Navigating the Health System : Diabetes Care in Georgia

Background Effective delivery of diabetes care requires integration across specialist teams delivering recognized interventions, a reliable pharmaceutical supply, and promoting self-management. Drawing on a framework incorporating physical, human, intellectual and social resources, the paper examines how these challenges are managed in diabetes care in Georgia. Methods The rapid appraisal study triangulated data from interviews with users, providers and key informants from various institutions in four regions of Georgia; data on clinical and social outcomes from diabetes; legislative and policy documents. Results Diabetes-related mortality in Georgia is among the worst in Europe and Central Asia, in a context of conflict, economic collapse and weak institutions. Essential inputs for diabetes care are in place (free insulin, training for primary care physicians, financed package of care), but constraints within the system hamper the delivery of accessible and affordable care. There are no evidence-based guidelines on diabetes management, formal support and quality assurance. The scope of work of primary care practitioners is limited and they rarely diagnose and manage diabetes, which instead takes place within the vertical system. Access to insulin is problematic in rural areas. Obtaining syringes, supplies and hypoglycemic drugs and self-monitoring equipment remains difficult everywhere. Prevention and effective management of complications is limited, increasing adverse outcomes. Diagnosis and treatment of diabetes complications involve hospital admission and unaffordable out-of-pocket payments. The complexity of pathways to key stages of care obstructs continuous care. There are poor linkages between primary and secondary care and ineffective patient follow-up or monitoring of outcomes. There is little effort to promote self-care, adherence to drug regimens and appropriate lifestyle, or to empower patients. Conclusions Improving diabetes outcomes will involve simplifying pathways to care and drugs, reassessing staff roles and insulin distribution systems. This would require better co-ordination of the inputs into the system and development of an integrated and patient-centred model.

URI

https://hdl.handle.net/10986/5177

Citations

Cited 43 times in Scopus (view citations)

Collections

Journal articles published externally

Full item page

Related items

Showing items related by metadata.

