Strengthening the role of local health systems to improve chronic disease care for urban poor in India

Chronic diseases are on the rise in India exerting a huge diseases and economic burden on health services and communities. India is leading the diabetes mellitus type-2 (DM-2) epidemic in the world. However health services remain primarily oriented around an acute-care model providing episodic care. People with chronic diseases, however, often face a life-long challenge of dealing with symptoms, finding good quality medical care, adhering to complex therapeutic regimes, making difficult life-style adjustments and coping with profound emotional impacts, which require long-term support services as opposed to purely medical care. In India, health services fail to provide such support services and even when provided, medical care provision is largely irrational. Despite the role of counselling and rational medical care in optimising DM-2 management, integration of these services into local health services organisations (HSO) remains a huge challenge. Clinicians often face constraints in terms of available time, skills and interest for engaging in intensive counselling support. Hence, integration of counselling services within HSO necessitates re-examining some organisational factors such as available expertise and resource, role distribution, relationships across service team members etc. We propose to study how counselling services and rational medical care can be organised within local health services in an urban multicultural setting. We propose to use a mix of participatory action research and quasi-experimental designs to tailor interventions to local system dynamics and at the same time generate lessons that can be applied to diverse settings. This research will guide Indian policy makers to improve chronic disease care within local health services.

Trefwoorden:B680-volksgezondheid