Integrated Public Health and Health Service Delivery for Non-Communicable Diseases

Authors: Matt Magee, Mohammed Ali, Dorairaj Prabhakaran, Ajay Vamadevan, Miriam Rabkin, KM Venkat Narayan

Introduction:

The co-occurrence of noncommunicable diseases and communicable diseases raises important challenges to the integration of public health and care delivery for more than one morbidity. Effective integration requires leveraging existing infrastructure and addressing resource challenges through creative organizational and technological strategies.

This chapter uses the example of diabetes as a prototypical noncommunicable diseases and highlights the urgent need for an integrated approach to address three key comorbidities in patients with diabetes: mental health disorders, tuberculosis, and HIV/AIDS. We explore the epidemiology of the joint burden, risk factors, and prognosis of these co-occurring conditions. We summarize the available evidence and address the challenges of integrating public health and health services to persons jointly affected by diabetes and the three co-morbidities. We focus on a case study for integrating care for diabetes and mental health disorders. Finally, then address gaps in data in terms of combined burdens and effectiveness and cost-effectiveness of integrated interventions, and we make recommendations for closing these gaps.