Delivery of Type 2 diabetes care in low- and middle-income countries: Lessons from Lima, Peru

Aims: The health system's response is crucial to addressing the increasing burden of diabetes, particularly that affecting low- and middle-income countries. This study aims to assess the facilitators and barriers that help or hinder access to care for people with diabetes in Peru. Methods: We used a survey tool to design and collect qualitative and quantitative data from primary and secondary sources of information at different levels of the health system. We performed 111 interviews in Lima, the capital city of Peru, with patients with diabetes, healthcare providers and healthcare officials. We applied the six building blocks framework proposed by the World Health Organization in our analysis. Results: We found low political commitment, as well as several barriers that directly affect access to medicines, regular laboratory check-ups and follow-up appointments for diabetes, especially at the primary healthcare level. Three major system-level barriers were identified: (1) the availability of information at different healthcare system levels that affects several processes in the healthcare provision; (2) insufficient financial resources; and (3) insufficient human resources trained in diabetes management. Conclusion: Despite an initial political commitment by the Peruvian government to improve the delivery of diabetes care, there exist several key limitations that affect access to adequate diabetes care, especially at the primary healthcare level. In a context in which various low- and middle-income countries are aiming to achieve universal health coverage, this study provides lessons for the implementation of strategies related to diabetes care delivery. What's new?: This study presents an assessment of the facilitators and barriers to diabetes care at different levels of the health system in Lima, Peru. The methods and analytical framework are both promoted by the World Health Organization. Analysis of a complex system using a comprehensive review of secondary sources and interviews. The findings provide lessons for the implementation of diabetes care programmes in other low- and middle-income countries. Despite political commitment and the adoption of universal health coverage in Peru, limitations affecting the adequate delivery of diabetes care at the primary healthcare level exist.