Study title

Multimorbidity, commonly defined as the co-occurrence of two-or-more long-term conditions in one individual, has been argued to be among the greatest global health challenges of our time. Health systems remain largely organised around specialist rather than generalist knowledge, which in many African nations translates into ‘siloed’ organisation of care, fuelled by ‘vertical’ single-disease programming. Multimorbidity has recently emerged on the health agendas of many lower-income countries, including in Africa. Yet with its conceptual origins in higher-income settings the global North, its meaning and utility in lower-resource settings remains abstract. KnowM (2021-2024) was an interdisciplinary research collaboration to characterize the meaning, significance, and transformative potential of the concept of multimorbidity within a global health context, centred on a case study of Zimbabwe. In Zimbabwe, KnowM brought together stakeholders from across the country’s health system to critically interrogate the concept of multimorbidity and co-produce a formative agenda for responding to it in this setting. The specific objectives were: to understand how multimorbidity is being defined and framed as a global health challenge; to describe concepts, experiences, and responses to multimorbidity across different spaces within Zimbabwe’s health system; and to co-produce a conceptual framework and formative agenda for responding to multimorbidity in Zimbabwe. The study was conducted in four provinces of Zimbabwe, including Harare, Bulawayo, Mashonaland East, and Matabeleland South, to represent both urban and rural settings. Within a participatory ethnographic study design, specific research methods included a health facility survey, participant-observation, in-depth interviews, audio-visual diaries, and participatory workshops. Through this holistic, bottom-up approach, KnowM sought to push thinking beyond the single disease paradigm and to open new conceptual pathways...