NIHR Global Health Research Centre for Multiple Long-Term Conditions

How can India and Nepal address the increasing burden of multiple long-term conditions (MLTC) effectively and efficiently, meeting the needs of the poor, socially marginalised and hard-to-reach populations? By creating an NIHR Centre for MLTC, led jointly by Public Health Foundation of India and University of Leicester, with several multidisciplinary collaborators and patient groups, we aim to: (i) improve care for people living with MLTC in both countries by co-designing, implementing and evaluating a contextually relevant, patient-centred, equity promoting, simple technology leveraged innovative health system intervention and (ii) strengthen national health research systems by capacity building, creating networks of MLTC researchers and key stakeholders, using systems (individual, institutional and environments) thinking. The three pillars of co-designed health system intervention are (i) an electronic decision support system; (ii) assisted telemedicine and (iii) patient-facing services. The co-design approach will enable the Centre (i) to strengthen research capacities and ecosystems of the co-applicant institutions, (ii) undertake extensive community engagement and involvement (CEI), and knowledge exchange (KE) activities. This meaningful engagement with patients, caregivers, healthcare providers, communities, and relevant stakeholders at every stage of research will enhance mutual learning to effectively address MLTC in both countries and beyond. In the short-term, we will assess the burden of MLTC, common clusters, determinants, health, and economic impact, using existing and new data. Systematic reviews will identify existing care models and their components most relevant to addressing MLTC in both countries. Formative research will help understand the principal barriers, enablers, and challenges in providing MLTC care and crucial outcomes identified by various stakeholders. In the medium-term, co-design workshops, in both countries with varied multi-disciplinary health system stakeholders including patients and the community will help co-design the health system intervention, its implementation and evaluation. Through CEI we will identify "Community Champions", representing people living with MLTC, to co-design a responsive care model. We will then pilot test this intervention in selected primary healthcare centres (PHCs) in both countries, to obtain insights on acceptability, feasibility, fidelity and delivery of intervention, costs, and quality of life. These insights will inform the definitive cluster randomised controlled trial, undertaken in 72 randomly selected PHCs, among 1440 participants aged over 40 years with MLTC. We will assess changes in quality of life (primary outcome) between the intervention and control arms and several other contextually relevant secondary outcomes at 2 years. Leveraging its extensive networks, the Centre will disseminate findings widely to diverse stakeholders to ensure scale-up of the responsive, patient-centred, equity promoting care model for MLTC. In the long-term, we visualize a fully functional, self-sustaining Global Centre for improving MLTC related health outcomes and research, that is aligned closely with the Governments of India and Nepal as strategic partners.