Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study
Private provider practices and incentives for hypertension management in rural and peri-urban Telangana, India– a qualitative study
Year: July 2020
Collaborator: Vital Strategies
Team: Samriddhi S Gupte, Ashish Sachdeva, Aman Kabra & Sarang Deo
Background
In the last two decades India has faced an epidemiological shift from infectious to non-communicable diseases, with cardiovascular diseases (CVDs) now a leading cause of mortality. In 2019, CVDs caused 35.5% of disability-adjusted life years lost in India. Hypertension, the most preventable cause of CVDs, significantly impacts Indians in their most productive years, with increasing prevalence particularly in peri-urban areas. This can be attributed to increased urbanization, lack of health literacy, and unhealthy lifestyles. India’s healthcare system is predominantly private led which caters to over 70% of outpatient care. However, the private sector lacks provisions for sustained long-term management of chronic conditions, such as hypertension.
About the Study
The study investigated the practices and incentives of private health providers in screening, diagnosing, treating, monitoring, and counselling hypertension patients in rural and peri-urban India with the aim to aid in designing targeted interventions for better hypertension management in these regions.
Methodology
We used an exploratory qualitative study involving semi-structured interviews with over 46 participants, including different types of private providers (AYUSH, modern medicine practitioners, informal providers). Additionally, patient interviews were also conducted to triangulate the information gathered from the providers. The study was conducted across three districts in Telangana: Warangal Urban, Karimnagar, and Sircilla.
Key Findings
The study highlights significant gaps in screening and diagnosis of hypertension among private providers, such as lack of compliance to opportunistic screening guidelines and arbitrary use of diagnostic thresholds and screening intervals, leading to delayed diagnosis and increased risk of complications. Furthermore, financial incentives influence the provider behaviour and treatment costs, resulting in overdiagnosis and overtreatment. This emphasizes the need for policies and regulations that promote transparency and accountability in the healthcare system, such as mandatory disclosure of financial relationships and the implementation of clinical guidelines for evidence-based prescribing. The findings also suggest a notable lack in adherence and structured follow-up mechanisms, along with inadequate record keeping practices, calling for targeted interventions to sensitize the providers as well as the patients about the significance of regular follow-ups and treatment compliance.
Key Recommendations
Following are the key recommendations of the study:
- Encouraging Compliance to Standardized Screening Protocols
- Continued Education and Training for local Private Providers
- Patient Education for Awareness and Self-Management
- Innovative Financing Models to minimize out-of-pocket expenses
- Structured follow-up routine and use of digital technology for better disease monitoring