Decentralizing noncommunicable disease care in Ahmedabad: Impact on service utilization and health outcomes

Background: Noncommunicable diseases (NCDs) pose a significant healthcare challenge in India, overwhelming tertiary facilities while primary care centers remain underutilized. This study assessed the effectiveness of decentralizing NCD care from tertiary to primary settings in Ahmedabad, Gujarat. Methodology: A quasi-experimental study was conducted from March 2023 to March 2024. Twenty Primary Healthcare Centers were assessed for NCD service availability, with seven well-equipped facilities selected for intervention. A total of 262 patients with uncomplicated diabetes mellitus type 2 and/or hypertension were motivated to receive care at nearby Primary Health Centers (PHCs). Clinical outcomes, treatment adherence, and patient satisfaction were evaluated after 6 months. In depth interviews with healthcare providers ( n = 7) and patients ( n = 10) provided qualitative insights. Results: After 6 months, 121 participants (46.2%) followed decentralized care. Significant improvements were observed, including increased proportion of patients with controlled blood glucose (61.8% to 76.8%, P = 0.003) and blood pressure (41.6% to 80.3%, P = 0.004). Mean reductions of 19.37 mg/dl in blood sugar ( P = 0.005) and 9.63 mmHg in systolic blood pressure ( P = 0.004) were achieved. Younger patients ( P = 0.035), those with higher education ( P = 0.001), shorter disease duration ( P = 0.010), and those previously receiving private care ( P = 0.040) were more likely to adopt decentralized care. 73.4% reported satisfaction with PHC services, with 70.2% experiencing reduced healthcare expenditure. Primary barriers included medicine unavailability (33.6%), perceived quality concerns (13.2%), and doctor unavailability (10.6%). Conclusion: Decentralization of NCD care to adequately equipped PHCs significantly improved clinical outcomes and treatment adherence while reducing healthcare costs.