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

<h4>Background</h4>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...

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Autores principales:	Upendra Bhojani, Narayanan Devedasan, Arima Mishra, Stefaan De Henauw, Patrick Kolsteren, Bart Criel
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/58124e355c4d4f3f831703f078c6117b
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spelling	oai:doaj.org-article:58124e355c4d4f3f831703f078c6117b2021-11-25T06:01:45ZHealth system challenges in organizing quality diabetes care for urban poor in South India.1932-620310.1371/journal.pone.0106522https://doaj.org/article/58124e355c4d4f3f831703f078c6117b2014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/25188582/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Result</h4>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.<h4>Conclusions</h4>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.Upendra BhojaniNarayanan DevedasanArima MishraStefaan De HenauwPatrick KolsterenBart CrielPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 9, p e106522 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Upendra Bhojani Narayanan Devedasan Arima Mishra Stefaan De Henauw Patrick Kolsteren Bart Criel Health system challenges in organizing quality diabetes care for urban poor in South India.
description	<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Result</h4>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.<h4>Conclusions</h4>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.
format	article
author	Upendra Bhojani Narayanan Devedasan Arima Mishra Stefaan De Henauw Patrick Kolsteren Bart Criel
author_facet	Upendra Bhojani Narayanan Devedasan Arima Mishra Stefaan De Henauw Patrick Kolsteren Bart Criel
author_sort	Upendra Bhojani
title	Health system challenges in organizing quality diabetes care for urban poor in South India.
title_short	Health system challenges in organizing quality diabetes care for urban poor in South India.
title_full	Health system challenges in organizing quality diabetes care for urban poor in South India.
title_fullStr	Health system challenges in organizing quality diabetes care for urban poor in South India.
title_full_unstemmed	Health system challenges in organizing quality diabetes care for urban poor in South India.
title_sort	health system challenges in organizing quality diabetes care for urban poor in south india.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/58124e355c4d4f3f831703f078c6117b
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Health system challenges in organizing quality diabetes care for urban poor in South India.

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