King's College London

The aim of the research is to produce evidence-based scalable solutions for care, treatment and support systems for people living with multiple long-term condition multimorbidity (MLTC-M) in LMICs so as to enhance their health and well-being. The research will be conducted across two diverse provinces in South Africa (Western Cape and KwaZulu-Natal). This country provides an opportune setting for this research given: 1) A high burden of all three MLTC-M disease clusters (mental disorders as well as communicable and non-communicable diseases); 2) Widely used functional public primary care system; and 3) Policy reforms that provide an enabling policy environment. These include reducing health inequities through the introduction of National Health Insurance, and re-engineering of primary health care to promote horizontal programming and strengthening of person- and people-centredness.

A core activity is to use South African data to identify the most prevalent disease combinations to guide development of solutions for primary healthcare. In South Africa health workers use PACK (Practical Approach to Care Kit) – a compilation of clinical policies and guidelines – to help them decide how to manage their patients. PACK standardises an approach to long-term care, but when there is more than one condition, the number of different components to check is overwhelming, making decisions difficult about what to prioritise and leaving little space for patients to share their health concerns. This research aims to develop and test a solution.

It will examine health information of over 10 million people to identify the commonest patterns of multimorbidity. examine a range of outcomes including patients functioning, living expenses, treatment success, clinic and hospital visits and patients and health workers experience. This will help to strengthen PACK Multimorbidity and inform policymakers of likely costs and benefits if adopted country-wide. Throughout the project will work closely with those affected by multimorbidity – health service managers, health workers and importantly people with multimorbidity and representatives of their communities.

The ENHANCE team has worked with stakeholders from the Western Cape and KwaZulu Natal Departments of Health and with people with lived experience to co-produce an intervention currently being tested among 1800 patients in 32 clinics, with results expected in late 2025.

Co-Principal Investigators: 

• Prof. Naomi Levitt (University of Cape Town)
• Prof. Inge Petersen (University of KwaZulu Natal)