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.
