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Abstract
Introduction Non-communicable diseases (NCDs) have become a major public health challenge worldwide; they account for 28 million deaths per year in low-and-middle-income countries (LMICs). Like many other LMICs, India is struggling to organise quality care for a large NCD-affected population especially at the primary healthcare level. The aim of this study was to assess local health system preparedness in a south Indian primary healthcare setting for addressing diabetes and hypertension.
Methods This paper draws on a mixed-methods research study on access to medicines conducted in Tumkur, Karnataka, India. We used quantitative data from household and health facility surveys, and qualitative data from focus group discussions and in-depth interviews with health workers and patients. We identified systemic drivers that influence utilisation of services at government primary health centres (PHCs) using thematic analysis of qualitative data and a systems framework on access to medicines to assess supply and demand side factors.
Results Majority of households depend on private facilities for diabetes and hypertension care because of the lack of laboratory facilities and frequent medicine stockouts at PHCs. Financial and managerial resource allocation for NCDs and prioritisation of care and processes related to NCDs was suboptimal compared to the prominence of this agenda at global and national levels. Primary healthcare has a limited role even in the activities under the national programme that addresses diabetes and hypertension.
Discussion The study finds critical gaps in the preparedness of PHCs and district health systems in organising and managing care for diabetes and hypertension. Due to the lack of continuous care organised through PHCs, patients depend on expensive and often episodic care in the private sector. There is a need to improve managerial and financial resource allocation towards diabetes and hypertension (and other NCDs) at the district level.
Trial registration number CTRI/2015/03/005640; Pre-results.
- health services research
- diabetes
- hypertension
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Footnotes
Handling editor Stephanie Topp
Contributors MAE and PNS were involved in the conception and design of the study. Field work, data collection and initial analysis was done by MAE, PA, MKP, CMG, SB and PNS. MAE, PA and MKP were involved in the initial analysis of the data. MAE reviewed and finalised the qualitative findings and MKP and PA were involved in summarising the quantitative findings. MAE wrote the first draft of the manuscript with review and addition by PNS, MB and ZS. All authors contributed to interpretation of findings and preparing, reading, revising and approving the manuscript.
Funding This study was funded by the WHO Alliance for Health Policy and Systems Research, Geneva and DFID and chosen through a competitive call for proposals for research on access to medicines launched by them in 2014.
Disclaimer The authors are staff members of the World Health Organization. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization
Competing interests Zubin Shroff is a staff member of the Alliance for Health Policy and Systems Research, WHO.
Ethics approval WHO Ethics Review Committee and the Institutional Ethics Committee of the Institute of Public Health, Bangalore.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Qualitative data in the form of anonymised transcripts are available with the corresponding author. Quantitative household survey data will be made available in an online data repository along with the results of the trial in 2018. If the reader requires any further information, they are welcome to contact the corresponding author.