Financial Determinants of Effective Hypertension and Diabetes Care in Rural Primary Health Facilities in Kisumu, Kenya: A Mixed-Methods Study

Background Noncommunicable diseases (NCDs), particularly hypertension and diabetes, account for 27% of deaths in Kenya, with 26% of adults having elevated blood pressure. Despite devolution of health services to county governments in 2013, financing for NCD management at the primary health care (PHC) level remains weak. This study examines financial determinants shaping hypertension and diabetes care in PHC facilities within a devolved county health system in rural Kisumu County, Kenya. Methods We conducted a convergent parallel mixed-methods cross-sectional study in seven public PHC facilities in Seme Sub-County. Quantitative data were collected via structured questionnaires and retrospective document review of financial records (January–August 2024). Qualitative data were gathered through in-depth interviews with facility in-charges exploring planning, budgeting, and resource allocation. Descriptive statistics were produced in STATA v16; qualitative data were analyzed thematically in R. Results All seven facilities prepared annual workplans and budgets, but none achieved comprehensive NCD-specific planning (workplan + budget + dedicated NCD budget line). Funding sources were narrow: 71.4% (n = 5) depended on NHIF reimbursements and donor support, while only 28.6% (n = 2) received direct county funding; 57.1% (n = 4) relied on only two funding streams. Although all facilities held bank accounts, none had formal financial autonomy and expenditures required county-level approval, typically taking 3–4 weeks (57.1%, n = 4) to over two months (28.6%, n = 2). Combined with unreliable central supplies, this lack of autonomy meant facilities could not procure locally when stockouts occurred; consequently 85.7% (n = 6) reported frequent medication stockouts. Facility in-charges attributed these failures to inadequate, unpredictable funding and centralized approval processes that prevented timely local procurement. Conclusions PHC facilities in this rural county operate under severely constrained financial conditions that undermine effective NCD care. Strengthening facility financial autonomy, instituting ring-fenced NCD budget lines, diversifying financing, and streamlining disbursement and emergency procurement mechanisms are urgent priorities to reduce stockouts and advance equitable chronic care under Kenya’s UHC agenda.