An Integrated Type-2 Diabetes and Hypertension Care in Cambodia: What is the optimum intervention for up-scaling?

Non-communicable diseases (NCDs) are defined as a major threat to global health and socio- economic development. The global burden of NCDs is rising; a recent report showed that NCDs were responsible for 74% of deaths globally [1], yet they received only around 1–2% of the global investment for health [2].
Over the past decade, the burden of these two diseases has transitioned from high-income countries to be highly dominant in lower-middle income countries (LMICs), especially in South-East Asia, in which one-third of adults have been diagnosed with hypertension (HTN) and an estimated 1.5 million deaths are associated with HTN annually [3]. Moreover, about 29.1 million adults aged 20–79 years are at an increased risk of developing type-2 diabetes (T2D) in the future [4].
Like many countries in LMICs, the prevalence of T2D and HTN in Cambodia is on the rise with 7.6% prevalence of T2D and 19.9% prevalence of HTN among adults aged 25–64 years in 2023 [5]. This growing burden may hinder Cambodia's healthcare systems from advancing toward the achievement of Sustainable Development Goal targets for NCDs, including target 3.4, which seeks to "reduce premature NCD mortality by one-third," and target 3.8, which aims to "achieve Universal Health Coverage," impacting various NCD-related promotion, prevention, and treatment initiatives [6]. Based on the complex nature of these diseases, and the changes in demographic, economic, and environmental conditions, they require a comprehensive response focusing on proactive care and a continuum of care delivered through integrated approaches.
Integrated care is defined as “the management and delivery of health services so that clients receive a continuum of preventive and curative services, according to their needs over time and across different levels of the health system” [7]. Healthcare services operate in an environment that incorporates different elements such as governance and leadership, health financing, health workforce, medical products and technologies, service delivery, and health information [8, 9]. Integrated care aims to improve health outcomes by combining different services and operational programs, using multidisciplinary teams who work together across settings for a comprehensive, seamless, effective, and efficient service that can address patients’ healthcare needs [10, 11]. In the context of low-resource settings, integration of NCDs into broader health systems (and other sectors) could ensure efficiency and sustainability. Even though integration of NCDs care into routine health system is being considered, evidence is needed on what and how to successfully implement it and to move towards scaling up integrated care in Cambodia.