Service coverage for diabetes mellitus in a pluralistic health system Experience from Sri Lanka Widanapathirana NDW1, Perera HSR1, Wickremasinghe AR2, Tangcharoensathien V3 1Ministry of Health, Nutrition and Indigenous Medicine, Sri Lanka, 2University of Kelaniya, Sri Lanka 3International Health Policy Programme, Thailand Introduction Methods Descriptive cross- sectional study Study design Diabetes prevalence in Sri Lanka shows a definitive increasing trend Diabetes mellitus is a global health emergency of the 21st century Gampaha district, second most populous district Study setting Adults aged 40 – 69 years with diabetes Study population 425 million, of which 75% from low- and middle-income countries, are affected 2.5% (1990) in a rural community to 10.3% in a national sample > 18 years (2005) Multi – stage cluster sampling Sampling method 383 individuals Sample size Interviewer-administered questionnaire Study instrument 2nd leading cause of disability-adjusted life years Early detection and effective treatment are the cornerstones of management Low coverage of effective interventions can lead to poor outcomes for the individual and the society. Social determinants and gaps in supply-side capacities can influence access to high-quality diabetes care. This study evaluated the service coverage for diabetes in a pluralistic setting. Conclusions Demand side characteristics have little influence than supply-side capacities as service coverage was equitable across socio-economic-demographic profiles, albeit at low levels ( < 50%) in four out of eight key interventions. Results 27% 96% 52% Recommendations Prevalence of diabetes Accessed healthcare provider last 12 months Accessed government health services Government services, which are a safety net primarily for low-income families, need to improve the performance of diabetes care and strengthen patient-centered care. The government should engage private providers to ensure high quality diabetes services. Key interventions Coverage 1 Bi-annual assessment of glycaemic control 95 % 2 Regular blood pressure measurement 82 % 3 Annual blood lipid assessment 71 % 4 Patient-centred collaborative care 59 % 5 Lifestyle advice and measurement of BMI 46 % 6 Annual retinopathy screening 36 % 7 Self-management education sessions 14 % 8 Annual examination of feet 9 % Government services fared better in blood pressure control (90 % vs 73 %) and patient education (20% vs 7%) The private sector fared better in patient-centred collaborative care (72 vs 47 %). Lifestyle management, retinopathy screening, self-management education and foot care were received by less than 50% in both sectors. References: Katulanda, P., et al. (2008). Prevalence and projections of diabetes and pre‐diabetes in adults in Sri Lanka—Sri Lanka Diabetes, Cardiovascular Study (SLDCS). Diabetic Medicine, 25(9), 1062-1069. Institute for health metrics and evaluation. (2017). Sri Lanka country profile. Retrieved 03.01.2019, from http://www.healthdata.org/sri-lanka International Diabetes Federation. (2017). IDF Diabetes Atlas 8th Edition 2017. The service coverage was mostly equitable across age, sex, education, income, urban/rural residence and occupation There was no difference in the median HbA1c level among users of government and private health services Please send feedback and inquiries to: Nimali Widanapathirana, nimalidw@gmail.com