---
title: ""
subtitle: ""
page-layout: full
toc: false
---
```{=html}
<div class="redesign-page">
<!-- ═══════════════════════════════════════════
RESEARCH HERO — Full-Width Impact Statement
═══════════════════════════════════════════ -->
<section class="rx-hero reveal-on-scroll">
<div class="rx-hero-inner">
<div class="rx-hero-copy">
<span class="section-eyebrow">Research</span>
<h1 class="rx-hero-heading">Studying what happens when clinics are expected to deliver chronic care without enough financial decision space.</h1>
<p class="rx-hero-lead">My first-author paper on hypertension and diabetes care in rural Kisumu is forthcoming in <em>BMC Public Health</em>. I focus on the institutional details that shape outcomes on the ground: budgets, approvals, reimbursement flows, and the hidden mechanics behind service continuity.</p>
<div class="rx-hero-actions">
<a href="thesis.html" class="btn-solid">View Thesis</a>
<a href="publications_files/01_NCDFin_ManuscriptV4.pdf" class="btn-ghost" target="_blank">Read Manuscript PDF →</a>
<a href="../posts/47-facility-decision-space-chronic-care/index.html" class="btn-ghost">Read Public Essay →</a>
</div>
</div>
<div class="rx-hero-visual">
<img src="../img/ncd manuscript.png"
alt="NCD Finance manuscript preview"
class="rx-manuscript-preview"
onerror="this.parentElement.style.display='none'">
</div>
</div>
</section>
<!-- ═══════════════════════════════════════════
IMPACT STATS STRIP
═══════════════════════════════════════════ -->
<section class="rx-stats-strip reveal-on-scroll">
<div class="rx-stats-inner">
<div class="rx-stat-card">
<span class="rx-stat-num">4</span>
<span class="rx-stat-label">Publications & manuscripts</span>
</div>
<div class="rx-stat-card">
<span class="rx-stat-num">7</span>
<span class="rx-stat-label">Public facilities studied</span>
</div>
<div class="rx-stat-card">
<span class="rx-stat-num">3</span>
<span class="rx-stat-label">Countries covered</span>
</div>
<div class="rx-stat-card">
<span class="rx-stat-num">1000+</span>
<span class="rx-stat-label">Households tracked</span>
</div>
<div class="rx-stat-card">
<span class="rx-stat-num">10yr</span>
<span class="rx-stat-label">Cancer registry analysis</span>
</div>
<div class="rx-stat-card">
<span class="rx-stat-num">85.7%</span>
<span class="rx-stat-label">Reported frequent stockouts</span>
</div>
</div>
</section>
<!-- ═══════════════════════════════════════════
FEATURED PUBLICATION — Full Card
═══════════════════════════════════════════ -->
<section class="rx-section reveal-on-scroll">
<div class="rx-section-inner">
<span class="section-eyebrow">Featured Publication</span>
<h2 class="section-h">Flagship paper</h2>
<article class="rx-pub-card rx-pub-featured">
<div class="rx-pub-header">
<div class="rx-pub-badges">
<span class="rx-badge rx-badge--forthcoming">Forthcoming</span>
<span class="rx-badge rx-badge--role">First Author</span>
</div>
<span class="rx-pub-journal">BMC Public Health</span>
</div>
<h3 class="rx-pub-title">Financial Determinants of Effective Hypertension and Diabetes Care in Rural Primary Health Facilities in Kisumu, Kenya: A Mixed-Methods Study</h3>
<p class="rx-pub-abstract">A mixed-methods study of seven public primary care facilities in Seme Sub-County showing how narrow funding streams, delayed county approvals, and missing protected NCD budget lines undermine continuity of chronic care for hypertension and diabetes patients.</p>
<div class="rx-pub-highlights">
<div class="rx-highlight">
<svg width="18" height="18" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2"><path d="M22 11.08V12a10 10 0 1 1-5.93-9.14"/><polyline points="22 4 12 14.01 9 11.01"/></svg>
<span>Chronic-care breakdown is a governance problem, not only procurement</span>
</div>
<div class="rx-highlight">
