Difficulties facing the provision of care for multimorbidity in low-income countries

Abstract

Low-income countries face a double burden of noncommunicable and communicable diseases, which further strains their limited resources. In response, the global community has prioritized four chronic noncommunicable diseases and four risk factors, not including neuropsychiatric disorders. Health systems play a key role in addressing the challenges of noncommunicable diseases, mental health and multimorbidity, but have failed to tackle this effectively. Noncommunicable disease as well as noncommunicable/communicable disease multimorbidity cannot be managed from only a biomedical perspective, but needs to include consideration of inequality and poverty. The health systems in low-income countries are currently failing in their management of individuals with single noncommunicable diseases; therefore, when a person is exposed to multiple risk factors and/or has multiple conditions, the health system cannot cope, leading to poor outcomes for individuals. Eleven elements were found to be necessary for diabetes care in low-income settings, and since diabetes makes a good tracer condition, these elements are presented for the issue of multimorbidity. They include organization of the health system, data collection, prevention, diagnostic tools and infrastructure, medicine procurement and supply, accessibility and affordability of medicines and care, healthcare workers, adherence issues, patient education and empowerment, community involvement and positive policy environment. Primary healthcare has been proposed as a solution, but there are numerous barriers to implementing this. Given health system constraints, there is a need to shift care back to the individual and their family for managing both the medical (self-care) and social aspects (e.g. stigma) of their conditions for better outcomes.