title: Health system challenges for the management of cardiovascular disease and diabetes: an empirical qualitative study from Syria.
abstract: OBJECTIVE
  To explore through empirical qualitative data health system barriers to effective management of cardiovascular disease and diabetes in Syria before the crisis, and how such analysis can inform the building of a post-crisis system.
  
  
  METHODS
  Data were collected through document review, semi-structured key informant interviews, and fieldwork in clinics.
  
  
  RESULTS
  Institutional commitment to address the increasing burden of CVD and diabetes in Syria was limited and uncoordinated. Challenges included an increasingly split healthcare system, with private provision for those who could afford it, and a residual state health sector for the majority. Public trust in the system had been declining.
  
  
  CONCLUSIONS
  We conclude that lack of effective management of CVD and diabetes indicated weaknesses of the state and its retracting role in providing effective healthcare. Such weaknesses that existed before the crisis are now compounded by new challenges resulting from wide destruction of the health system due to the ongoing war. The rebuilding of post-conflict heath care system may benefit from insights into the structural problems of the pre-crisis system.
authors.affiliation: Institute of Health and Society, Newcastle University, Richardson Road, Newcastle upon Tyne, NE2 4AX, UK, balsam.ahmad@ncl.ac.uk.
authors.forename: Balsam
authors.initials: B
authors.lastname: Ahmad
authors.forename: Fouad M
authors.initials: FM
authors.lastname: Fouad
authors.forename: Madonna
authors.initials: M
authors.lastname: Elias
authors.forename: Shahaduz
authors.initials: S
authors.lastname: Zaman
authors.forename: Peter
authors.initials: P
authors.lastname: Phillimore
authors.forename: Wasim
authors.initials: W
authors.lastname: Maziak
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000628:therapy*; D003142:Communication; D003695:Delivery of Health Care / Q000458:organization & administration*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D017149:Private Sector / Q000458:organization & administration; D017150:Public Sector / Q000458:organization & administration; D036301:Qualitative Research; D011787:Quality of Health Care; D012959:Socioeconomic Factors; D013593:Syria / Q000453:epidemiology
references.citation: Lancet. 2014 Jan 25;383(9914):309-20
references.pmid: 24452042
references.citation: Lancet. 2014 Jan 25;383(9914):356-67
references.pmid: 24452044
references.citation: Ann Epidemiol. 2007 Sep;17(9):713-20
references.pmid: 17553700
references.citation: Bull World Health Organ. 2012 Nov 1;90(11):847-53
references.pmid: 23226897
references.citation: Glob Public Health. 2006;1(1):5-30
references.pmid: 19153892
references.citation: Int J Public Health. 2009;54(5):349-55
references.pmid: 19662333
references.citation: Int J Public Health. 2013 Aug;58(4):547-53
references.pmid: 23111372
references.citation: BMC Public Health. 2012 Oct 28;12:912
references.pmid: 23102008
references.citation: Lancet. 2013 Apr 6;381(9873):1179
references.pmid: 23561991
references.citation: Lancet. 2012 May 26;379(9830):1936-7
references.pmid: 22645740
references.citation: BMJ. 2006 Oct 21;333(7573):815-6
references.pmid: 17053215
references.citation: Health Policy Plan. 1994 Dec;9(4):353-70
references.pmid: 10139469
references.citation: Lancet. 2013 Jun 29;381(9885):2242-3
references.pmid: 23819155
references.citation: Public Health. 1999 May;113(3):141-6
references.pmid: 10910412
references.citation: Glob Public Health. 2013;8(8):875-89
references.pmid: 24004405
references.citation: BMC Public Health. 2012 Sep 09;12:754
references.pmid: 22958443
references.citation: Avicenna J Med. 2012 Jul;2(3):51-53
references.pmid: 23826546
references.citation: Int J Health Plann Manage. 2012 Apr-Jun;27(2):167-79
references.pmid: 22378184
references.citation: Lancet. 2014 Jan 25;383(9914):284-6
references.pmid: 24452039
references.citation: Int J Health Plann Manage. 2013 Jul-Sep;28(3):290-302
references.pmid: 23801552
references.citation: Heart Asia. 2010 Jul 29;2(1):67-72
references.pmid: 27325946
references.citation: Bull World Health Organ. 2003;81(4):292-7
references.pmid: 12764496
references.citation: BMC Public Health. 2013 May 25;13:507
references.pmid: 23705638