<svg width="18" height="18" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2"><path d="M22 11.08V12a10 10 0 1 1-5.93-9.14"/><polyline points="22 4 12 14.01 9 11.01"/></svg>
<span>Protected NCD budgets and faster local execution matter as much as funding volume</span>
</div>
<div class="rx-highlight">
<svg width="18" height="18" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="2"><path d="M22 11.08V12a10 10 0 1 1-5.93-9.14"/><polyline points="22 4 12 14.01 9 11.01"/></svg>
<span>Facilities can plan and budget, yet still fail if financial authority stays too distant</span>
</div>
</div>
<div class="rx-pub-chips">
<span>R</span><span>Mixed Methods</span><span>Health Systems</span><span>Facility Finance</span><span>Policy Translation</span><span>STATA</span>
</div>
<div class="rx-pub-actions">
<a href="publications_files/01_NCDFin_ManuscriptV4.pdf" class="btn-solid" target="_blank">Read PDF</a>
<a href="thesis.html" class="btn-ghost">View Full Thesis →</a>
</div>
</article>
</div>
</section>
<!-- ═══════════════════════════════════════════
METHODS & APPROACH
═══════════════════════════════════════════ -->
<section class="rx-section rx-section--warm reveal-on-scroll">
<div class="rx-section-inner">
<span class="section-eyebrow">Approach</span>
<h2 class="section-h">How I work</h2>
<p class="section-sub">Mixed-methods designs that connect financial records, structured facility data, and management interviews so analysis stays close to operational reality.</p>
<div class="rx-methods-grid">
<article class="rx-method-card">
<div class="rx-method-icon">
<svg width="28" height="28" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="1.5"><circle cx="11" cy="11" r="8"/><line x1="21" y1="21" x2="16.65" y2="16.65"/></svg>
</div>
<h4>Study Design</h4>
<p>Scoping, protocol design, IRB submissions, tool digitization. Setting the foundation for high-quality data.</p>
<div class="rx-method-tools"><span>Cross-sectional</span><span>Qualitative</span><span>Mixed methods</span></div>
</article>
<article class="rx-method-card">
<div class="rx-method-icon">
<svg width="28" height="28" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="1.5"><rect x="5" y="2" width="14" height="20" rx="2"/><line x1="9" y1="7" x2="15" y2="7"/><line x1="9" y1="11" x2="15" y2="11"/><line x1="9" y1="15" x2="12" y2="15"/></svg>
</div>
<h4>Data Collection</h4>
<p>Structured facility assessments, key informant interviews, financial record review, and health system observations.</p>
<div class="rx-method-tools"><span>KoboToolbox</span><span>REDCap</span><span>ODK</span></div>
</article>
<article class="rx-method-card">
<div class="rx-method-icon">
<svg width="28" height="28" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="1.5"><path d="M3 3h18M3 9h18M9 3v18M3 15l4-4 4 4 4-6 4 6"/></svg>
</div>
<h4>Analysis</h4>
<p>Descriptive statistics, thematic analysis, mixed-methods integration, and econometric modelling.</p>
<div class="rx-method-tools"><span>R</span><span>STATA</span><span>SPSS</span><span>DiD</span></div>
</article>
<article class="rx-method-card">
<div class="rx-method-icon">
<svg width="28" height="28" viewBox="0 0 24 24" fill="none" stroke="currentColor" stroke-width="1.5"><rect x="3" y="3" width="18" height="18" rx="2"/><path d="M8 17V13"/><path d="M12 17V9"/><path d="M16 17V11"/></svg>
</div>
<h4>Translation</h4>
<p>Policy briefs, stakeholder presentations, publication-ready manuscripts, and evidence-to-action workshops.</p>
<div class="rx-method-tools"><span>Quarto</span><span>R Markdown</span><span>Policy Briefs</span></div>
</article>
</div>
</div>
</section>
<!-- ═══════════════════════════════════════════
RESEARCH INTERESTS — Icon Cards
═══════════════════════════════════════════ -->
<section class="rx-section reveal-on-scroll">
<div class="rx-section-inner">
