title: Delivery of Type 2 diabetes care in low- and middle-income countries: lessons from Lima, Peru.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: M K
authors.initials: MK
authors.lastname: Cardenas
authors.affiliation: CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.|Department of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
authors.forename: J J
authors.identifier: 0000-0002-4738-5468
authors.initials: JJ
authors.lastname: Miranda
authors.affiliation: Geneva University Hospitals and University of Geneva, Division of Tropical and Humanitarian Medicine, Geneva, Switzerland.
authors.forename: D
authors.initials: D
authors.lastname: Beran
mesh_terms: D000328:Adult; D000368:Aged; D020811:Biomedical Technology / Q000706:statistics & numerical data; D054976:Clinical Governance; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy*; D006296:Health Services / Q000592:standards / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000592:standards*; D006280:Health Workforce / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000600:supply & distribution; D007857:Leadership; D008875:Middle Aged; D010568:Peru / Q000453:epidemiology; D015995:Prevalence; D017149:Private Sector / Q000706:statistics & numerical data; D017150:Public Sector / Q000706:statistics & numerical data; D019472:Universal Health Insurance / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents