This thesis investigates how to improve and strengthen care for chronic conditions, like diabetes, in rural India. Chronic conditions are the leading cause of death world over. Low- and middle-income countries such as India bear a large share of this burden. Most of India (up to 70%) lives in villages, many of which even today are remote and hard to reach. Access and quality of health care for chronic conditions are huge public health challenges in India. I first studied the current delivery of care for chronic conditions both in the public and private sectors of health in a rural setting. I identified important gaps in the quality of care such as lack of counselling and support for patients with chronic conditions, lack of regular follow up of patients and processes of care that were centred around doctors and not around patients. I used these insights to co-design with primary care teams of three primary health centres (PHC), a package of interventions to address these gaps. I implemented four interventions: a redesigned workflow for the team, medical records, team -based care and training at PHCs. I evaluated these interventions for implementation. The implementation of these interventions was challenging and in two of three PHCs, it stopped after four months. In one PHC, the team that was engaged from the beginning was transferred; and in another the interventions did not continue after the initial few months. At all three PHCs I found that hierarchies within the health system impeded team -based care whereas team cohesion and the motivation from patients’ positive feedback facilitated implementation. The participatory methods used in this research attempted to bring change in the orientation towards team -based care.
|Qualification||Doctor of Philosophy|
|Place of Publication||Maastricht|
|Publication status||Published - 2022|