People living with multiple chronic illnesses in Murang’a are set to benefit from a pilot project that integrates care for mental health and non-communicable disease at primary healthcare facilities.
The five-year MCare programme will bring together care for conditions such as diabetes, hypertension and other cardio-metabolic diseases with mental health screening and treatment.
It is being implemented by the African Population and Health Research Centre (APHRC) in partnership with the Ministry of Health and the Murang’a county government with support from the European Commission.
Dr Mercy Karanja, head of Mental Health at the Ministry of Health, said the project will address the country’s mental health treatment gap by making services more accessible at primary healthcare level.
“We have seen a rise in the number of mental health conditions in our country with an estimation that one out of four Kenyans at some point in their life will suffer from a mental health condition,” Karanja said.
She said integrating mental health services into primary healthcare will improve access to treatment while also enhancing outcomes for patients living with NCDs.
“Failure to recognise mental health conditions also affects the outcome of treatment of the NCDs and metabolic disorders,” she said.
Professor Charles Agyemang, a researcher at the University of Amsterdam who is working with APHRC, said many patients with multiple chronic conditions were forced to visit different doctors and clinics for each illness.
The project will establish a one-stop model where patients can receive comprehensive care at a single facility, reducing the time and money spent travelling between health facilities.
“By getting all the care that they need at one stop shop, they can use that money for other purposes rather than having to use it to support all of this,” Agyemang said.
The project will target those aged 18 and above although researchers said the burden of hypertension, diabetes and other chronic conditions was particularly high among older people.
Dr Gershim Asiki, the project’s principal investigator in Kenya, said patients presenting more than one condition often had one illness missed during assessment.
“Most often people present for care with more than two conditions either hypertension and depression or anxiety and diabetes. But then when they are assessed most often one condition is missed,” Asiki said.
He said the project will integrate World Health Organisation (WHO) guidelines for mental health and cardio-metabolic conditions to enable healthcare workers to assess patients more holistically.
The first two years of the project will focus on co-designing and preparing the intervention with health authorities, patients and other stakeholders.
Implementation is scheduled to begin in June 2027 when 100 facilities in Murang’a will be randomised into intervention and control groups and followed up for 12 months.
Researchers will assess whether the integrated model improves patient care before considering its expansion across the county and nationally.
The intervention will have five components including establishing one-stop clinics training healthcare workers on integrated care and using electronic medical records to provide decision support.
Researchers will also strengthen diagnostic capacity by providing equipment such as blood pressure machines, diabetes testing kits and weighing scales.
The project will work with national and county governments to improve the supply of medicines so patients diagnosed with multiple conditions can receive treatment for each condition.
Asiki said the project will focus on the link between mental and physical health as chronic illnesses can contribute to depression and anxiety while conditions such as prolonged stress can worsen physical illnesses.
Dr James Mburu, Murang’a county director of health, said the project will help the county move away from a siloed approach to healthcare delivery and make greater use of data generated through its investments in digitisation.
“This will inform policy both at county and national level,” Mburu said.
The county has invested in digital health services, infrastructure, workforce capacity and medical supplies. It has also introduced telemedicine and mobile dialysis services to expand access to specialised care.
Mburu said the county currently has two fixed dialysis sites at Kigumo Hospital and Murang’a County Referral Hospital in addition to a mobile dialysis truck equipped with four units.
He said the growing demand for dialysis demonstrated the rising burden of complications linked to NCDs and the need to strengthen prevention and early detection.
The study will also assess the preparedness of participating facilities including staffing equipment, health commodities and their capacity to screen patients for mental health conditions alongside chronic diseases.
The officials said participation will be voluntary and will not impose additional costs on patients who would continue receiving their usual care.
The researchers hope evidence generated from Murang’a together with similar work in Ghana and Uganda will provide a basis for scaling up integrated care for patients with multiple chronic conditions across Africa.
