Financial Determinants of Effective Hypertension and Diabetes Care

Thesis Presentation

Nichodemus Werre Amollo

Jaramogi Oginga Odinga University of Science and Technology

2026-02-22

Financial Determinants of Effective Hypertension and Diabetes Care

A mixed methods study in rural primary health facilities in Kisumu County, Kenya.

Forthcoming in BMC Public Health · final thesis stage

Nichodemus Werre Amollo · MSc Epidemiology and Biostatistics

Why this study matters

NCD pressure

NCDs now account for a major share of mortality in Kenya while hypertension and diabetes care demand is growing quickly.

Financing bottleneck

Primary care facilities face practical financing constraints that affect medicine availability and care continuity.

Policy relevance

County financing reforms can produce immediate quality gains when linked to facility execution realities.

Study design

Design

Convergent parallel mixed methods cross sectional study

Setting

Seme Sub County in Kisumu County
7 public primary health facilities

Data streams

Structured facility questionnaire
Financial record review from Jan to Aug 2024
In depth interviews with facility in charges

Interactive result profile

Click the controls to switch between percentage view and facility count view.

Funding architecture pattern

Observed funding dependence

  • 71.4 percent of facilities depended on NHIF reimbursements
  • 71.4 percent reported donor support dependence
  • Only 28.6 percent received direct county funding
  • 57.1 percent relied on only two active funding streams

Execution implication

Where financing channels are narrow and delayed, procurement flexibility falls and stockout risk increases.

Narrow stream dependence
Direct county funding
Frequent stockouts

Decision simulator for policy planning

Move the sliders to test a practical reform scenario and observe the projected stockout risk signal.

Projected stockout risk index

72.6

Key findings

  1. All facilities produced annual plans, but none had a complete NCD planning and dedicated budget line package.
  2. No facility had full direct spending autonomy despite holding bank accounts.
  3. County approval timelines often delayed procurement response during stockout periods.
  4. Frequent medicine stockouts were reported by 85.7 percent of facilities.

Recommendations for county and facility action

Financing rules

Ring fence NCD lines in planning and budget execution at facility and county levels.

Procurement pathway

Create fast emergency procurement workflow for essential NCD medicines and diagnostics.

Accountability loop

Track budget release, approval cycle time, and stockout days in one county facility dashboard.

Implementation roadmap

Quarter 1

Finance design

Define ring fenced NCD budget structure and autonomy thresholds.

Quarter 2

Digital workflow

Deploy approval tracking and emergency procurement trigger logic.

Quarter 3

Quality monitoring

Run quarterly review on stockout days and refill reliability indicators.

Quarter 4

Scale and adapt

Expand to additional sub counties using evidence from implementation results.

Access full materials

Thesis page Research page Current manuscript PDF Project portfolio

Thank you

Questions, critique, and collaboration are welcome.

Email: nichodemuswerre@gmail.com
LinkedIn: linkedin.com/in/nichodemusamollo