Roy Priyanka, Bardhan Mainak
Department of Labour, Government of West Bengal, India.
Indian Council of Medical Research (ICMR), India.
J Family Med Prim Care. 2025 Jun;14(6):2158-2167. doi: 10.4103/jfmpc.jfmpc_1050_24. Epub 2025 Jun 30.
Challenges the socioeconomically vulnerable urban population faces in managing chronic diseases are compounded by deficiencies and lacunae in the healthcare delivery system. In the socioeconomic context of chronic disease management (CDM) under the ambit of the healthcare delivery system under National Urban Health Mission (NUHM), there is a dearth of adequate provision of health services and its delivery mechanisms to mitigate the issues. The objective of this research was to identify the barriers that lead to the snowballing of the deficiencies and inadequacies of the healthcare delivery mechanism related to CDM amongst the urban poor of Kolkata.
The design of this study was a sequential explanatory mixed method using both structured and semistructured tools. The quantitative and qualitative data were collected separately at different time intervals and integrated to establish the interpretation. The study locations were Kalighat, Khidirpur, Mominpur, Ekbalpur, Ultadanga, and Brace Bridge under Kolkata Municipal Corporation, West Bengal. The total number of respondents was 271, which included NUHM programme officers at the state level, service providers at Urban Primary Health Centres (UPHCs), and urban poor population beneficiaries.
The accessibility barriers were the location of UPHCs, logistics barriers, quality of care and patients dissatisfaction, out-door timing, lack of medicines, diagnostics facilities, job loss due to repeated health visits, patients' choice, preference over secondary and tertiary care delivery centres, inadequate information, education and communication, and dysfunctional referral system.
There are several accessibility barriers to appropriate healthcare relevant to CDM and a huge implementation gap under NUHM policy.
社会经济弱势群体在管理慢性病时面临的挑战，因医疗服务体系的缺陷和不足而更加复杂。在国家城市卫生使命（NUHM）框架下的医疗服务体系中慢性病管理（CDM）的社会经济背景下，缺乏足够的卫生服务及其提供机制来缓解这些问题。本研究的目的是确定导致加尔各答城市贫困人口中与CDM相关的医疗服务提供机制的缺陷和不足不断累积的障碍。
本研究采用结构化和半结构化工具的顺序解释性混合方法设计。定量和定性数据在不同时间间隔分别收集，并整合以建立解释。研究地点为西孟加拉邦加尔各答市市政公司下属的卡利哈特、基迪普尔、莫明布尔、埃克巴尔布尔、乌尔塔丹加和布雷斯桥。受访者总数为271人，包括州级NUHM项目官员、城市初级卫生中心（UPHC）的服务提供者以及城市贫困人口受益者。
可及性障碍包括UPHC的位置、后勤障碍、护理质量和患者不满、门诊时间、药品短缺、诊断设施、因多次就医导致的失业、患者选择、对二级和三级医疗服务中心的偏好、信息、教育和沟通不足以及转诊系统功能失调。
与CDM相关的适当医疗服务存在若干可及性障碍，且NUHM政策下存在巨大的实施差距。
