Intended for healthcare professionals

Feature Essay

Communitisation of healthcare: peer support groups for chronic disease care in rural India

BMJ 2018; 360 doi: (Published 10 January 2018) Cite this as: BMJ 2018;360:k85
  1. Yogesh Jain, paediatrician and public health physician1,
  2. Priyank Jain, internal medicine physician1 2
  1. 1Jan Swasthya Sahyog, Bilaspur, Chhattisgarh, India
  2. 2Cambridge Health Alliance, Cambridge, USA
  1. Correspondence to: Y Jain yogeshjain.jssbilaspur{at}

Such groups can help patients find support, adhere to treatment, and advocate for their needs collectively, say Yogesh Jain and Priyank Jain, describing their impact in a resource poor setting

Historically, health systems evolved to tackle the most prevalent illnesses—primarily acute infections and injuries. The management of chronic diseases requires the sustained motivation of patients to engage in long term adherence and periodic review of the treatment plan. Even in developed countries, long term adherence rates are about 50%—in developing countries the rates are much lower.1 Given this, the assumed primacy of doctors and hospitals as providers of care is increasingly being challenged, and recognition is increasing that health outcomes are “co-produced” by healthcare systems and patients.2

Peer support is support from people who have the same health condition as the patients they help—they experience the same challenges of living with the same chronic condition. A review of 1000 studies from countries of the Organisation for Economic Co-operation and Development noted that peer support groups improve patient experience, psychological outcomes, behaviour, health outcomes, and service use among people with long term physical and mental health conditions.3 It describes many effective models of peer support: face-to-face or telephone based; one-to-one or groups of 10 or more; run by trained peers or healthcare professionals. All these models require investment in organisation of the peer networks, and most of the research is from North America.

In poorer countries, peer support groups have been used for mental illness4 and HIV5 but with relatively little research on benefits or about applicability to other chronic diseases.67 Patients in poorer settings are even more vulnerable because they also lack access to healthcare facilities, which can be a further demotivator to the long term engagement needed for optimal health outcomes. …

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