Provider workload and multiple morbidities in the Caribbean and South Africa

Abstract

This chapter discusses the current state of healthcare, challenges and potential local and cross-national solutions related to multiple morbidity in low and middle income countries and vulnerable populations in high income countries, based on interdisciplinary research of provider workload in South Africa and the Caribbean. With a high chronic and noncommunicable disease (NCD) and HIV burden in both settings, it is not uncommon to find patients having this double burden of disease. Additionally, patient resiliency is exacerbated by the multiplication of both demands made by the interactions from treatment modalities and multiple service providers. The Cumulative Complexity Model (CCM) posits that as the burden of disease and resulting workload increase, the patient capacity to respond to it diminishes. In middle and high-income countries, a dedicated system of care for people living with HIV/AIDS was developed in parallel to existing systems of care for NCDs, which has been successful in increasing advocacy, political will, and healthcare worker empowerment. We explore the application of this model across settings, along with other potential solutions.