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Health system challenges in organizing quality diabetes care for urban poor in South India

Upendra Bhojani, Narayanan Devadasan, Arima Mishra, Stefaan De Henauw UGent, Patrick Kolsteren UGent and Bart Criel (2014) PLOS ONE. 9(9).
abstract
Background: Weak health systems in low-and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. Methods: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. Result: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. Conclusions: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.
Please use this url to cite or link to this publication:
author
organization
year
type
journalArticle (original)
publication status
published
subject
keyword
chronic conditions, health system, chronic diseases, urban, non-communicable diseases, poverty, slum, healthcare delivery, diabetes, India, CHRONIC DISEASES, NORTHERN INDIA, RISK-FACTORS, PREVALENCE, MANAGEMENT
journal title
PLOS ONE
PLoS One
volume
9
issue
9
article number
e106522
pages
10 pages
Web of Science type
Article
Web of Science id
000341271500049
JCR category
MULTIDISCIPLINARY SCIENCES
JCR impact factor
3.234 (2014)
JCR rank
9/57 (2014)
JCR quartile
1 (2014)
ISSN
1932-6203
DOI
10.1371/journal.pone.0106522
language
English
UGent publication?
yes
classification
A1
copyright statement
I have retained and own the full copyright for this publication
id
5704394
handle
http://hdl.handle.net/1854/LU-5704394
date created
2014-09-17 15:41:51
date last changed
2016-12-21 15:41:20
@article{5704394,
  abstract     = {Background: Weak health systems in low-and middle-income countries are recognized as the major constraint in responding to the rising burden of chronic conditions. Despite recognition by global actors for the need for research on health systems, little attention has been given to the role played by local health systems. We aim to analyze a mixed local health system to identify the main challenges in delivering quality care for diabetes mellitus type 2. 
Methods: We used the health system dynamics framework to analyze a health system in KG Halli, a poor urban neighborhood in South India. We conducted semi-structured interviews with healthcare providers located in and around the neighborhood who provide care to diabetes patients: three specialist and 13 non-specialist doctors, two pharmacists, and one laboratory technician. Observations at the health facilities were recorded in a field diary. Data were analyzed through thematic analysis. 
Result: There is a lack of functional referral systems and a considerable overlap in provision of outpatient care for diabetes across the different levels of healthcare services in KG Halli. Inadequate use of patients' medical records and lack of standard treatment protocols affect clinical decision-making. The poor regulation of the private sector, poor systemic coordination across healthcare providers and healthcare delivery platforms, widespread practice of bribery and absence of formal grievance redress platforms affect effective leadership and governance. There appears to be a trust deficit among patients and healthcare providers. The private sector, with a majority of healthcare providers lacking adequate training, operates to maximize profit, and healthcare for the poor is at best seen as charity. 
Conclusions: Systemic impediments in local health systems hinder the delivery of quality diabetes care to the urban poor. There is an urgent need to address these weaknesses in order to improve care for diabetes and other chronic conditions.},
  articleno    = {e106522},
  author       = {Bhojani, Upendra and Devadasan, Narayanan and Mishra, Arima and De Henauw, Stefaan and Kolsteren, Patrick and Criel, Bart},
  issn         = {1932-6203},
  journal      = {PLOS ONE},
  keyword      = {chronic conditions,health system,chronic diseases,urban,non-communicable diseases,poverty,slum,healthcare delivery,diabetes,India,CHRONIC DISEASES,NORTHERN INDIA,RISK-FACTORS,PREVALENCE,MANAGEMENT},
  language     = {eng},
  number       = {9},
  pages        = {10},
  title        = {Health system challenges in organizing quality diabetes care for urban poor in South India},
  url          = {http://dx.doi.org/10.1371/journal.pone.0106522},
  volume       = {9},
  year         = {2014},
}

Chicago
Bhojani, Upendra, Narayanan Devadasan, Arima Mishra, Stefaan De Henauw, Patrick Kolsteren, and Bart Criel. 2014. “Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India.” Plos One 9 (9).
APA
Bhojani, U., Devadasan, N., Mishra, A., De Henauw, S., Kolsteren, P., & Criel, B. (2014). Health system challenges in organizing quality diabetes care for urban poor in South India. PLOS ONE, 9(9).
Vancouver
1.
Bhojani U, Devadasan N, Mishra A, De Henauw S, Kolsteren P, Criel B. Health system challenges in organizing quality diabetes care for urban poor in South India. PLOS ONE. 2014;9(9).
MLA
Bhojani, Upendra, Narayanan Devadasan, Arima Mishra, et al. “Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India.” PLOS ONE 9.9 (2014): n. pag. Print.