Abstract
Background: Health systems in Africa primarily focus on communicable diseases (CDs) such as HIV, TB, and malaria. However, with the rise of non-communicable diseases (NCDs) like diabetes and cancer, there is an urgent need to integrate CD and NCD care to reduce health inequalities and improve health across the continent. This review systematically explores where and how integrated care models have been implemented in Africa and identifies the barriers and facilitators to integration.
Approach: A scoping literature review was conducted, focusing on communicable and non-communicable diseases and health service integration in the African region. The search was conducted in PubMed. Only peer-reviewed studies in English were included. To be eligible for inclusion in the analysis, the integrated care model had to involve treatment for at least one CD and one NCD at a single delivery point in one or more African countries.
Results: The search yielded 179 studies (2000–2025), of which 25 studies were included in the review. Most studies focused on integrated care models for HIV and NCDs, specifically hypertension, diabetes, and mental health. The findings reveal promising outcomes in both patient health and service delivery outcomes. For instance, one study demonstrated that integrated HIV-chronic disease clinics in Uganda improved blood pressure control and resulted in lower costs of care. Barriers to effective integration were also identified, which included limited resources, inconsistent medical supplies, and fragmented payment systems. Studies conducted in Tanzania and Ethiopia highlighted that national guidelines and training for healthcare workers were important facilitators for integrated care models. Meanwhile, a study in South Africa emphasized the role of community health workers in expanding comprehensive and integrated care beyond clinical settings, which could enhance service provision in underserved populations. Another study in Botswana identified task-sharing as a facilitator of HIV-hypertension care integration, although resource shortages were noted as a significant barrier. Additional studies in Uganda and Tanzania highlighted challenges with patient retention, signaling the importance of expanding structural capacity for NCDs within existing HIV care. These findings suggest that integration alone may be insufficient without strengthening the health system as a whole.
Implications: This review highlights the potential of integrated CD-NCD care models to reduce health inequalities and improve public health in Africa by leveraging existing CD infrastructure to support NCD care. Effective integration requires improved structural capacity and financial investment to address local health needs. Further research is needed to explore funding mechanisms and inform evidence-based policies supporting integrated care across African settings.