Enhancing care for urban poor living with chronic conditions: role of local health systems

This thesis is about a poor urban neighborhood in south India. It is aimed at understanding role of the local health system in enhancing care for urban poor living with chronic conditions. Based on research over five years it reveals high burden of chronic conditions in the neighborhood where majority rely on private health facilities for care. Poverty hinders people from accessing health care and those who do get further impoverished. Socially defined roles and positions particularly limit women and elderly in managing care. Fragmented services imply residents having to visit more than one facility for a single episode of care. Limited use of medical records and lack of referral system hinder continuity of care. Poor regulation of heterogeneous private sector, lack of platforms for patient engagement and widespread bribery mark inadequate governance of the mixed health system. While there is inadequate care provision in government sector, the private sector with many of its care providers lacking adequate training strive to maximize profits where care for poor is at best seen as charity. Health service experiment to improve diabetes care delivery reveals complex nature of local health system wherein implementing intervention is not easy and requires careful consideration of local dynamics and opportunities