Assessing Facility Readiness and Spatial Accessibility for the Management of Hypertension in Kilifi County, Kenya: A Cross-Sectional Study

Background Non-communicable diseases (NCDs) currently cause 43 million deaths globally. Health systems in low-and middle-income countries, including Kenya, are struggling to respond to the growing NCD burden and respond to population health needs in an equitable and accessible manner. The aim of this study was to examine health facility readiness, health workers’ knowledge, and spatial accessibility to hypertension management in Kilifi County, Kenya. Methods We conducted a cross-sectional survey of 34 facilities in Kilifi North and Kilifi South sub-counties. Readiness was assessed across five domains: basic infrastructure, equipment, diagnostics, medicines, and training/guidelines. Facilities with readiness index ≥ 70% for all the assessed domains were classified as ready to provide hypertension services. Fisher’s exact test was used to examine factors associated with facility readiness. Health worker knowledge in managing hypertension was evaluated using self-administered questionnaires. Spatial accessibility to geocoded health facilities was modelled in AccessMod using high spatial resolution raster datasets of the elevation, land cover, and population combined with vector datasets of a detailed road network and travel barriers. Four travel scenarios were adopted: walking only, motorcycle only, walking followed by motorcycle, and walking followed by motorcycle and then vehicle. Results The overall mean hypertension service readiness index was 42.9% (95% CI: 37.1–48.8). We found strong evidence that readiness varied by facility type, facility location and supervisory practices ( p  < 0.05). The weakest readiness domains were in the availability of anti-hypertensive medicines (21.4%; 95% CI: 12.2–30.6) and staff training/guidelines (25%; 95% CI: 11.6–38.1). Whereas the mean overall knowledge score was 11.9 out of 13 (91.4%; 95% CI: 89.3–93.4), only 14% of health workers were familiar with the latest cardiovascular treatment guidelines. Spatial accessibility analysis using the most pragmatic travel scenario for the Coast region indicated that over 80% of the population in the two sub-counties (~ 530,000 people) resided within 30 minutes travel time to a health facility. Conclusion Health facilities were geographically accessible, but they lacked the readiness to deliver hypertension care. To improve health facility readiness, measures to ensure the availability of anti-hypertensive medicines, healthcare worker training and dissemination of treatment guidelines should be prioritised.