Multimorbidity: a core priority for learning health systems amidst vertical disease programme cuts

Health systems globally face increasingly complex, multifaceted challenges, cross-cutting many of which is multimorbidity. While rising to multimorbidity has been a slow and incremental process, the recent US funding cuts and rupture of vertical disease programmes may be a pivotal moment for health systems to become at once more integrated, adaptive and self-reliant towards this end. This article considers learning health systems (LHS) as a framework for building such systems, with multimorbidity a core priority and focal point for operationalizing LHS in practice. To illustrate, we draw from an interdisciplinary initiative to catalyse and evaluate a multimorbidity-learning health system in Zimbabwe, centred on three domains of sociotechnical infrastructure: reengineered electronic health records (EHR) to integrate and democratize parallel research, data and decision-support systems; deliberative platforms to support multi-condition sense-making and knowledge translation; and investment in learning sites at service delivery level to facilitate the practical development and iteration of integrated treatment and prevention models. Strategies to build LHS must necessarily be tailored to particular contexts. However, the infrastructural domains and specific mechanisms presented may be valuable for many lower-income countries seeking to emerge from the current funding crisis with the in-house learning capabilities needed to address the complex needs of older, multimorbid populations with less external funding and technical support.