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Health system obstacles in the delivery of quality care to people with chronic diseases (PWCD): a case study from urban India

Upendra Bhojani, Thriveni S Beerenahalli, CM Munegowda, Roopa Devadasan, C AnthonyAmma, Werner Soors, Narayanan Devadasan, Bart Criel and Patrick Kolsteren UGent (2011) TROPICAL MEDICINE & INTERNATIONAL HEALTH. 16(suppl. 1). p.346-347
abstract
INTRODUCTION India is undergoing a rapid epidemiologic transition with chronic diseases now constituting a leading cause of death and suffering. Delivering an appropriate response to this rising burden implies health systems strengthening. We analysed the structure and functioning of the Local Health System (LHS) in the poor urban neighbourhood of KG Halli (Bangalore) in order to identify its principal weaknesses in providing quality care to PWCD. METHODS We applied the health-system analysis framework developed by Van Olmen et al. to the situation of KG Halli using data generated over a period of 2 years through (i) a household census (n = 9299, response rate = 98.5%) using a questionnaire on socio-demographic characteristics, illness profile, health seeking behaviour, and healthcare expenditure; (ii) mapping and interviewing healthcare providers (n = 24); and (iii) observational fieldnotes. Document analysis and STATA were used to analyse data. RESULTS The KG Halli LHS faces poor operational and administrative integration across public and private healthcare providers. Most resources including trained personnel, laboratory and pharmacy support lie in a poorly regulated private sector that cares-on a fee-for-service basis – for more than 80% of PWCD. Lack of gate-keeping at the primary care level leads to hospitals managing almost 60% of PWCD. These inefficiencies contribute to have one out of four families experiencing catastrophic expenditure (>10% of household income) in ambulatory care alone. All the preceding factors, plus poor referral and information systems, negatively affect continuity and effectiveness of care, with a high hospitalisation rate of 191.4/1000 per year in PWCD, pointing to delays in receiving adequate care at the primary care level. The geographical delimitation of the population of responsibility of the public facilities in the KG Halli area is inappropriate; among the private providers, the notion of a ‘population of responsibility’ is simply not taken into consideration. Contextual factors like rapid urbanisation and internal migration pose additional challenges. CONCLUSION The KG Halli LHS not only responds poorly to needs of PWCD but also causes them considerable impoverishment. Rising chronic disease burden provides an opportunity to reexamine organisation and performance of health systems. A structured analysis allows identification of the main obstacles to overcome.
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author
organization
year
type
conference (meetingAbstract)
publication status
published
subject
keyword
India, urban poor, health system, Chronic illness, non-communicable diseases, slum
in
TROPICAL MEDICINE & INTERNATIONAL HEALTH
Trop. Med. Int. Health
volume
16
issue
suppl. 1
article number
abstract 4.3-030
pages
346 - 347
conference name
7th European congress on Tropical Medicine and International Health
conference location
Barcelona, Spain
conference start
2011-10-03
conference end
2011-10-06
Web of Science type
Meeting Abstract
Web of Science id
000295519101178
JCR category
TROPICAL MEDICINE
JCR impact factor
2.795 (2011)
JCR rank
3/20 (2011)
JCR quartile
1 (2011)
ISSN
1360-2276
DOI
10.1111/j.1365-3156.2011.02861.x
language
English
UGent publication?
no
classification
C3
id
4158849
handle
http://hdl.handle.net/1854/LU-4158849
date created
2013-10-09 13:53:17
date last changed
2016-12-21 15:40:49
@inproceedings{4158849,
  abstract     = {INTRODUCTION India is undergoing a rapid epidemiologic transition with chronic diseases now constituting a leading cause of death and suffering. Delivering an appropriate response to this rising burden implies health systems strengthening. We analysed the structure and functioning of the Local Health System (LHS) in the poor urban neighbourhood of KG Halli (Bangalore) in order to identify its principal weaknesses in providing quality care to PWCD.
