Evaluating Healthy Heart Africa: Finding the Best Approaches to Address NCDs in Kenya
- Kenya faces significant burdens of both infectious and non-communicable diseases
- Abt evaluated the Healthy Heart Africa program, created to reduce hypertension in Kenya
- The evaluation showed that the project’s approach produced mixed results and recommended new approaches
Kenya faces a double burden of disease. Infectious disease rates remained high. At the same time, the prevalence of non-communicable diseases such as heart disease, cancer, and diabetes was increasing. A major factor in the rise of cardiovascular diseases was a spike in hypertension. There were three major barriers to improvement:
- Inadequate public health education and public awareness about hypertension
- Inadequate provider training and insufficient national hypertension screening and care guidelines
- Inadequate access to affordable hypertension medication
To address these gaps, the Healthy Heart Africa (HHA) program developed and tested models of chronic-disease care across the public, private, and faith-based health sectors. The project informed individuals about hypertension risks, reaching men and women through churches, health facilities, mabarazas, workplaces, and home visits. HHA screened men and women for hypertension, referred individuals with elevated blood pressure for further diagnosis, and treated confirmed cases. The program poured resources into increasing awareness and knowledge about hypertension among providers and the public. The program updated healthcare protocols for hypertension, trained providers, and equipped them to provide screening and diagnostic services. The program encouraged providers to offer dedicated days to address blood pressure screening and monitoring. Abt evaluated the project.
Abt developed baseline and end line evaluations of awareness levels for healthy lifestyles, hypertension screening, and treatment behavior at the household and provider levels. We measured the programmatic impact of each model. The evaluations produced clear evidence that the initiatives increased provider knowledge about hypertension, though not about its consequences. The team found suggestive but not conclusive evidence that the program increased public knowledge. The evaluation found no evidence of an increase in the proportion of respondents screened or treated. It provided some recommendations on innovative approaches, especially for men, whose hypertension prevalence is higher than that of women.