P-355: Financial barriers to care for children and adolescents with type 1 diabetes in Kenya: a narrative synthesis
S WanjukiAbstract
Introduction
Type 1 diabetes (T1D) in children and adolescents requires lifelong insulin therapy and consistent monitoring, yet in Kenya, as in many low-resource settings, the financial burden of care remains a major barrier to consistent management and access. Our organization implements the Changing Diabetes in Children (CDiC) program in Kenya, which provides subsidized diabetes care to children and adolescents with T1D across the country.
Objectives
To synthesize published evidence on the economic burden faced by families of children and adolescents with T1D in Kenya, including within programs such as CDiC, and the resulting barriers to sustained care.
Methods
A narrative review of peer-reviewed literature reporting on cost, access, and program evaluation data for pediatric T1D care in Kenya was conducted, drawing on studies identified through PubMed/PMC.
Results
An independent evaluation of the CDiC public-private partnership found that although the program subsidizes treatment costs for children with T1D, indirect costs (transport, monitoring supplies, caregiver time) remain a substantial barrier to consistent care, and that reliance on donor funding creates sustainability risk, as any transition to government-funded care may increase costs borne by families (Ogle et al., 2021). A separate qualitative study of children with T1D and their caregivers in Kenya found that financial strain — from insulin, syringes, and supplies, to indirect costs like transport and food — was pervasive across households and a major driver of poor disease management, disproportionately affecting low-income families (Palmer et al., 2022).
Conclusions
Even where subsidized insulin and supplies are available, indirect and transitional costs remain key barriers to sustained T1D care for children in Kenya. Programs like CDiC, and the policies that support them, should explicitly address these secondary cost drivers and plan for the financial risks of transitioning children from donor-funded to government- or family-financed care.