<span class="section-eyebrow">Focus Areas</span>
<h2 class="section-h">Research interests</h2>
<div class="rx-interests-grid">
<article class="rx-interest-card">
<div class="rx-interest-icon">💰</div>
<h4>Health financing and decision space</h4>
<p>How county rules, purchasing arrangements, and approval chains shape what frontline facilities can actually do.</p>
</article>
<article class="rx-interest-card">
<div class="rx-interest-icon">💊</div>
<h4>NCD care in primary health systems</h4>
<p>Hypertension and diabetes care, medicine continuity, and the operational conditions required for chronic-care delivery.</p>
</article>
<article class="rx-interest-card">
<div class="rx-interest-icon">🔬</div>
<h4>Mixed-methods health systems research</h4>
<p>Combining records, interviews, and implementation context to explain not just what failed, but why it failed.</p>
</article>
<article class="rx-interest-card">
<div class="rx-interest-icon">🏥</div>
<h4>Life-course diabetes epidemiology</h4>
<p>Urbanization, work history, and the pathways through which diabetes risk accumulates and returns to rural settings.</p>
</article>
<article class="rx-interest-card">
<div class="rx-interest-icon">🤝</div>
<h4>Community-delivered intervention design</h4>
<p>Locally grounded support models for chronic disease management, lifestyle change, and implementation feasibility.</p>
</article>
<article class="rx-interest-card">
<div class="rx-interest-icon">⚙️</div>
<h4>Research data systems</h4>
<p>Practical workflows for data capture, data quality, reproducibility, and research operations in real project environments.</p>
</article>
</div>
</div>
</section>
<!-- ═══════════════════════════════════════════
ALL PUBLICATIONS — Card Stack
═══════════════════════════════════════════ -->
<section class="rx-section rx-section--dark reveal-on-scroll">
<div class="rx-section-inner">
<span class="section-eyebrow light">Publications</span>
<h2 class="section-h light">Selected publications & contributions</h2>
<div class="rx-pubs-stack">
<article class="rx-pub-card rx-pub-card--dark">
<div class="rx-pub-header">
<div class="rx-pub-badges">
<span class="rx-badge rx-badge--forthcoming">Forthcoming</span>
<span class="rx-badge rx-badge--role">First Author</span>
</div>
<span class="rx-pub-journal rx-pub-journal--light">BMC Public Health</span>
</div>
<h3 class="rx-pub-title rx-pub-title--light">Financial Determinants of Effective Hypertension and Diabetes Care in Rural Primary Health Facilities in Kisumu, Kenya: A Mixed-Methods Study</h3>
<p class="rx-pub-desc rx-pub-desc--light">Role: study design, mixed-methods analysis, interpretation, and writing.</p>
<div class="rx-pub-chips rx-pub-chips--dark"><span>R</span><span>Mixed Methods</span><span>BMC Public Health</span></div>
</article>
<article class="rx-pub-card rx-pub-card--dark">
<div class="rx-pub-header">
<div class="rx-pub-badges">
<span class="rx-badge rx-badge--published">Published</span>
<span class="rx-badge rx-badge--coauthor">Co-Author</span>
</div>
</div>
<h3 class="rx-pub-title rx-pub-title--light">Addressing priority gaps in access and quality of NCD services in primary care settings in rural Kenya: A participatory approach to intervention development</h3>
<p class="rx-pub-desc rx-pub-desc--light">Role: conceptualization, data collection, management, analysis, and co-writing results and discussion.</p>
<div class="rx-pub-chips rx-pub-chips--dark"><span>Participatory</span><span>NCD Services</span><span>Primary Care</span></div>
</article>
<article class="rx-pub-card rx-pub-card--dark">
<div class="rx-pub-header">
<div class="rx-pub-badges">
<span class="rx-badge rx-badge--published">Published</span>
<span class="rx-badge rx-badge--coauthor">Co-Author</span>
</div>
</div>
