Bhojani, Upendra and Devedasan, Narayanan and Mishra, Arima and De Henauw, Stefaan
(2014)
Health system challenges in organizing quality diabetes care for urban poor in South India.
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.
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