Challenges and opportunities in screening and management of hypertension and type 2 diabetes in informal settlements in Nairobi, Kenya: A qualitative study of multi-sectoral stakeholders

The purpose of the study is to explore barriers and facilitators to noncommunicable disease (NCD) screening and management in Nairobi's informal settlements to inform future NCD programme development. Semi-structured interviews were conducted among 38 multi-sectoral stakeholders, comprising of community health workers (CHWs), nurses, clinical officers, physicians, community-based organisation (CBO) staff, individuals living with hypertension or type 2 diabetes (T2D), and individuals who are eligible for screening but never screened. Workforce shortages and medication unavailability were raised as primary barriers by all stakeholders in informal settlements. Misconceptions and stigma around NCDs contributed to social isolation for people living with NCDs and hindered them from getting the health care and social support they need. Fragmented NCD registries contributed to resource misallocation. Long waiting times, poverty and competing life demands further hindered care access. Several opportunities to overcome challenges in NCD care were also identified. Many advocated for supporting and leveraging CHWs to enhance community-based NCD programs, recognising their potential to address gaps in healthcare access. Strengthening patient support groups and expanding community outreach were proposed as strategies to raise public awareness, provide social support and improve care accessibility. A top-down, multi-level intervention approach is needed to improve health equity for these communities.