Multimorbidity after USAID

Multimorbidity-the coexistence of multiple chronic conditions within a single individual-has emerged as a powerful lens through which to understand the growing mismatch between population health needs and health systems historically organised around single diseases. In many lower-income countries, multimorbidity has reinvigorated calls for more integrated and person-centred models of care. Yet responses have often been fragmented and incremental, remaining tethered to the vertical programmes and disease-specific architectures they seek to overcome. The recent disruption of USAID funding represents a critical juncture for health systems that have long relied on externally funded programmes. While the immediate consequences for service delivery are substantial, this moment also presents an opportunity to move beyond piecemeal integration towards more fundamental health system transformation. Realising this opportunity will require greater emphasis on locally led adaptation, recognising that multimorbidity is experienced and managed within highly contextual social, organisational and epidemiological realities. Learning health systems offer a promising conceptual horizon for this transition by providing a framework through which health systems can continuously generate, interpret and act upon knowledge in response to changing needs. The challenge ahead is not simply sustaining services, but building more integrated, adaptive and person-centred systems capable of responding to shifting realities of multimorbidity.