Like many LMICs, Malawi faces a dual burden of communicable and noncommunicable diseases.1 The population in the Neno District, an extremely rural district in Southern Malawi heavily reliant on subsistence farming,23 face significant geographic and financial barriers to accessing high-quality comprehensive health care. While there are care systems in place - a district hospital, community hospital, and 12 health centers - these systems are marked by a disproportionate allocation of funding and staff to HIV care despite the rising burden of NCDs. As an integrated strategy to address the complex burden of disease and promote more efficient use of financial and human resources,45 Malawi worked with Partners in Health to leverage the success of the HIV program to improve NCD outcomes. The Integrated Care Cascade is an integrated care management model that integrates HIV and NCD screening and treatment through a coordinated care and referral network between households, communities, and facilities.6

As a strategy to increase case finding and provide decentralized access to high-quality care, individuals may undergo either community-based or facility-based screening for HIV, diabetes, hypertension, TB, malnutrition, and family planning needs depending on their mode of entry to the Integrated Care Cascade. At the community level, individuals in remote communities would be screened by a mobile team or a community health worker and at the facility level, outpatients would be screened at the facility before seeing a clinician. From this point, all patients who screen positive for conditions would receive treatment and additional health screening at an Integrated Chronic Care Clinic (IC3) by a centralized clinical team. In efforts to retain patients and promote continuity in rural and remote areas, every household is assigned a community health worker who provides ongoing psychosocial support and supports staff members in making home visits to follow-up on missed appointments and incomplete referrals.4 While the Integrated Care Cascade is still undergoing rollout, the person-centered approach at the core this strategy is an important example of how to use integrated models to work toward universal coverage of high-quality comprehensive care.

References:

  1. Msyamboza KP, Ngwira B, Dzowela T, Mvula C, Kathyola D, Harries AD, et al. The burden of selected chronic non-communicable diseases and their risk factors in Malawi: nationwide STEPS survey. PLoS One. 2011 May 23;6(5):e20316.
  2. Wroe EB, Kalanga N, Mailosi B, Mwalwanda S, Kachimanga C, Nyangulu K, et al. Leveraging HIV platforms to work toward comprehensive primary care in rural Malawi: the Integrated Chronic Care Clinic. Healthc (Amst). 2015 Dec;3(4):270–6.
  3. National Statistics Office M. National Statistical Office of Malawi: Population Projections [Internet]. 2008 [cited 2018 Dec 13]. Available from: http://www.nsomalawi.mw/2008-population-and-housing-census.html
  4. Abt Associates, Greene K, Sakolsky N, Abt Associates, Daly J, Medtronic Philanthropy, et al. Key principles to accelerate progress in noncommunicable disease care and treatment. NAM Perspectives. 2016 Jan 15;6(1).
  5. Temu F, Leonhardt M, Carter J, Thiam S. Integration of non-communicable diseases in health care: tackling the double burden of disease in African settings. Pan Afr Med J. 2014 Jul 5;18:202.
  6. Partners in Health -, Neno District Council Health Sector -. Integrated Care Cascade Toolkit: an Implementation Guide to Screening, Treatment, and Follow-up for HIV & NCDs. Partners in Health; 2017.