IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0106522.html
   My bibliography  Save this article

Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India

Author

Listed:
  • Upendra Bhojani
  • Narayanan Devedasan
  • Arima Mishra
  • Stefaan De Henauw
  • Patrick Kolsteren
  • Bart Criel

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.

Suggested Citation

  • Upendra Bhojani & Narayanan Devedasan & Arima Mishra & Stefaan De Henauw & Patrick Kolsteren & Bart Criel, 2014. "Health System Challenges in Organizing Quality Diabetes Care for Urban Poor in South India," PLOS ONE, Public Library of Science, vol. 9(9), pages 1-10, September.
    • Handle: RePEc:plo:pone00:0106522
    DOI: 10.1371/journal.pone.0106522
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0106522
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0106522&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0106522?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Anonymous, 2013. "National Urban Health Mission," Working Papers id:5343, eSocialSciences.
    2. Gilson, Lucy, 2003. "Trust and the development of health care as a social institution," Social Science & Medicine, Elsevier, vol. 56(7), pages 1453-1468, April.
    Full references (including those not matched with items on IDEAS)

    Citations

    Citations are extracted by the CitEc Project, subscribe to its RSS feed for this item.
    as


    Cited by:

    1. Sandipana Pati & F G Schellevis, 2017. "Prevalence and pattern of co morbidity among type2 diabetics attending urban primary healthcare centers at Bhubaneswar (India)," PLOS ONE, Public Library of Science, vol. 12(8), pages 1-12, August.

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Gore, Radhika, 2021. "Ensuring the ordinary: Politics and public service in municipal primary care in India," Social Science & Medicine, Elsevier, vol. 283(C).
    2. Wouters, Olivier J. & Cylus, Jonathan & Yang, Wei & Thomson, Sarah & McKee, Martin, 2016. "Medical savings accounts: assessing their impact on efficiency, equity, and financial protection in health care," LSE Research Online Documents on Economics 65448, London School of Economics and Political Science, LSE Library.
    3. Schneider, Pia, 2005. "Trust in micro-health insurance: an exploratory study in Rwanda," Social Science & Medicine, Elsevier, vol. 61(7), pages 1430-1438, October.
    4. Brownlie, Julie & Howson, Alexandra, 2006. "'Between the demands of truth and government': Health practitioners, trust and immunisation work," Social Science & Medicine, Elsevier, vol. 62(2), pages 433-443, January.
    5. Coast, Joanna, 2018. "A history that goes hand in hand: Reflections on the development of health economics and the role played by Social Science & Medicine, 1967–2017," Social Science & Medicine, Elsevier, vol. 196(C), pages 227-232.
    6. Smirnova, Michelle & Owens, Jennifer Gatewood, 2017. "Medicalized addiction, self-medication, or nonmedical prescription drug use? How trust figures into incarcerated women's conceptualization of illicit prescription drug use," Social Science & Medicine, Elsevier, vol. 183(C), pages 106-115.
    7. Costa-Font, Joan & Vilaplana-Prieto, Cristina, 2023. "Health System Trust and Compliance with COVID-19 Restrictions," IZA Discussion Papers 15961, Institute of Labor Economics (IZA).
    8. Stasiulis, Elaine & Gibson, Barbara E. & Webster, Fiona & Boydell, Katherine M., 2020. "Resisting governance and the production of trust in early psychosis intervention," Social Science & Medicine, Elsevier, vol. 253(C).
    9. Rosemarie Sheehan & Gerard Fealy, 2020. "Trust in the nurse: Findings from a survey of hospitalised children," Journal of Clinical Nursing, John Wiley & Sons, vol. 29(21-22), pages 4289-4299, November.
    10. Tritter, Jonathan Quetzal & McCallum, Alison, 2006. "The snakes and ladders of user involvement: Moving beyond Arnstein," Health Policy, Elsevier, vol. 76(2), pages 156-168, April.
    11. Jae-Young Lim & Hyun-Hoon Lee & Yeon-Hee Hwang, 2011. "Trust on doctor, social capital and medical care use of the elderly," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(2), pages 175-188, April.
    12. Dyer, Thomas Anthony & Owens, Janine & Robinson, Peter Glenn, 2014. "The acceptability of care delegation in skill-mix: The salience of trust," Health Policy, Elsevier, vol. 117(2), pages 170-178.
    13. Xue-Jing Liu & Gustavo S. Mesch, 2020. "The Adoption of Preventive Behaviors during the COVID-19 Pandemic in China and Israel," IJERPH, MDPI, vol. 17(19), pages 1-18, September.
    14. Jamison, Amelia M. & Quinn, Sandra Crouse & Freimuth, Vicki S., 2019. "“You don't trust a government vaccine”: Narratives of institutional trust and influenza vaccination among African American and white adults," Social Science & Medicine, Elsevier, vol. 221(C), pages 87-94.
    15. Arakelyan, Stella & Jailobaeva, Kanykey & Dakessian, Arek & Diaconu, Karin & Caperon, Lizzie & Strang, Alison & Bou-Orm, Ibrahim R. & Witter, Sophie & Ager, Alastair, 2021. "The role of trust in health-seeking for non-communicable disease services in fragile contexts: A cross-country comparative study," Social Science & Medicine, Elsevier, vol. 291(C).
    16. Polonsky, Michael Jay & Brijnath, Bianca & Renzaho, André M.N., 2011. ""They don't want our blood": Social inclusion and blood donation among African migrants in Australia," Social Science & Medicine, Elsevier, vol. 73(2), pages 336-342, July.
    17. Adelman, Sarah W. & Essam, Timothy M. & Leonard, Kenneth L., 2008. "Idle Chatter or Learning? Evidence from Rural Tanzania of Social Learning about Clinicians and the Health System," Working Papers 42884, University of Maryland, Department of Agricultural and Resource Economics.
    18. Schottmüller, Christoph, 2013. "Cost incentives for doctors: A double-edged sword," European Economic Review, Elsevier, vol. 61(C), pages 43-58.
    19. Dahai Zhao & Hongyu Zhao & Paul D. Cleary, 2019. "International variations in trust in health care systems," International Journal of Health Planning and Management, Wiley Blackwell, vol. 34(1), pages 130-139, January.
    20. Radin, Dagmar, 2013. "Does corruption undermine trust in health care? Results from public opinion polls in Croatia," Social Science & Medicine, Elsevier, vol. 98(C), pages 46-53.

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0106522. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.