Advances in science and healthcare mean that global life expectancy has increased significantly over the past 40 years. At the same time, however, there has been a concurrent rise in the number of people living with more than one chronic health condition. This poses a challenge for health systems everywhere, but for those in low-resource settings, it is of particular concern.

For years, the health systems of many low- and middle-income countries, including in sub-Saharan Africa, have taken shape as a composite of single-disease programmes informed by donor priorities. The rise of multimorbidity reveals the need to adapt approaches to health to account for the coexistence of multiple illnesses in populations that are now living longer, but often in poor health, both due to age and persistent health inequalities. Moreover, current understandings of multimorbidity disproportionately reflect research and practice in high-income settings and may not translate into lower-resource settings.

In June 2022, 60 researchers and practitioners with regional expertise from nine sub-Saharan African countries gathered in Blantyre, Malawi to discuss ongoing multimorbidity research across the region. Leveraging insights from epidemiology, clinical medicine, anthropology, sociology, history and other disciplines, participants critically considered the meaning, potentials, and limitations of multimorbidity as a conceptual lens for redesigning health systems in sub-Saharan Africa.

“The workshop revealed that that while multimorbidity is still crystallising as a concept and as a field, it exposes fundamental tensions within the organisation of global health knowledge and practice,” said Felix Limbani, Senior Research Associate at Malawi Liverpool Wellcome Trust Clinical Research Programme (MLW) and member of the workshop organising committee.

“It challenges us to move beyond entrenched divisions between disciplines and sectors and put people rather than diseases at the centre of systems of research, training, and care. With health systems already struggling to meet the needs of the populations they serve amidst ongoing resource constraints, now is a crucial moment to make new connections to open up thinking to inform action on multimorbidity.”

The retreat was funded by the National Institute for Health and Care Research and The Wellcome Trust, in collaboration with Malawi-Liverpool-Wellcome Trust Clinical Research Programme (MLW) and The Health Research Unit Zimbabwe (THRU-ZIM).

The workshop proceedings have been published open access through Wellcome Open Research, available here. The main take home points include:

• The definition of multimorbidity as two or more conditions may perpetuate a focus on disease. There is need to decentre diseases and put people at the centre of our models of multimorbidity
• Re-centring people means moving beyond a focus on ‘modifiable lifestyle factors’ to recognising social and economic vulnerabilities to multimorbidity that may be exacerbated by fragmented, donor-dependent healthcare systems
• Seeking a universal definition of multimorbidity may be counterproductive. Multimorbidity can mean different things in different contexts, and some flexibility may be needed to maximise its transformative potentials
• There is need for a pragmatic approach to multimorbidity in sub-Saharan Africa that leverages available knowledge, expertise, resources, and infrastructure.

The Africa Multimorbidity Alliance

Following the Blantyre workshop, participants agreed to take forward the momentum and generated by the event under the Africa Multimorbidity Alliance. The Africa Multimorbidity Alliance was established to provide a platform for identifying and optimising synergies among researchers and other stakeholders working on multimorbidity across the continent through sharing resources, learning from each other’s work, identifying outstanding challenges, and building a shared agenda. Please follow the link here for an overview of the aims, scope, and proposed activities of the Alliance, as well as information its structure, founding institutions, and contact information.

For more information about the Alliance, including how to join our community, please contact felix.limbani@mlw.ac.uk or justin.dixon@lshtm.ac.uk.