Stakeholder perspectives on the barriers and facilitators to integrating cardiovascular disease and diabetes management at primary care in Kenya.

Integrated care is increasingly recognised as a key strategy for the management of multimorbidity. However, evidence on the factors associated with the implementation of integrated care models in low- and middle-income countries remains limited. We explored how stakeholders perceived integrated care, existing challenges, and recommendations for integrating cardiovascular disease and diabetes management at primary health care (PHC) level in Kenya. We conducted a qualitative study using key informant interviews with 16 key stakeholders involved in healthcare delivery, research, and policy on non-communicable diseases (NCDs) in Kenya between February and March 2024. All interviews were audio recorded and transcribed; and the data analysed both inductively and deductively within NVivo software. The deductive analysis was guided by the Rainbow Model of Integrated Care (RMIC) framework, which combines key dimensions necessary for successful integrated care with key elements of primary care. The RMIC framework dimensions include systems, clinical, organisational, professional, functional, and normative integration. Out of the six RMIC dimensions, stakeholders' description of integrated care included elements of clinical, systems, and professional integration. Key systems level challenges included disparity between policy and practice, inadequate resource allocation, donor-driven priorities, and limited stakeholder collaboration. Fragmented care delivery was a key organisational challenge. Limited resources for integrated care delivery and inadequate staff numbers and capacity were considered key challenges in the functional and professional dimensions of the RMIC framework. Additional challenges included 'siloed' mindset (normative) and limited evidence on effective or cost-effective integrated care models. To address the identified barriers, policy-makers should develop clear and adaptable how-to county-specific guidelines for implementation and evaluation of integrated care at PHC level. There is a need for advocacy and research on models of integrated care at PHC level to guide prioritization and resource allocation in Kenya.