Integrated Primary Healthcare Platform

The integrated primary health care platform focuses on the common multimorbidities among chronic noncommunicable diseases (NCDs), and the challenges that these pose to the delivery of high-quality integrated care. There is a high burden, worldwide, of common mental disorders (CMD – depression, generalized anxiety and stress-related disorders)1. With alcohol and substance use disorders, they are an important part of the growing NCD burden affecting all world regions, including sub-Saharan Africa. There are complex inter-relationships between the commonest NCDs – hypertension, diabetes mellitus, cardiovascular disease and chronic respiratory disease, on the one hand, and mental and substance use disorders on the other2.

Among attenders of primary healthcare in Southern Africa, multimorbidity of NCDs is already the rule rather than the exception3. Depression is a risk factor for developing hypertension and diabetes, but can also be a consequence of either condition (and some of the medications used to treat them). Common determinants include poverty, poor diet, physical inactivity, obesity and hazardous drinking; more effective promotion of healthy lifestyles and behaviours is therefore a necessary and important strategy for prevention, with benefits to be realised across conditions4, 5. The consequences of undetected mental health and substance use problems in people with NCDs include low quality of life and increased disability6, poorer adherence to medications, worse self-care and lower uptake of beneficial lifestyle changes, culminating in worse prognosis and poorer outcomes2.

Nevertheless, health systems in most LMICs provide care for each disorder in isolation3. Mental health and substance use co-morbidity with NCDs is often overlooked, and, in general CMD are rarely recognized or treated7. Health service configurations that support integrated and co-ordinated care benefit people with chronic health conditions. In pursuit of the 2030 Sustainable Development agenda the vision of the Declaration of Astana (2018) is for primary healthcare services that are “accessible, equitable, safe, of high quality, comprehensive, efficient, acceptable, available and affordable, and will deliver continuous, integrated services that are people-centred and gender-sensitive”8. The Declaration further specifies that comprehensive services means that the full range of promotive, preventive, curative, rehabilitative and palliative care services should be available to all.

We are researching HSSS within integrated primary healthcare in Ethiopia (work package 1), South Africa (work packages 4 and 5), and Zimbabwe (work package 8).


  1. Steel Z, Marnane C, Iranpour C, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol 2014;43:476–93. doi:10.1093/ije/dyu038
  2. World Health Organzation and Calouste Gulbenkian Foundation. Integrating the response to mental disorders and other chronic diseases in health care systems. Geneva, Switzerland: : World Health Organization 2014.
  3. Folb N, Timmerman V, Levitt NS, et al. Multimorbidity, control and treatment of noncommunicable diseases among primary healthcare attenders in the Western Cape, South Africa. South Afr Med J Suid-Afr Tydskr Vir Geneeskd 2015;105:642–7.
  4. Kontis V, Mathers CD, Rehm J, et al. Contribution of six risk factors to achieving the 25×25 non-communicable disease  mortality reduction target: a modelling study. Lancet Lond Engl 2014;384:427–37. doi:10.1016/S0140-6736(14)60616-4
  5. Pryor L, Da Silva MA, Melchior M. Mental health and global strategies to reduce NCDs and premature mortality. Lancet Public Health 2017;2:e350–1. doi:10.1016/S2468-2667(17)30140-8
  6. Moussavi S, Chatterji S, Verdes E, et al. Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet Lond Engl 2007;370:851–8. doi:10.1016/S0140-6736(07)61415-9
  7. Evans-Lacko S, Aguilar-Gaxiola S, Al-Hamzawi A, et al. Socio-economic variations in the mental health treatment gap for people with anxiety, mood, and substance use disorders: results from the WHO World Mental Health (WMH) surveys. Psychol Med 2018;48:1560–71. doi:10.1017/S0033291717003336
  8. World Health Organization and the United Nations Children’s Fund (UNICEF). Declaration of Astana. Global Conference on Primary Health Care. From Alma-Ata towards universal health coverage and the Sustainable Development Goals. Astana, Kazakhstan 25 and 26 October 2018. 2018.