Diabetic retinopathy/diabetes mellitus service delivery and integration into the health system in Pakistan: a qualitative study

Main Objectives

This report is based on qualitative research carried out in 2019 in a diabetes mellitus (DM)/diabetic retinopathy (DR) prevention programme in three districts of Pakistan. The report presents an analysis of the organisation and delivery of services and the extent to which the programme interventions were seen to result in a more integrated health systems approach to sight-threatening diabetic retinopathy care.

Summary

The study sought to build understanding of the pathways for referral and treatment of DM/DR and the organisation of service delivery at three large tertiary hospitals in Pakistan. It also explored the factors enabling or hindering adherence to referrals and treatment follow-up in these settings. The study has a number of programme implications regarding training and support systems for lady health workers (LHW), the nature and role of counselling; and the approaches needed to enhance women’s access to DM/DR services.

The results of this study also call for finding the models of care, which are responsive to the needs of diabetes patients, i.e. delivered through smaller and less overburdened facilities, closer to patients’ home and with more convenient opening times. Mobile services and innovative technologies should be considered as part of these alternative models of care. Monitoring systems should be adapted to ensure inclusion of DM, DR and other vision care issues.