Planning DR services: Where to begin?

Planning in healthcare is a process that starts by establishing a clear picture (the baseline) of the existing situation. That is, the magnitude of the need and the available resources to address that need (human and infrastructure resources). It is only after this situation analysis that a realistic and practical development programme suited to the local health system can be started.

Diabetes and diabetic retinopathy in India

“India is the diabetes capital of the world!” was the title of a recent Times of India article. Looking beyond the alarmist headlines, we know that one in five of the 382 million people living with diabetes are in India and that the prevalence of diabetes in some parts of urban India is as high as 20% in people aged over 20 years (Murthy et al. 2016). And, as we learned in week one, diabetic retinopathy (DR) complications affect 18–34% of people with diabetes.

The increasing diabetes prevalence and longer lives of people with diabetes mean that the Indian health system faces a major challenge in managing an exponentially increasing risk of sight threatening complications amongst people with diabetes.

Based on this epidemiological evidence:

• What do you think needs to be done to manage the growing challenge of diabetes in India?
• Should existing initiatives by non-governmental organisations (NGO) be strengthened to deliver diabetic retinopathy services?
• How best can the existing health system infrastructure be strengthened for sustainable detection and treatment of sight threatening diabetic retinopathy?

In the video on this step, Professor GVS Murthy from the Public Health Foundation of India describes a large and comprehensive situation analysis carried out to assess the need for and resources available to deliver diabetes and diabetic retinopathy services in India. The study’s findings are being used to inform a comprehensive and integrated district model of screening and management of DR in the government health system.