Primary healthcare system insights for cardiovascular diseases health services delivery

In developing nations, primary healthcare (PHC) is the first crucial level of contact for patients including emergencies. We examined the capacity of PHC for cardiovascular diseases (CVDs) prevention and management in Kenya from health workforce experiences in order to inform strategies for strengthening their capability and associated implications for measures of accessibility. The study was conducted in urban and rural settings of Nairobi and Machakos counties, Kenya. The cross-sectional study adopted purposive sampling applying mixed methods approach through health facility survey and key informant interviews. Despite the rural–urban populations variations, a higher proportion of rural facilities (81.2%) offered monthly CVD outpatient services than the urban counterparts (46.2%). More CVD home visits were predominantly conducted by rural PHC facilities at 17.6% versus 6.6% for urban. Unpredictable early access to diagnostic testing and medication occasioning missed opportunities and unwarranted referrals was a critical concern. Most facilities stocked anti-arrhythmia, a diuretic antihypertensive and anti-thrombolytic for essential CVDs related medications. Healthcare providers were emphatic on the need for continuous medical education opportunities for up-to-date evidence-based clinical decisions support competence. Moreover, the health workers advocated for increased outpatient financing for CVDs due to costly out of pocket financing limiting early treatment uptake. Efforts to streamline and upscale CVD resources mainly supply and health labour force at PHC will go a long way in alienating unnecessary referrals and patients’ attrition in the continuum of care. More efficient and continuous medical education particularly in the rural and urban poor settings with emphasis on the evolving CVDs burden is desirable. Electronic health record system is a timely endeavor for enhanced patients’ systematic referral and tracking considering that CVDs are lifelong conditions.