Barriers and facilitators of Cardiovascular Disease Prevention in Kenya: A qualitative exploration of stakeholder perspectives

Background Cardiovascular diseases (CVD) are the leading cause of non-communicable disease (NCD) deaths in Kenya. Since 1990, Kenya has seen a significant rise in CVD risk factors, coupled with low levels of public awareness regarding these risks. Despite the critical role of prevention interventions in reducing the high burden of CVD and improving public health, Kenya lags in the control of some risk factors. This study sought to explore the barriers and facilitators of CVD prevention in Kenya. Methods Sixteen interviews were conducted with stakeholders involved in CVD prevention in Kenya in February-April 2024. The study participants included ministry of health officials at the national and county levels, civil society organisations, private sector, health economists, researchers and patient representatives. A combination of deductive and inductive thematic analysis was conducted guided by the three-level health system framework proposed by Caldwell and Mays. Results Macro (national)-level facilitators included the existence of health policies at the national level that prioritised CVD prevention, which was also included in primary healthcare and social health insurance packages. Barriers included the gap between policy and practice related to CVD prevention, and lack of reliable data for evidence-based decision making, limited investment in CVD prevention compared to disease management and skewed resource allocation towards curative care. At the meso (county) level, limited financing towards prevention interventions and improvement in resource allocation were reported as key facilitators. At the health provider level, participants reported limited capacity and workforce numbers, lack of clear CVD prevention guidelines as barriers. A key enabler was the introduction of community health policy that operationalises the involvement of community health promoters in CVD risk factor screening and management. At the micro (patient) level, lack of awareness of CVD risk, poor access and utilisation of healthcare, and cultural barriers were reported to impede CVD prevention. Conclusion Addressing gaps between policy and practice, enhancing resource allocation towards prevention, strengthening healthcare infrastructure and workforce, and promoting community engagement are crucial steps towards achieving meaningful progress in CVD prevention efforts.