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Diabetic retinopathy service delivery and integration into the health system in Pakistan—Findings from a multicentre qualitative study

Author

Listed:
  • Stevens Bechange
  • Anne Roca
  • Elena Schmidt
  • Munazza Gillani
  • Leena Ahmed
  • Robina Iqbal
  • Imran Nazir
  • Anna Ruddock
  • Muhammed Bilal
  • Itfaq Khaliq Khan
  • Sandeep Buttan
  • Emma Jolley

Abstract

This paper is based on qualitative research carried out in a diabetic retinopathy (DR) programme in three districts of Pakistan. It analyses the organisation and delivery of DR services and the extent to which the interventions resulted in a fully functioning integrated approach to DR care and treatment. Between January and April 2019, we conducted 14 focus group discussions and 37 in-depth interviews with 144 purposively selected participants: patients, lady health workers (LHWs) and health professionals. Findings suggest that integration of services was helpful in the prevention and management of DR. Through the efforts of LHWs and general practitioners, diabetic patients in the community became aware of the eye health issues related to uncontrolled diabetes. However, a number of systemic pressure points in the continuum of care seem to have limited the impact of the integration. Some components of the intervention, such as a patient tracking system and reinforced interdepartmental links, show great promise and need to be sustained. The results of this study point to the need for action to ensure inclusion of DR on the list of local health departments’ priority conditions, greater provision of closer-to-community services, such as mobile clinics. Future interventions will need to consider the complexity of adding diabetic retinopathy to an already heavy workload for the LHWs.

Suggested Citation

  • Stevens Bechange & Anne Roca & Elena Schmidt & Munazza Gillani & Leena Ahmed & Robina Iqbal & Imran Nazir & Anna Ruddock & Muhammed Bilal & Itfaq Khaliq Khan & Sandeep Buttan & Emma Jolley, 2021. "Diabetic retinopathy service delivery and integration into the health system in Pakistan—Findings from a multicentre qualitative study," PLOS ONE, Public Library of Science, vol. 16(12), pages 1-20, December.
    • Handle: RePEc:plo:pone00:0260936
    DOI: 10.1371/journal.pone.0260936
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    References listed on IDEAS

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    1. Mapa Mudiyanselage Prabhath Nishantha Piyasena & Gudlavalleti Venkata S Murthy & Jennifer L Y Yip & Clare Gilbert & Maria Zuurmond & Tunde Peto & Iris Gordon & Suwin Hewage & Sureshkumar Kamalakannan, 2019. "Systematic review on barriers and enablers for access to diabetic retinopathy screening services in different income settings," PLOS ONE, Public Library of Science, vol. 14(4), pages 1-29, April.
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