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PhD Defence of Upendra Bhojani

Enhancing care for urban poor with chronic conditions in India

09 Sep 201618:00

Image 1/4 : picture of a woman cooking on a fire

Booking recommended


  • Prof. Dr. Stefaan De Henauw (Ghent University) 
  • Prof. Dr. Patrick Kolsteren (Ghent University)
  • Prof. Dr. Narayanan Devadasan (Institute of Public Health Bangalore, India)


This thesis focuses on a poor urban neighborhood in south India. It is aimed at understanding the role of the local health system in enhancing care for the urban poor living with chronic conditions. Based on research over five years it reveals a high burden of chronic conditions in the neighborhood where the majority rely on private health facilities for care. Poverty hinders people from accessing health care and those who do, get further impoverished. Socially defined roles and positions particularly limit women and elderly in managing care. Fragmented services imply residents having to visit more than one facility for a single episode of care. The limited use of medical records and the lack of a referral system hinder continuity of care. Poor regulation of the heterogeneous private sector, lack of platforms for patient engagement and widespread bribery mark inadequate governance of the mixed health system. While there is inadequate care provision in the government sector, the private sector with many of its care providers lacking adequate training strives to maximize profits where the care for poor is at best seen as charity. Health service experiments to improve diabetes care delivery reveal the complex nature of the local health system wherein implementing interventions is not easy and requires careful consideration of local dynamics and opportunities.