<h3 class="rx-pub-title rx-pub-title--light">Characteristics and mortality risk among esophageal cancer patients with varied HIV status seeking care in western Kenya: A 10-year analysis</h3>
<p class="rx-pub-desc rx-pub-desc--light">Role: data management and analysis.</p>
<div class="rx-pub-chips rx-pub-chips--dark"><span>Cancer Epidemiology</span><span>Survival Analysis</span><span>10-Year Study</span></div>
</article>
<article class="rx-pub-card rx-pub-card--dark">
<div class="rx-pub-header">
<div class="rx-pub-badges">
<span class="rx-badge rx-badge--published">Published</span>
<span class="rx-badge rx-badge--coauthor">Co-Author</span>
</div>
</div>
<h3 class="rx-pub-title rx-pub-title--light">Survival disparities in cervical cancer patients with and without HIV at Jaramogi Oginga Odinga Teaching and Referral Hospital</h3>
<p class="rx-pub-desc rx-pub-desc--light">Role: data management and analysis.</p>
<div class="rx-pub-chips rx-pub-chips--dark"><span>Cancer Research</span><span>HIV Co-morbidity</span><span>Survival Analysis</span></div>
</article>
</div>
</div>
</section>
<!-- ═══════════════════════════════════════════
INTERACTIVE RESEARCH LAYER
═══════════════════════════════════════════ -->
<section class="rx-section rx-section--warm reveal-on-scroll">
<div class="rx-section-inner">
<span class="section-eyebrow">Interactive Research Layer</span>
<h2 class="section-h">Explore the research footprint</h2>
<p class="section-sub">These widgets turn the page from a static dossier into a browsable research surface: where the work happened, how the portfolio is distributed, and which outputs sit at each stage.</p>
<div class="rx-widget-grid">
<div class="rx-widget-card">
<div class="rx-widget-head">
<h3>Study geography</h3>
<p>Selected fieldwork, analysis, and collaboration footprint across the health systems work.</p>
</div>
<div id="researchMap" class="rx-widget-frame"></div>
</div>
<div class="rx-widget-card">
<div class="rx-widget-head">
<h3>Portfolio explorer</h3>
<p>Hover each output to see where it sits in the current publication pipeline.</p>
</div>
<div id="researchPortfolioChart" class="rx-widget-frame"></div>
</div>
</div>
</div>
</section>
<section class="rx-section reveal-on-scroll">
<div class="rx-section-inner">
<span class="section-eyebrow">Publications Explorer</span>
<h2 class="section-h">Sortable publication table</h2>
<p class="section-sub">This adds the searchable, filterable layer the audit called for, while keeping the editorial cards above for first-read storytelling.</p>
<div class="rx-table-toolbar">
<input
type="search"
id="researchTableSearch"
class="rx-table-search"
placeholder="Search publications, themes, or geography"
aria-label="Search publications table"
>
<p class="rx-table-hint">Filter by title, role, status, focus, or geography.</p>
</div>
<div class="rx-table-shell">
<table class="rx-data-table">
<thead>
<tr>
<th>Title</th>
<th>Status</th>
<th>Role</th>
<th>Focus</th>
<th>Geography</th>
</tr>
</thead>
<tbody id="researchTableBody"></tbody>
</table>
</div>
</div>
</section>
<!-- ═══════════════════════════════════════════
COLLABORATION CTA
═══════════════════════════════════════════ -->
<section class="rx-section reveal-on-scroll">
<div class="rx-section-inner">
<div class="rx-collab-card">
<div class="rx-collab-copy">
<span class="section-eyebrow">Collaborate</span>
<h2 class="section-h">Open to research partnerships</h2>
<p>I am interested in collaborations on health systems research, chronic disease management, mixed-methods implementation studies, research data systems, and public-health analytics in Africa.</p>
<div class="rx-collab-topics">
<span>Health financing</span>
<span>NCD care systems</span>
<span>Mixed-methods</span>
<span>Research data pipelines</span>
<span>Policy translation</span>
<span>Open-source tools</span>
</div>
</div>
<div class="rx-collab-actions">
