Background: The 2011 UN declaration on non-communicable diseases (NCDs) recognized their importance as a global health issue, particularly for low- and middle-income countries. The extent to which these countries address policy implementation gaps in the face of resource limitations and competing priorities remains largely unexplored. Objective: This qualitative study presents Kenya’s experience of translating the UN declaration to national policies for diabetes prevention and control. Methods: Policy documents published between 2006 and 2016 were analyzed. Thirty-two documents were included in the analysis. Interviews with six purposively selected policy stakeholders at multiple levels of decision-making were conducted. Emerging themes were deconstructed into a policy analysis triangle. Results: Diabetes-specific policies already existed in Kenya before 2011, suggesting successful advocacy work by diabetes interest groups. The 2011 UN declaration subsequently coincided with a period of political transition in Kenya, opening policy windows that the diabetes community leveraged to trigger political drive against prevailing challenges. The post-declaration period reflected a transition from diabetes-specific policies to a wider NCD agenda. Most of the documents and national strategies aligned strongly with international documents, however, were based on scant local evidence. The implementation process was largely health-sector driven. The non-health sector remained largely uninvolved, contrary to global recommendations. This, in addition to fragmented health governance and weak monitoring systems, continues to undermine existing gains and efforts to fight diabetes and NCDs on a wider scale. Conclusions: In Kenya, a major gap remains between how diabetes is addressed within the NCD policy agenda and tackling diabetes in reality, with respect to local implementation processes. More emphasis on population-wide prevention and inclusion of the non-health sector could help to cascade national efforts to the grassroots level. A concerted effort from the highest political level is needed to address overarching NCD drivers while maintaining health system improvement strategies.

Despite positive NCD policies in recent years, majority of Sub-Saharan African (SSA) health systems are inadequately prepared to deliver comprehensive first-line care for NCDs. Primary health care (PHC) settings in countries like Malawi and Zambia could be a doorway to effectively manage NCDs by moving away from delivering only episodic care to providing an integrated approach over time. As part of a collaborative health system strengthening project, we assessed and compared the preparedness and operational capacity of two target networks of public PHC settings in Lilongwe (Malawi) and Lusaka (Zambia) to integrate NCD services within routine service delivery. Data was collected and analyzed using validated health facility survey tools. These baseline assessments conducted between August 2018 and March 2019, also included interviews with 20 on-site health personnel and focal persons, who described existing barriers in delivering NCD services. In both countries, policy directives to decentralize disease-specific NCD services to the primary care level were initiated to meet increased demand but lacked operational guidance. In general, the assessed PHC sites were inadequately prepared to integrate NCDs into various service delivery domains, thus requiring further support. In spite of existing multi-faceted limitations, there was motivation among healthcare staff to provide NCD services.

Background: Addressing health in the Sustainable Development Goals (SDGs) calls for intersectoral strategies that mutually enhance both health promotion and sustainable development. Health in All Policies (HiAP) approach aims to address this as well as promote ownership among key stakeholders. Kenya was at the forefront of adopting the SDGs and has committed to the HiAP approach in its Health Policy document for the period 2014-2030. This study aims to assess how the adoption of the HiAP approach can leverage on SDGs implementation in Kenya. Methods: This is an exploratory case study using qualitative data and some descriptive quantitative data. The Organisation for Economic Co-operation and Development’s (OECD’s) eight building blocks for policy coherence on sustainable development was our guiding framework. Qualitative data was derived from a review of relevant peer-reviewed and grey literature, as well as 40 key informant interviews and analyzed in NVIVO. Quantitative data was accessed from the United Nations SDG indicator database and exported to Excel. Results: Kenya has expressed a strong political commitment to achieving the SDGs and has now adopted HiAP. The study showed that Kenya can leverage on local level implementation and long-term planning horizons that it currently has in place to address the SDGs as it rolls out the HiAP approach. The SDGs could be mapped out against the sectors outlined in the Adelaide statement on HiAP. It is also possible to map out how various ministries could coordinate to effectively address HiAP and SDGs concurrently. Funding for HiAP was not addressed in the OECD framework. Conclusion: Kenya can advance a HiAP approach by leveraging the ongoing SDGs implementation. This will be made possible by facilitating coordinated intersectoral action both at national and local level. Funding for HiAP is crucial for its propagation, especially in low- and middle-income countries (LMICs) and can be considered in the budgetary allocations for SDGs.

Background: In 2022, we adapted the World Health Organization Digital Adaptation Kit (DAK) for antenatal care (ANC) into the BornFyne digital health platform. Because ANC services in many facilities relied on fragmented paper-based guidance, the DAK represented the first exposure for many providers to a structured, comprehensive ANC guideline framework integrated into a digital system. Understanding providers’ motivation, capabilities, and readiness to adopt guideline-driven digital care was essential to inform implementation strategies. We therefore conducted a workshop to explore healthcare providers’ expectations, perceived challenges, and readiness to integrate a comprehensive digital ANC system into routine practice. Methods: A prospective mixed-methods pre–post implementation pilot workshop was conducted between June and August 2023 across four districts. The 5-h workshop targeted ANC providers and included exposure to the WHO ANC DAK and demonstration of its integration into the BornFyne platform. Survey tools assessed perceived knowledge, attitudes, perceived behavioural control, intention, and social norms using Likert scales. Constructs were mapped to the COM-B framework. Paired student’s t-tests assessed pre–post changes (p < 0.05), and Cohen’s d estimated effect sizes. Qualitative responses were thematically analysed. Results: Nineteen participants, including doctors, nurses, midwives, and data managers from public, private, and faith-based facilities, completed the surveys. Most participants were women (90%). Following the workshop, perceived knowledge of behaviour change and digital guideline use significantly increased (t(19) = 3.22, p = 0.004, d = 0.78). Although no statistically significant changes were observed in attitudes, perceived behavioural control, intentions, or social norms, descriptive trends suggested improved confidence and openness toward digital ANC systems. Qualitative findings identified increased knowledge as the most important outcome, with 80% of participants emphasizing its role in strengthening capability. Participants also reported greater confidence in integrating digital tools into routine care but highlighted contextual and motivational barriers as ongoing challenges. Acceptability was high: 90% expressed satisfaction, and all participants rated the workshop as useful, relevant, engaging, and worth their time. Conclusions: The workshop improved providers’ perceived knowledge and demonstrated high acceptability of DAK-aligned digital ANC systems. While changes in attitudes and behavioural control were not statistically significant, the findings support the feasibility of behaviour change-based digital ANC interventions. Addressing contextual and motivational barriers will be essential for sustained adoption in resource-limited settings.