# Non-communicable disease multi-morbidity in policies from India, Thailand, and South Africa: A comparative document review

## TL;DR

This paper compares how India, Thailand, and South Africa address multiple chronic non-communicable diseases in their health policies.

## Contribution

The study reveals the absence of specific policies for managing multi-morbidity in NCDs in three LMICs.

## Key findings

- None of the three countries have specific policies for NCD multi-morbidity.
- Health promotion targets multiple risk factors, but self-management is limited to specific diseases like diabetes.
- The study emphasizes the need for patient-centered policies addressing social determinants of health.

## Abstract

Over the years, non-communicable diseases (NCDs), as well as the number of people with multiple chronic NCDs or multi-morbidity, are on a sharp rise globally, especially in low and middle-income countries (LMICs). This review attempts to deepen the knowledge (policy landscape) of how managing multiple NCDs and associated challenges are addressed across the health systems policies from India, South Africa and Thailand.

We conducted a search of two search engines (PubMed and Google) and the websites of national departments from February 2022 to December 2022. An analytical framework was produced for the qualitative document analysis, focusing on definitions of multi-morbidity, potential policy actions at patient, provider, health system, and macro-level domains, including social determinants of health. We utilised framework analysis of the national-level policies and related documents to explore the co-existent nature of multiple NCDs in India, South Africa, and Thailand.

Of the 54 analysed documents, 11 (20.4%) were national policies/ programmes, 15 (27.8%) were operational or implementation or management guidelines, 12 (22.2%) were training manuals, 16 (29.6%) were action plans/ strategic plans/ frameworks. None of the countries had specific policies dealing with NCD multi-morbidity. Findings from the thematic analysis showed that health promotion activities at patient-level targeted multiple risk factors; however self-management support is for specific NCDs such as diabetes.

Our study highlights the need for dedicated policies that adopt a patient-centred and integrated approach with appropriate consideration of social determinants of health and health inequalities within these policies to manage NCD multi-morbidity holistically and effectively.