Implementation of an Integrated Care Model for Patients with Multiple Cardiometabolic and Mental Health Conditions in Sub-Saharan Africa

Objective

Addressing multiple long-term conditions including non-communicable diseases (MLTC-NCDs) in fragile health systems in sub-Saharan African(SSA) demands a shift from fragmented models of care, that treat individual health issues separately to a more holistic integrated care that provides a whole-person focus. However, the feasibility and effectiveness of concurrently implementing evidence-based WHO PEN and mhGAP-IG for integrated care of NCDs and common mental health problems in real primary healthcare settings remain unexplored. In addition, the adoption and implementation of the WHO PEN and mhGAP-IG strategy has been poor in the SSA, where recent analysis found the adoption and implementation to be off-track. M-CARE project therefore aims to improve primary care for patients (aged ≥18 years) with MLTC-cardiometabolic and common mental health conditions in three SSA countries (Ghana, Kenya & Uganda) by designing, deploying, and evaluating strategies for implementing the evidence-based integrated primary care model interventions that map onto WHO PEN and mhGAP-IG for PHC, taking into account diverse socioeconomic environments of these countries. The intervention delivery will be a pragmatic trial implemented in usual primary care facilities by primary care providers through a parallel arm cluster randomized design. The trial is preceded by codesign of the integrated care with stakeholders. This multi-sectoral approach will increase the capability, opportunity to improve integrated management of patients with MLTC-cardiometabolic disease and common mental health disorders in diverse SSA environments. We anticipate that the M-CARE project will lead to 35% increase in proportion of patients with MLTC-NCDs to be engaged and retained in care for effective management within 12 months. The M-CARE project will pave the way for translation and broad scale-up implementation of the evidence-based interventions to manage patients with MLTC-NCDs in SSA and beyond.