Equity in Health Care- the Case of Diabetes in Sri Lanka
Sri Lanka has a public health care system that is free at the point of use for patients, and has maintained a focus on equity. However, non-communicable diseases, such as diabetes, are rapidly increasing in prevalence and are posing new challenges to the system and to patients and their households. In-depth interviews and focus group discussions were conducted in 4 districts of Sri Lanka to investigate the care seeking experiences of diabetes patients from households at different income levels. Patients’ care seeking pathways, the barriers to care, their health consequences and the social and economic consequences to the household were investigated. In this paper we discuss these findings and illustrate them by presenting vignettes of patient’s experiences.
Although health care was free, other direct costs and indirect costs of treatment seeking served as deterrents to care seeking before and after diagnosis, and placed a high burden on households. The need for frequent visits to clinics with appropriate facilities for diagnosis and management of diabetes, that were often far from rural communities, posed high costs, in particular due to income foregone in accessing these hospitals.
Households employed coping strategies to deal with these costs, but the need for frequent visits to the clinic required repeated costs, which made it difficult for households to recover their economic status. Many patients, especially those from low income, rural households, were not able to maintain the management regime and their condition deteriorated. Although the Sri Lankan health care system has been successful in tackling communicable diseases, diabetes and treatment seeking for diabetes are posing severe burdens on households, pushing even non-poor households into poverty.
There is a need for increased funding for the training of personnel, health education and promotion of appropriate health behavior and provision of specialist facilities for the diagnosis and management of diabetes at health care facilities closer to rural locations.
Authors:
Myrtle Perera.
Godfrey Gunatilleke.
Philippa Bird.
