Challenges in organizing quality diabetes care for the urban poor: a local health system perspective

Introduction India is urbanizing at a rapid pace. Moreover, a quarter of the urban population lives in slum areas [1]. Unfavorable social determinants in health and huge inequities in access to healthcare within urban India leave the urban poor with dismal health indicators [2]. The burden from chronic diseases is also on rise in India, disproportionately so for urban population, and is now the leading cause of deaths [3,4]. India is leading the diabetes epidemic in the world [5]. In urban south India, diabetes prevalence is on a rapid rise (from 5% in 1984 to 13.9% in 2000) [6]. There has been a growing concern among public health researchers/programmers regarding the neglect of urban poor in governments’ health policies/programs [7,8]. The government health services remain primarily oriented towards management of acute episodes [9]. In this study, we analyze a local health system in Bangalore’s KG Halli neighborhood, identify the main challenges in organizing the quality diabetes care, and discuss the way forward. KG Halli has a population of over 44,500 with one notified slum area. The median per-capita income is INR 2200/ month.