1. 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),
Institute for health metrics and evaluation. (2017). Sri Lanka country profile. Retrieved , from
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
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