Health Insurance Coverage and Health Care Access in Moldova
(2011) Richardson, E.; Roberts, B.; Sava, V.; Menon, R.; McKee, M.
BACKGROUND In 2004, the Moldovan government introduced mandatory (social) health insurance (MHI) with the goals of sustainable health financing and improved access to services for poorer sections of the population. The government pays contributions for non-employed groups but the self-employed, which in Moldova include many agricultural workers, must purchase their own cover. This paper describes the extent to which the Moldovan MHI scheme has managed to achieve coverage of its population and the characteristics of those who remain without cover. METHODS The 2008 July-October enhanced health module of the Moldovan Household Budget Survey was used. The survey uses multi-stage random sampling, identifying individuals within households within 150 primary sampling units. Numbers and characteristics of those without insurance were tabulated and the determinants of lack of cover were assessed using multivariate regression. RESULTS 3760 respondents were interviewed. Seventy-eight per cent were covered by MHI. Factors associated with being uninsured include being self-employed (particularly in agriculture), unemployed, younger age and low income. Respondents who were self-employed in agriculture were over 27 times more likely to be uninsured than those who were employed. Agricultural workers in Moldova are responsible for purchasing their own cover; most respondents cited cost as the main reason for not doing so. CONCLUSION While being uninsured has an impact on utilization, financial barriers persist for those with insurance who seek care. The strengths and weaknesses of the MHI system in Moldova provide valuable lessons for policy makers in low- and middle-income countries addressing the challenges of achieving equitable coverage in health insurance schemes and the complex nature of financial barriers to access.
Public Policy and the Challenge of Chronic Noncommunicable Diseases
(Washington, DC: World Bank, 2007) Adeyi, Olusoji; Smith, Owen; Robles, Sylvia
Since the early 1990s, the importance of chronic non-communicable diseases (NCDs) to global health has gained increased recognition. This report contains an agenda for action in response to the growing economic, social, and health problems posed by NCDs. Its objective is to enable the World Bank and its clients to examine and, where appropriate, strategically shift their approaches to public policy as a tool to prevent and control NCDs. The report highlights two broad themes. First, public policies need to prevent NCDs to the greatest extent possible and, in doing so, promote healthy aging and avoid premature deaths. Second, at the same time, public policies need to recognize that the burden of NCDs will increase because of population aging, and therefore public policy has a role to play in dealing with the pressures that this will impose on health services. Thus the report has a dual purview: how to avoid the burden of NCDs as much as possible and how to prepare for the consequences of more NCDs associated with demographic change.
Integration of Targeted Health Interventions into Health Systems : A Conceptual Framework for Analysis
(2010) Atun, R.; de Jongh, T.; Secci, F.; Ohiri, K.; Adeyi, O.
The benefits of integrating programmes that emphasize specific interventions into health systems to improve health outcomes have been widely debated. This debate has been driven by narrow binary considerations of integrated ( horizontal) versus non-integrated ( vertical) programmes, and characterized by polarization of views with protagonists for and against integration arguing the relative merits of each approach. The presence of both integrated and non-integrated programmes in many countries suggests benefits to each approach. While the terms 'vertical' and 'integrated' are widely used, they each describe a range of phenomena. In practice the dichotomy between vertical and horizontal is not rigid and the extent of verticality or integration varies between programmes. However, systematic analysis of the relative merits of integration in various contexts and for different interventions is complicated as there is no commonly accepted definition of 'integration'-a term loosely used to describe a variety of organizational arrangements for a range of programmes in different settings. We present an analytical framework which enables deconstruction of the term integration into multiple facets, each corresponding to a critical health system function. Our conceptual framework builds on theoretical propositions and empirical research in innovation studies, and in particular adoption and diffusion of innovations within health systems, and builds on our own earlier empirical research. It brings together the critical elements that affect adoption, diffusion and assimilation of a health intervention, and in doing so enables systematic and holistic exploration of the extent to which different interventions are integrated in varied settings and the reasons for the variation. The conceptual framework and the analytical approach we propose are intended to facilitate analysis in evaluative and formative studies of-and policies on-integration, for use in systematically comparing and contrasting health interventions in a country or in different settings to generate meaningful evidence to inform policy.
A Systematic Review of the Evidence on Integration of Targeted Health Interventions into Health Systems
(2010) Atun, R.; de Jongh, T.; Secci, F.; Ohiri, K.; Adeyi, O.
In this paper we present findings of a systematic review that explores a broad range of evidence on: (i) the extent and nature of the integration of targeted health programmes that emphasize specific interventions into critical health systems functions, (ii) how the integration or non-integration of health programmes into critical health systems functions in different contexts has influenced programme success, (iii) how contextual factors have affected the extent to which these programmes were integrated into critical health systems functions. Our analysis shows few instances where there is full integration of a health intervention or where an intervention is completely non-integrated. Instead, there exists a highly heterogeneous picture both for the nature and also for the extent of integration. Health systems combine both non-integrated and integrated interventions, but the balance of these interventions varies considerably.
Clearing the Global Health Fog : A Systematic Review of the Evidence on Integration of Health Systems and Targeted Interventions
(World Bank, 2009-03-01) Atun, Rifat; de Jongh, Thyra; Secci, Federica V.; Ohiri, Kelechi; Adeyi, Olusoji
A longstanding debate on health systems organization relates to benefits of integrating health programs that emphasize specific interventions into mainstream health systems to increase access and improve health outcomes This paper is organized in five chapters. This introduction is followed by the methodology chapter, which includes a brief section on the conceptual framework used to analyze the studies retrieved and the programs presented within these to map the nature and extent of integration into critical health system functions. The results chapter includes: a summary of the outcomes for each study grouped by the disease area or the clinical problem the intervention seeks to address, including the reported success; for each program, analysis and mapping of the nature and extent of integration into critical health system functions; and an analysis of how contextual factors either created opportunities for introducing or integrating a program or influenced the desirability or feasibility of program integration. The discussion chapter provides an overview of the implication of findings for policy makers, practitioners and researchers. The final chapter draws conclusions.

Users also downloaded

Showing related downloaded files

No results found.