Guideline Adherence among Kenyan Healthcare Providers in Peri-Urban For-Profit Clinic

Saturday, 7 November 2015

Brittney J. Sullivan, MS, BS, RN, CPNP
School of Nursing, Duke University, Durham, NC, USA

Background: Penda Health is a chain of private, for-profit outpatient clinics that delivers comprehensive primary care to low and middle income Kenyans using midlevel care providers (certified nurse practitioners and clinical officers), caring for approximately 2,000 patients per month. Penda’s aim is to provide high quality, low cost services, and empathetic and caring healthcare to patients through innovative standardized protocols, qualified right-skilled providers1, and strong supplier partnerships.2 In low and middle-income settings, healthcare provider adherence to guidelines has shown mixed results – with many studies showing public sectors having more adherence to guidelines3; however, after implementing organizational and educational interventions, Penda has nearly doubled adherence rates surrounding four diagnoses although adherence rates varied significantly per diagnosis (urinary tract infection, vaginal discharge, tonsillitis, and childhood diarrhea).4 Adherence to guidelines has been shown to be lower in private sector healthcare systems in low and middle income countries, although Penda has show great success in improving adherence rates through targeted interventions.3 Specifically in childhood diarrhea, both in public and private clinics dehydration guideline adherence ranged between 0% and 84% across 23 countries with a median of 20% correct treatment.5 Penda has goals of scaling and replicating quickly in Kenya and has had a focus on provider guideline adherence. However, as an organization, it is still working to identify core components that enhance provider adherence and operationalize a systematized provider development plan. Thus, gaining leadership understanding of provider barriers and facilitators to guideline adherence will aid in understanding and developing a systemized provider development plan in the future.

Purpose: To gain an understanding of organizational leadership understanding of healthcare providers’ barriers and facilitators in guideline adherence in order to develop interventions to retain healthcare providers.

Setting: Penda Health clinics surrounding Nairobi, Kenya in East Africa.

Methods: In May and June 2015 we will conduct contextual qualitative interviews with Penda organizational leadership (N=3).  This will allow for further interpretation of quantitative data based on healthcare providers’ adherence to guidelines related to urinary tract infections, vaginal discharge, childhood diarrhea, and tonsillitis.   

Findings: We believe a comprehensive understanding of healthcare provider rationale for guideline adherence will benefit Penda in their future scaling and replication plans to open 100 clinics by 2020 across East Africa, seeing over 2 million patients per year.2 Barriers and facilitators to guideline adherence will allow for creation of low-cost, high-impact organization level interventions to improve healthcare provider adherence now, as well as during Penda’s rapid scale-up. Not only will Penda be able to increase consistent healthcare provider guideline adherence between all providers and sites, but they may also improve patient safety and quality of care due to improved provider guideline adherence quality improvement and evaluation projects.6