<a href="mailto:nichodemuswerre@gmail.com" class="btn-solid">Email Me</a>
<a href="thesis.html" class="btn-ghost">View Thesis →</a>
<a href="https://github.com/gondamol" class="btn-ghost" target="_blank">GitHub ↗</a>
</div>
</div>
</div>
</section>
</div>
<script>
// Scroll reveal for research page
(function() {
var researchSites = [
{
site: 'Seme Sub-County facilities',
location: 'Kisumu County, Kenya',
focus: 'Financing chronic care for hypertension and diabetes',
lat: -0.0907,
lon: 34.7679
},
{
site: 'JOOTRH referral analysis',
location: 'Kisumu, Kenya',
focus: 'Oncology survival and HIV co-morbidity analysis',
lat: -0.1022,
lon: 34.7617
},
{
site: 'National policy engagement',
location: 'Nairobi, Kenya',
focus: 'Stakeholder engagement and research translation',
lat: -1.2864,
lon: 36.8172
},
{
site: 'Regional methods collaboration',
location: 'Kampala, Uganda',
focus: 'Mixed-methods and public-health analytics exchange',
lat: 0.3476,
lon: 32.5825
},
{
site: 'Regional field systems exchange',
location: 'Dar es Salaam, Tanzania',
focus: 'Field systems, training, and implementation learning',
lat: -6.7924,
lon: 39.2083
}
];
var portfolio = [
{
output: 'Financial determinants of chronic care',
year: 2026,
theme: 'Health financing',
status: 'Forthcoming',
role: 'First author',
geography: 'Kisumu'
},
{
output: 'Participatory NCD intervention development',
year: 2025,
theme: 'Primary care design',
status: 'Published',
role: 'Co-author',
geography: 'Rural Kenya'
},
{
output: 'Esophageal cancer and HIV mortality',
year: 2024,
theme: 'Oncology',
status: 'Published',
role: 'Co-author',
geography: 'Western Kenya'
},
{
output: 'Cervical cancer survival disparities',
year: 2024,
theme: 'Oncology',
status: 'Published',
role: 'Co-author',
geography: 'Kisumu'
}
];
var publicationTable = [
{
title: 'Financial Determinants of Effective Hypertension and Diabetes Care in Rural Primary Health Facilities in Kisumu, Kenya',
status: 'Forthcoming',
role: 'First Author',
focus: 'Health financing and chronic care',
geography: 'Kisumu County'
},
{
title: 'Addressing priority gaps in access and quality of NCD services in primary care settings in rural Kenya',
status: 'Published',
role: 'Co-Author',
focus: 'Participatory intervention design',
geography: 'Rural Kenya'
},
{
title: 'Characteristics and mortality risk among esophageal cancer patients with varied HIV status seeking care in western Kenya',
status: 'Published',
role: 'Co-Author',
focus: 'Cancer survival and HIV',
geography: 'Western Kenya'
},
{
title: 'Survival disparities in cervical cancer patients with and without HIV at JOOTRH',
status: 'Published',
role: 'Co-Author',
focus: 'Cancer survival disparities',
geography: 'Kisumu'
}
];
function loadScript(src) {
return new Promise(function(resolve, reject) {
var existing = document.querySelector('script[src="' + src + '"]');
if (existing) {
resolve();
return;
}
var script = document.createElement('script');
script.src = src;
script.onload = resolve;
script.onerror = reject;
document.head.appendChild(script);
});
}
function loadStylesheet(href) {
if (document.querySelector('link[href="' + href + '"]')) return;
var link = document.createElement('link');
link.rel = 'stylesheet';
link.href = href;
document.head.appendChild(link);
}
function renderResearchMap() {
var mapEl = document.getElementById('researchMap');
if (!mapEl || !window.L) return;
var map = L.map(mapEl, {
scrollWheelZoom: false,
zoomControl: true
}).setView([-1.2, 35.9], 5);
L.tileLayer('https://{s}.basemaps.cartocdn.com/light_all/{z}/{x}/{y}{r}.png', {
attribution: '© OpenStreetMap contributors © CARTO'
}).addTo(map);
researchSites.forEach(function(site) {
L.circleMarker([site.lat, site.lon], {
radius: 8,
fillColor: '#b84e16',
fillOpacity: 0.9,
color: '#191917',
weight: 1.5
}).bindPopup(
