Health system readiness assessment and quality of services for dementia in Peru: Study Protocol (Preprint)

BACKGROUND Dementia is a global health priority with significant challenges due to its complex nature and increasing prevalence. Health systems worldwide struggle to address chronic conditions like dementia, often providing fragmented care. However, information about how health systems respond to the needs of people with dementia (PWD) and their carers, and the quality of care provided, is scarce in low- and middle- income countries OBJECTIVE This study aims to understand the response of the Peruvian health system to PWD and their carers as well as to explore the experiences of PWD of receiving their diagnosis, management and quality of care for this condition. Additionally, the study will explore the willingness of the health system and stakeholders to adopt new tools for the diagnosis, management and quality of care of dementia. METHODS This study is part of a research programme called “IMPACT Salud: Innovations using Mhealth for PWD and Co-morbidities”, aimed at strengthening health systems to provide care for PWD and their carers. The study has a descriptive, cross-sectional design that uses mixed methods methodology and consists of two sub-studies, a health system assessment and an exploration of the patient journey. The first sub-study employs a health system assessment methodology suitable for low- and middle-income countries, conducting 160 structured interviews with 12 different stakeholder types across three levels of the health system (micro, meso, and macro) in four Peruvian regions, each with distinct geographical and urbanization profile. The second sub-study, utilizes a patient journey methodology, which involves conducting 40 in-depth interviews with PWD, carers, and healthcare workers from the same four regions. The insights into the PWD patient and caregiver experience within the health system from the interviews will be used to produce a patient journey map. The analysis will be guided by the High-Quality Health System Framework and the findings from the health system assessment and patient journey will be structured using the domains included in the framework through the lens of quality of services. RESULTS Data collection began in March 2024, aiming to finish by late July 2024. As of end of April 2024, 59 interviews from the health system assessment have been conducted in three regions. CONCLUSIONS This study will provide a national, multi-level insight into the current operation of the Peruvian health system including an analysis of the quality of services provide, with regards dementia diagnosis, management and care; from the perspectives of system stakeholders, patients and their carers.