Introduction:

The hypertension programme was started in October 2014 aimed at reaching 22 counties in Kenya targeting 134 CHAK health facilities in the rural and rural peri-urban. The program utilized three strategies: community, health facility and health systems improvement strategy. In the community strategy 450 community health workers and 127 religious leaders were trained to educate communities on risk factors and screen for high blood pressure. At the facility 12 staff were trained as trainer of trainers with ongoing CME’s. Health facilities were provided for mercury column blood pressure machines and one set of stethoscopes. 20 High volume facilities with hospital management information systems were sensitized on integration of NCD modules in their respective systems to capture NCD data at the point of care in their facilities.

Narrative: Data Collection, Organization, and Use

CHAK has three levels of data collection and reporting. Community health workers and religious leaders do sensitization and screening in the community while the facilities provide information on linkage and treatment. This data is collected monthly at the facility , CHAK programme officers compare what has been collected from the community and referrals that have been made by CHVs. Referrals who reach health facilities and initiated on treatment are counted as successful referrals ,.Out of those referred what proportion actually were successfully linked and put on treatment. Quantitative and Qualitative data is collected from the meetings held with the community health workers, religious leaders and health care workers. This data is compiled and validated by data managers and the programme officers before it is shared with CHAK management for consumption and next steps forward.

Tools for data collection

The needs identified were based on country data on the rise of non-communicable disease with hypertension being the 11th common cause of death in Kenya with a prevalence of 21 to 50 percent among the rural and urban areas.

Considerations that were made were: the end user and ease in filling the tools, how often the data will be collected and applications of interventions.

Taking into account the needs and consideration, CHAK partnered with the Ministry of Health to develop the following tools:

• Community awareness and education reporting form
• Community Client referral form with documentation of blood pressure
• Hypertension initial encounter form that has patient bio data, vitals and clinical observations, treatment prescribed and a follow up plan
• Client education booklets

These tools were developed due to the gaps identified in the government community health workers referral form that is general and does not capture the details on hypertension. Being a chronic illness early identification and management is important.

Challenges Identified

There were challenges which were identified which were:

At the beginning of the implementation of the programme there were challenges with data management due to poor use of patient treatment registers at point of care. This was due to prioritization by clinicians the hospital forms and registers instead of the hypertension patient level data collection tools. One of the challenges was capturing of the NCD’s in the Health Management Information system.

Majority of those screened in the community were below the age of 40 years and have a lower prevalence of hypertension compared to those above 40 years. More women than men were targeted and low effective linkage with the main reasons being: distance to health facility, cost of transport to health facility and lack of appreciation on severity of hypertension and failure by CHW to refer clients. Health facilities not buying the subsidized hypertension drugs from Medicine and Essential Drug supply (MEDS) that is supporting in supply of subsidized quality hypertension drugs.

Data Use and Decisions made

• Integration of the hypertension module in the different hospital HMIS systems.
• Continue mentorship of community health workers and religious leaders to improve referral and tracking of patients who default on treatment.
• Support formation of psychosocial support groups
• Improve health facility screening by targeting caregivers of patients and visitors
• Scale up screening at all points of care at health facilities
• Target agricultural based industries to increase its reach to men
• Compensation of community health workers for clients successfully linked
• Support of health facilities to carry out monthly outreach clinics to bring services to the clients increasing access

Detailed Process: Activity, Data Collection, and Data Use