Operationalising Global Chronic Care Frameworks in Africa: Innovative Integrated Service Models from Namibia, Botswana, and Ethiopia
1
Public Health Medicine, University of KwaZulu Natal, Durban, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Sub-Saharan Africa faces a double burden of disease: persistent HIV and tuberculosis (TB) alongside rapidly rising non-communicable diseases (NCDs) and mental health disorders. 1,2 Health systems designed for vertical, episodic care struggle to meet these complex, lifelong needs, resulting in fragmented services, inefficiency, and poor outcomes.3,4 The World Health Organization’s Innovative Care for Chronic Conditions (ICCC) framework and South Africa’s Integrated Chronic Disease Management (ICDM) model offer roadmaps for integrated, people-centred chronic care,5,6 yet practical guidance for diverse low- and middle-income country (LMIC) contexts remains limited.
METHODS:
We synthesised three doctoral implementation studies that adapted ICCC and ICDM principles to distinct service gaps: (1) the Integrated Mental Health and HIV (IMH&HIV) model in Namibia;7 (2) the Community TB Care Strengthening and Sustainability (CTBCSS) model in Botswana;8 and (3) the Integrated Hypertension/Diabetes–HIV for People Living with HIV model in Ethiopia.9 Each applied structured implementation science methods—Triple C change management,10 Logic Model planning,11 and/or the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.12
RESULTS:
All three models successfully operationalised ICCC and ICDM under resource constraints. Namibia increased mental health screening and reduced stigma via task-shifting and facility reorganisation.^7 Botswana strengthened community TB care by addressing all six WHO health system building blocks and aligning financing with workforce retention.^8 Ethiopia integrated hypertension and diabetes screening into HIV clinics, embedding RE-AIM evaluation and securing essential commodities.^9 Cross-cutting lessons include contextual adaptation, proactive change management, simultaneous system strengthening, early monitoring and evaluation, and policy/financing alignment to build health system resilience.
CONCLUSIONS:
Locally led African innovation is translating global chronic care frameworks into actionable, sustainable models. These experiences provide a practical roadmap for LMIC policymakers and implementers to strengthen primary health care for complex chronic conditions and move beyond short-term pilots toward financed, system-wide scale-up.
Sub-Saharan Africa faces a double burden of disease: persistent HIV and tuberculosis (TB) alongside rapidly rising non-communicable diseases (NCDs) and mental health disorders. 1,2 Health systems designed for vertical, episodic care struggle to meet these complex, lifelong needs, resulting in fragmented services, inefficiency, and poor outcomes.3,4 The World Health Organization’s Innovative Care for Chronic Conditions (ICCC) framework and South Africa’s Integrated Chronic Disease Management (ICDM) model offer roadmaps for integrated, people-centred chronic care,5,6 yet practical guidance for diverse low- and middle-income country (LMIC) contexts remains limited.
METHODS:
We synthesised three doctoral implementation studies that adapted ICCC and ICDM principles to distinct service gaps: (1) the Integrated Mental Health and HIV (IMH&HIV) model in Namibia;7 (2) the Community TB Care Strengthening and Sustainability (CTBCSS) model in Botswana;8 and (3) the Integrated Hypertension/Diabetes–HIV for People Living with HIV model in Ethiopia.9 Each applied structured implementation science methods—Triple C change management,10 Logic Model planning,11 and/or the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.12
RESULTS:
All three models successfully operationalised ICCC and ICDM under resource constraints. Namibia increased mental health screening and reduced stigma via task-shifting and facility reorganisation.^7 Botswana strengthened community TB care by addressing all six WHO health system building blocks and aligning financing with workforce retention.^8 Ethiopia integrated hypertension and diabetes screening into HIV clinics, embedding RE-AIM evaluation and securing essential commodities.^9 Cross-cutting lessons include contextual adaptation, proactive change management, simultaneous system strengthening, early monitoring and evaluation, and policy/financing alignment to build health system resilience.
CONCLUSIONS:
Locally led African innovation is translating global chronic care frameworks into actionable, sustainable models. These experiences provide a practical roadmap for LMIC policymakers and implementers to strengthen primary health care for complex chronic conditions and move beyond short-term pilots toward financed, system-wide scale-up.
| eISSN: | 2654-1459 |
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