METHODS We applied the health-system analysis framework developed by Van Olmen et al. to the situation of KG Halli using data generated over a period of 2 years through (i) a household census (n = 9299, response rate = 98.5\%) using a questionnaire on socio-demographic characteristics, illness profile, health seeking behaviour, and healthcare expenditure; (ii) mapping and interviewing healthcare providers (n = 24); and (iii) observational fieldnotes. Document analysis and STATA were used to analyse data.
RESULTS The KG Halli LHS faces poor operational and administrative integration across public and private healthcare providers. Most resources including trained personnel, laboratory and pharmacy support lie in a poorly regulated private sector that cares-on a fee-for-service basis -- for more than 80\% of PWCD. Lack of gate-keeping at the primary care level leads to hospitals managing almost 60\% of PWCD. These inefficiencies contribute to have one out of four families experiencing catastrophic expenditure ({\textrangle}10\% of household income) in ambulatory care alone. All the preceding factors, plus poor referral and information systems, negatively affect continuity and effectiveness of care, with a high hospitalisation rate of 191.4/1000 per year in PWCD, pointing to delays in receiving adequate care at the primary care level. The geographical delimitation of the population of responsibility of the public facilities in the KG Halli area is inappropriate; among the private providers, the notion of a {\textquoteleft}population of responsibility{\textquoteright} is simply not taken into consideration. Contextual factors like rapid urbanisation and internal migration pose additional challenges.
CONCLUSION The KG Halli LHS not only responds poorly to needs of PWCD but also causes them considerable impoverishment. Rising chronic disease burden provides an opportunity to reexamine organisation and performance of health systems. A structured analysis allows identification of the main obstacles to overcome.},
  articleno    = {abstract 4.3-030},
  author       = {Bhojani, Upendra and Beerenahalli, Thriveni S and Munegowda, CM and Devadasan, Roopa and AnthonyAmma, C and Soors, Werner and  Devadasan, Narayanan and Criel, Bart and Kolsteren, Patrick},
  booktitle    = {TROPICAL MEDICINE \& INTERNATIONAL HEALTH},
  issn         = {1360-2276},
  keyword      = {India,urban poor,health system,Chronic illness,non-communicable diseases,slum},
  language     = {eng},
  location     = {Barcelona, Spain},
  number       = {suppl. 1},
  pages        = {abstract 4.3-030:346--abstract 4.3-030:347},
  title        = {Health system obstacles in the delivery of quality care to people with chronic diseases (PWCD): a case study from urban India},
  url          = {http://dx.doi.org/10.1111/j.1365-3156.2011.02861.x},
  volume       = {16},
  year         = {2011},
}

Chicago
Bhojani, Upendra, Thriveni S Beerenahalli, CM Munegowda, Roopa Devadasan, C AnthonyAmma, Werner Soors, Narayanan Devadasan, Bart Criel, and Patrick Kolsteren. 2011. “Health System Obstacles in the Delivery of Quality Care to People with Chronic Diseases (PWCD): a Case Study from Urban India.” In Tropical Medicine & International Health, 16:346–347.
APA
Bhojani, U., Beerenahalli, T. S., Munegowda, C., Devadasan, R., AnthonyAmma, C., Soors, W., Devadasan, N., et al. (2011). Health system obstacles in the delivery of quality care to people with chronic diseases (PWCD): a case study from urban India. TROPICAL MEDICINE & INTERNATIONAL HEALTH (Vol. 16, pp. 346–347). Presented at the 7th European congress on Tropical Medicine and International Health.
Vancouver
1.
Bhojani U, Beerenahalli TS, Munegowda C, Devadasan R, AnthonyAmma C, Soors W, et al. Health system obstacles in the delivery of quality care to people with chronic diseases (PWCD): a case study from urban India. TROPICAL MEDICINE & INTERNATIONAL HEALTH. 2011. p. 346–7.
MLA
Bhojani, Upendra, Thriveni S Beerenahalli, CM Munegowda, et al. “Health System Obstacles in the Delivery of Quality Care to People with Chronic Diseases (PWCD): a Case Study from Urban India.” Tropical Medicine & International Health. Vol. 16. 2011. 346–347. Print.