Access to CKD Care in Rural Communities of India: A Qualitative Study Exploring the Barriers and Potential Facilitators

Abstract

Background Despite the high and rising burden of chronic kidney disease (CKD) in South Asia, factors that influence access to CKD care at the community level have not been studied previously, especially in the rural areas. We conducted a mixed methods study and interviewed key stakeholders to explore the views and experiences of key stakeholders, and identify barriers and potential facilitators that influence access to CKD care at the primary care level in rural India. Methods A total of 21 stakeholders participated in the study. We conducted 15 in-depth interviews on a purposive sample of stakeholders (CKD patients, healthcare providers and health planners) and one focus group discussion with 6 community health workers. The interviews were audio-recorded and transcribed verbatim. We employed the Lévesque’s framework for access to care to base interview guides and structure the initial codes. By inductive and deductive approaches, thematic analysis was undertaken using QSR NVivo version 11. Results The major patient-level barriers to CKD care as reported by the most patients and healthcare providers was poor knowledge and awareness of CKD. Health system-level barriers included shortages of skilled healthcare professionals and medicines, fragmented referrals pathways to the specialists at the hospitals with inadequate follow up care. Many patients and healthcare providers, when asked about areas for improving access to CKD care, reported educational initiatives to increase awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a systems-level approach to care coordination including task shifting by engaging community health workers in CKD care, as potential facilitators. Conclusions We identified several barriers to access CKD care at the primary care level in rural India that need urgent attention. Targeted CKD screening programs and CKD specific educational initiatives may improve awareness of CKD. Additionally, primary care infrastructure needs to be strengthened for CKD care, ensuring trained staff, availability of essential diagnostics and medications, and creating efficient referral pathways for quality CKD care.

Management of chronic kidney disease: perspectives of Brazilian primary care physicians

“…Research conducted in India identified several barriers to access for patients with CKD who needed urgent attention in PHC, recommending the creation of screening programs and specific educational initiatives to improve awareness of this disease. The study also points out that the PHC infrastructure needs to be strengthened for the care of patients with CKD, ensuring trained staff, availability of diagnoses, essential drugs, and creating efficient reference paths for quality care (Jafar et al, 2020).…”

“…Barriers at the health system level included shortages of qualified professionals, medicines, fragmented referrals, and care and inadequate follow-up by specialists in hospitals. For patients and health care professionals, access to care in CKD can be improved through educational initiatives to raise awareness about CKD by the health care team in patients and their families by providing supplies and coordinating the care and involving the community health workers providing in-home care (Jafar et al, 2020).…”

Low renal transplantation rates in children with end‐stage kidney disease: A study of barriers in a low‐resource setting

“…Mobile applications and e‐health programmes have been successfully initiated for non‐communicable diseases in low‐resource settings 34 . Mobile health technologies in CKD care have also been shown to be acceptable to rural Indians 35 . These strategies can also be implemented when managing children in ESKD. Reducing indirect losses to families Income loss through missed work days can be reduced by increasing the efficiency of clinic visits for ESKD care or living donor evaluation.…”

Chronic kidney disease in Low- and Middle- Income Countries: Protocol for a systematic review of diagnostic and prognostic models

“…4 In LMIC, that remain as resource-constrained settings, there is a need for optimization of the CKD screening strategies which usually challenge the health system. 5 Risk equations or risk scores are a cost-effective alternative for CKD screening. 6 These equations are less invasive and accepted by the general population; 7 also, they require less resources like laboratory tests.…”