South Africa’s healthcare professionals are now routinely treating patients juggling three to five chronic illnesses simultaneously, forcing clinicians to balance complex treatment plans while ensuring that interventions for one condition do not worsen another, writes Pitso Molemane for TimesLIVE.
The mounting pressure of working under this load, in a healthcare system largely designed to treat one illness at a time, is straining both personnel and resources, say experts, warning that the growing burden of multi-morbidity, defined as living with two or more long-term conditions, is increasingly common, exposing the limitations of traditional, disease-focused care models.
“Having two or more conditions, like HIV and diabetes, or mental healhth conditions alongside metabolic disease, is becoming commonplace. But single-disease-focused care models in primary care are increasingly mismatched with the reality of complex, multi-morbid patients,” said Dr Tumi Moshoeshoe-Mthombeni, a specialist physician in internal medicine.
As multi-morbidity rises, it is outstripping the capacity of conventional healthcare systems, which remain largely organised around individual diseases. Experts warn that without a shift toward integrated, patient-centred care, outcomes will continue to deteriorate.
Evidence shows that holistic care models, which treat the patient rather than isolated conditions, can improve health outcomes, reduce emergency visits and lower overall healthcare costs.
The challenge is compounded by a surge in non-communicable diseases (NCDs), now among the leading causes of death globally and in South Africa. Alarmingly, these conditions are increasingly affecting younger people – and those in lower-income communities.
“We are seeing more patients with complex, multi-chronic conditions occurring simultaneously,” added Moshoeshoe-Mthombeni.
“This places healthcare professionals in a difficult position, where they must avoid over-treatment while managing conflicting clinical needs.”
For patients, the burden is deeply personal.
Media personality, inspirational speaker and counsellor Criselda Kananda has had HIV for more than two decades and was diagnosed with diabetes in 2019.
“I prefer not to have any disease at all, but diabetes is harder to manage because many symptoms are silent until serious complications develop,” she said. “Without regular monitoring, it’s difficult to tell when things are going wrong. Most people don’t have the knowledge or resources to understand their numbers.”
Kananda expressed concern that diabetes is not being treated with the necessary sense of national urgency.
“It pains me that this is the number one killer in our country, yet I’ve never heard President Cyril Ramaphosa mention it in his speeches or prioritise it as an emergency,” she said.
While some progress has been made through initiatives such as South Africa’s Integrated Chronic Disease Management (ICDM) model, implementation remains inconsistent across provinces.
Access to integrated care often depends on where patients live. Some are able to receive antiretroviral therapy (ART) and treatment for non-communicable diseases at the same facility, or through the Central Chronic Medicine Dispensing and Distribution (CCMDD) programme. Others must navigate multiple clinics, separate departments and long travel distances to access comprehensive care.
“I am fortunate that my medical aid gives me access to private healthcare, but many people with different chronic illnesses are not as lucky and must move between different facilities for treatment,” Kananda said.
Moshoeshoe-Mthombeni’s research into diabetes management highlights further systemic challenges.
Her study of more than 200 patients found that many struggle to control their blood sugar levels because of barriers like the high cost of healthy food, cultural mismatches in dietary advice, and broader food system constraints.
These challenges are closely tied to social determinants of health, including rapid urbanisation, sedentary lifestyles, financial strain and climate pressures on food production.
To address these issues, she advocates lifestyle medicine, an approach that targets the root causes of chronic disease through evidence-based behavioural interventions.
“Lifestyle medicine can help treat, prevent and, in some cases, reverse chronic conditions,” she said.
South Africa’s experience in tackling HIV offers a potential blueprint. The country’s large-scale mobilisation, strong community networks and public health infrastructure demonstrate that meaningful progress is possible.
“By applying similar principles, including community education and empowering individuals to make healthier choices, we have an opportunity to reduce the burden of non-communicable diseases and improve quality of life,” Moshoeshoe-Mthombeni said.
The rise of multi-morbidity presents one of the most complex challenges facing the healthcare system today, one that will require urgent, co-ordinated reform to ensure patients are treated as whole individuals, rather than a collection of separate conditions.
• Pitso Molemane has long-term diabetes and is a senior journalist at Kaya FM.
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