Health system challenges for the management of cardiovascular disease and diabetes: an empirical qualitative study from Syria

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. Data were collected through document review, semi-structured key informant interviews, and fieldwork in clinics. 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. 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.