Human resources, patient load, and infrastructure at institutions providing diabetic care in India: The India 11-city 9-state study

Background: There is a lack of information on the practice patterns and available human resources and services for screening for eye complications among persons with diabetes in India.Objectives: The study was undertaken to document existing health care infrastructure and practice patterns for managing diabetes and screening for eye complications. Methods: This cross-sectional, hospital-based survey was conducted in 11 cities where public and private diabetic care providers were identified. Both multispecialty and standalone diabetic care facilities were included. A semi-structured questionnaire was administered to senior representative(s) of each institution to evaluate parameters using the World Health Organization health systems framework. Results: We interviewed physicians in 73 hospitals (61.6% multispecialty hospitals; 38.4% standalone clinics). Less than a third reported having skilled personnel for direct ophthalmoscopy. About 74% had provision for glycated hemoglobin testing. Only a third had adequate vision charts. Printed protocols on management of diabetes were available only in 31.5% of the facilities. Only one in four facilities had a system for tracking diabetics. Half the facilities reported having access to records from the treating ophthalmologists. Direct observation of the services provided showed that reported figures in relation to availability of patient support services were overestimated by around 10%. Three fourths of the information sheets and half the glycemia monitoring cards contained information on the eye complications and the need for a regular eye examination. Conclusions: The study highlighted existing gaps in service provision at diabetic care centers in India.