Mapping Diabetes Care in Kenya Through a Systems Thinking Lens: A Narrative Review Using the WHO Health System Building Blocks and the Intervention-Level Framework.

INTRODUCTION: Diabetes prevalence in Kenya is rising, yet care remains constrained by fragmented service delivery, shortages of trained health workers, limited access to diagnostics and medicines, and weak integration of diabetes education and nutrition counselling. These challenges reflect underlying system dynamics that are insufficiently captured by linear assessments.

METHODS: This narrative review synthesised evidence published between 2015 and 2025 and examined diabetes care in Kenya through a systems-thinking approach combining the WHO Health System Building Blocks (HSBB) and the Intervention-Level Framework (ILF). The combined framework enabled classification of system weaknesses according to subsystem (e.g. governance, workforce, financing) and depth of leverage (from structural elements to paradigms).

RESULTS: Twenty-eight studies met the inclusion criteria. Across all HSBB domains, recurrent problems, such as inconsistent policy implementation, shortages of trained staff, supply-chain disruptions, insufficient financing, and weak information systems, interacted through reinforcing feedback loops that reduced continuity, quality, and equity of care. Nutrition-related findings appeared less frequently but highlighted significant gaps in diabetes self-management education, food access, and cultural norms. Application of the HSBB-ILF framework revealed that many barriers extend beyond structural deficits (ILF Level 1) into deeper system features including weak feedback mechanisms (Level 2), fragmented organisational arrangements (Level 3), unstable or reactive system goals (Level 4), and entrenched paradigms that deprioritize NCDs (Level 5).

CONCLUSION: Diabetes care in Kenya functions as a complex adaptive system in which structural, organisational, financial, and sociocultural factors interact to shape outcomes. Sustainable improvement will require coordinated, multi-level strategies that strengthen governance, workforce capacity, supply chains, and information systems while also addressing community realities, food insecurity, and cultural beliefs. The HSBB-ILF combination proved valuable for identifying leverage points that could inform more integrated and equitable approaches to diabetes nutrition care.