Advocacy for a responsive health system to control diabetes: learning from western Indian state Gujarat, India

Background: Health advocacy is vital for the attainment of better health outcomes. First step in the process of advocacy is to identify the problems followed by potential interventions. Along with the need of advocacy, one needs to understand and recognize that the sustainability and effectiveness of any program can be enhanced only by the commitment of policymakers. Keeping this background, this study tried to document that, how advocacy works to make a health system responsive to control diabetes burden in one of the western Indian state, Gujarat. Objectives: Present study aims to document the initiatives undertaken by the Government for control of diabetes followed by advocacy at different level of the health system. Materials and Methods: Interventions in the form of training and advocacy mobilization were carried out in three districts of Gujarat namely Mehsana district (Rural), Vadodara district (Tribal), and Ahmedabad district (Urban). Responses by the health system were documented with reference to diabetes management and access to diabetic care. Results: Awareness about availability of services was done with frontline health workers. Participation of medical college in training of health-care providers, improved the capacity and managerial effectiveness on diabetic management. Specific budgetary provision for diabetes management, improved availability of antidiabetes drugs by public-private-partnership (PPP) and supply of Auto-Analyzer to all the health facilities and enhancing Management of Information System (MIS) through advocacy found to be effective. Conclusion: Targeted advocacy at different level was successful. Key advocacy strategies such as training to all health-care providers, involving community-level health workers with incentives improving access to diabetic care, ensuring availability of diabetic drugs through PPP and developing MIS increased reporting of diabetes cases. Further studies are required in other parts of developing nation to understand the key strategies applicable to respective settings.