'<strong>' + site.site + '</strong><br>' +
site.location + '<br>' +
site.focus
).addTo(map);
});
}
function renderPortfolioChart() {
var chartEl = document.getElementById('researchPortfolioChart');
if (!chartEl || !window.Plotly) return;
var colors = {
Forthcoming: '#b84e16',
Published: '#2d4a2d'
};
var trace = {
x: portfolio.map(function(item) { return item.year; }),
y: portfolio.map(function(item) { return item.theme; }),
text: portfolio.map(function(item) {
return '<b>' + item.output + '</b><br>' +
'Role: ' + item.role + '<br>' +
'Geography: ' + item.geography;
}),
hovertemplate: '%{text}<extra></extra>',
mode: 'markers',
type: 'scatter',
marker: {
size: 18,
color: portfolio.map(function(item) { return colors[item.status]; }),
line: {
color: '#f5f1ea',
width: 1.5
}
}
};
Plotly.newPlot(chartEl, [trace], {
paper_bgcolor: 'rgba(0,0,0,0)',
plot_bgcolor: 'rgba(0,0,0,0)',
margin: { l: 10, r: 10, t: 10, b: 45 },
xaxis: { title: '', dtick: 1, tickmode: 'linear' },
yaxis: { title: '' }
}, {
displayModeBar: false,
responsive: true
});
}
function renderPublicationsTable() {
var tbody = document.getElementById('researchTableBody');
var searchInput = document.getElementById('researchTableSearch');
if (!tbody || !searchInput) return;
function drawRows(query) {
var normalizedQuery = (query || '').trim().toLowerCase();
var filtered = publicationTable.filter(function(row) {
var haystack = [
row.title,
row.status,
row.role,
row.focus,
row.geography
].join(' ').toLowerCase();
return !normalizedQuery || haystack.indexOf(normalizedQuery) !== -1;
});
tbody.innerHTML = filtered.map(function(row) {
return '<tr>' +
'<td>' + row.title + '</td>' +
'<td>' + row.status + '</td>' +
'<td>' + row.role + '</td>' +
'<td>' + row.focus + '</td>' +
'<td>' + row.geography + '</td>' +
'</tr>';
}).join('');
if (!filtered.length) {
tbody.innerHTML = '<tr><td colspan="5">No publications match that search yet.</td></tr>';
}
}
searchInput.addEventListener('input', function() {
drawRows(searchInput.value);
});
drawRows('');
}
var prefersReduced = window.matchMedia('(prefers-reduced-motion: reduce)').matches;
var revealEls = document.querySelectorAll('.reveal-on-scroll');
if (!prefersReduced) {
var observer = new IntersectionObserver(function(entries) {
entries.forEach(function(entry) {
if (entry.isIntersecting) {
entry.target.classList.add('is-visible');
observer.unobserve(entry.target);
}
});
}, { threshold: 0.06, rootMargin: '0px 0px -40px 0px' });
revealEls.forEach(function(el) { observer.observe(el); });
} else {
revealEls.forEach(function(el) { el.classList.add('is-visible'); });
}
// Stat counter animation
var statsAnimated = false;
function animateStats() {
if (statsAnimated || prefersReduced) return;
var strip = document.querySelector('.rx-stats-strip');
if (!strip) return;
var rect = strip.getBoundingClientRect();
if (rect.top < window.innerHeight - 60) {
statsAnimated = true;
strip.querySelectorAll('.rx-stat-num').forEach(function(el) {
el.classList.add('rx-stat-num--animated');
});
}
}
window.addEventListener('scroll', animateStats, { passive: true });
animateStats();
renderPublicationsTable();
loadStylesheet('https://unpkg.com/leaflet@1.9.4/dist/leaflet.css');
Promise.all([
loadScript('https://unpkg.com/leaflet@1.9.4/dist/leaflet.js'),
loadScript('https://cdn.plot.ly/plotly-2.35.2.min.js')
]).then(function() {
renderResearchMap();
renderPortfolioChart();
}).catch(function() {
var mapEl = document.getElementById('researchMap');
var chartEl = document.getElementById('researchPortfolioChart');
if (mapEl) {
mapEl.innerHTML = '<p class="rx-widget-fallback">The interactive map could not load in this browser.</p>';
}
if (chartEl) {
chartEl.innerHTML = '<p class="rx-widget-fallback">The interactive chart could not load in this browser.</p>';
}
});
})();
</script>
```
