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Health care delivery
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Plurality in healthcare providers and care delivery platforms:
KG Halli, with an area
of less than a square kilometer, had several and diverse healthcare delivery platforms
that catered to diabetes patients, most of which belonged to the private sector. Whereas
doctors in the government health center were formally trained in allopathy, the doctors
in the private sector were formally trained in different systems of medicine.
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Hospitals providing primary care:
All the hospitals explicitly market for and provide
basic primary care for diabetes in addition to providing the referral specialist care,
creating a significant functional overlap with services provided by private clinics and
the government health center.
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Private clinics delaying referrals:
“One thing is that no one [doctor] wants to leave their
patients. If a patient goes [referred to other facility], he may not come back. They
[non-specialist doctors at clinics] have this fear.” (R13, private hospital) |
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Knowledge and
information
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Inadequate use of the patient medical records:
Only six of the 15 health facilities in
this study had a system that tracked medical records of diabetes patients.
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Periodically updating the knowledge of doctors & influence of pharmaceutical industry:
Nearly half of all the doctors indicated that they periodically updated their clinical knowledge.
The pharmaceutical companies had easy access to doctors for influencing their practice through
personal periodic visits by company representatives, sponsoring of continuing medical education
activities and provision of medical literature to doctors.
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Lack of standard treatment protocols:
“No, there is nothing like that [standard treatment
protocol]. It depends on how we analyze it [diabetes condition] and accordingly treat it.”(R2, private clinic) |
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Leadership and
governance
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Poor regulation of the private sector:
“Many doctors in this area are not qualified to
practice [allopathy]. But they have been doing it. … We have doctors who have a diploma
in acupuncture and are practicing allopathy. Nothing is being done by the government.”(R7, private clinic) |
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Poor systemic coordination:
There was lack of coordination across different types of healthcare
providers (government, private for-profit and not-for-profit) and across multiple health care delivery
platforms (clinics, health centers, hospitals).
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Widespread bribery:
“… It [kickbacks] happens in 90% of cases. It’s between pharmaceutical
company and the doctor. This is rampant in this area.” (R18, private pharmacy) |
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Lack of formal grievance redress platforms:
Despite spending considerable amounts of money out of
their pockets, the patients or community representatives had no formal functional platforms to engage
with the formal healthcare services for expressing grievances, conveying opinions on issues or demanding accountability.
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Values and
principles
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Maximization of profit:
“It [healthcare] has become a business nowadays.” (R6, private clinic) |
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Healthcare for poor as a charity:
“We conduct the camps to test blood sugar for free to provide some
services for those who can’t afford even sugar test.” (R16, super-specialty private hospital) |
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Trust deficit among patients and providers:
“Let the patient go to a physician. They will come back
to you [non-specialist doctor] for small ailments. You should be happy because it is a circle. There
should be no fear that if I send a patient to you, then tomorrow the patient will never come back to
me. … I don’t think doctors have this kind of trust today” (R1, private clinic) |
