response to diabetes through policy reforms. Civil society groups seized a window of political opportunity lobbying successfully for changes in policy development for NCD and diabetes locally. However, some policies disregard local realities, implementation monitoring is neglected. Multi-sector engagement is needed to address cross-sectoral issues and to enhance political power to fight diabetes risk factors.

Additional information

Funding

The data collection for this work was supported by a Masters scholarship of the German Academic Exchange Service (DAAD) awarded to Veronica Shiroya under scholarship number 57169058. We acknowledge financial support towards publishing this paper by Deutsche Forschungsgemeinschaft within the funding programme Open Access Publishing, by the Baden-Württemberg Ministry of Science, Research and the Arts and by Ruprecht-Karls-Universität Heidelberg. The funders had no role in designing, conducting or writing this study nor in the decision to submit for publication.