Abstract
BackgroundThe incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions.MethodsPatient exit interviews collected data on demographic and socio-economic characteristics, health spending and care seeking for people with diabetes, tuberculosis and both diabetes and tuberculosis. Qualitative data were collected through semi-structured interviews with healthcare workers involved in diabetes and tuberculosis care, to understand delivery of care and how providers view effectiveness of care.ResultsThe experience of co-affected individuals within the health system is different than those just with tuberculosis or diabetes. Co-affected patients do not receive more care and also have different care for their tuberculosis than people with only tuberculosis. Very high levels of catastrophic spending are found among all groups despite these two conditions being included in the Kyrgyz state benefit package especially for medicines.ConclusionsThis study highlights that different patterns of service provision by disease group are found. Although Kyrgyzstan has often been cited as an example in terms of health reforms and developing Primary Health Care, this study highlights the challenge of managing conditions that are viewed as “too complicated” for non-specialists and the impact this has on costs and management of individuals.
Highlights
The incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals
According to the World Health Organization (WHO), the world is on track to meet the target of a 50% mortality reduction of tuberculosis (TB) [1], but new challenges such as diabetes are challenging this progress [2]
Looking at diabetes and TB from the population perspective can be seen as a double burden of disease, with the same population being affected by both conditions
Summary
The incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. A WHO collaborative framework on diabetes and TB designed to help policy-makers, public health specialists and healthcare workers address the joint burden of diabetes and TB calls for improved collaboration between diabetes and TB programs, as a part of the broader agenda in strengthening health systems [6]. It describes how past successes in coordination and collaboration between TB and HIV/AIDS programs can be used as a model
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