What happens when you screen a patient for diabetes and address their anxiety or depression in the exact same visit? You transform healthcare delivery.
Pakistan’s primary health care system took a step forward this summer with the launch of SUSTAIN. This ambitious initiative aims to rethink NCD care in Pakistan by scaling up and sustaining integrated care for three of the country’s most pressing non-communicable diseases (NCDs): depression, hypertension, and diabetes.
The Launch
The launch unfolded across two cities.
In Karachi, the project’s Expert Steering Group convened for the first time, bringing together senior clinical, academic, and health-system stakeholders to provide strategic oversight and guidance as the project moves from planning into implementation.
In Islamabad, researchers from all three theme areas: depression, hypertension, and diabetes, came together with a wider group of stakeholders for a dedicated workshop to streamline NCD care.
The project aims to move beyond three separate, condition-specific pathways, and design a single, common pathway for screening, confirmation, management, and referral that primary care workers can deliver for all three conditions at once.
The Challenge: Divided Care in Low-Resource Settings
For decades, healthcare systems worldwide have treated mental and physical health in separate clinics or facilities. A patient managing hypertension or diabetes often navigates a completely different pathway for mental health support—if mental health services are available to them at all.
In underserved communities, this fragmentation leads to higher drop-out rates, worse health outcomes, and increased financial strain on families.
The Solution: Integrated Primary Care
The SUSTAIN project is pioneering a model that treats mental health, diabetes, and hypertension concurrently at the primary care level.
Building on years of evidence from the SPiRiT-D trial, the DiaDeM programme and COBRA-BPS trial, SUSTAIN brings together researchers, clinicians, and health system partners to move proven, task-shifted collaborative care models from small-scale demonstration sites to province-wide implementation.
Working together for a better healthcare
The project spans Khyber Pakhtunkhwa (KP) and Sindh provinces, working across public, public-private, and private-run primary care facilities, in partnership with:
- Indus Hospital & Health Network
- PPHI (People Primary Healthcare Initiative) Sindh
- KP Government primary care facilities
- Khyber Medical University
- Aga Khan University
- SINA Health, Education and Welfare Trust
- The Initiative
- University of York.
This collaboration ensures that both public infrastructure and private service delivery networks are aligned toward common strategic goals.
“The NCD care package is flexible to adapt. Everyone coming to PHC should be screened — we shouldn’t confine screening to the community alone.”
—One of the project’s investigators emphasised during the workshop, underscoring the project’s ambition for broad, equitable reach across primary care
Key Takeaways from the launch meetings
- One Pathway: Combining treatment for mental health, diabetes, and hypertension into a single, effective process.
- Practical Screening: Two simple checks and four questions enable frontline workers to screen all conditions simultaneously.
- Data-Driven: Using insights to refine care and improve outcomes.
- Collaboration: Aligning public and private sectors to bridge healthcare gaps.
When academia, government, and civil society align behind a shared vision, system-wide healthcare transformation is within reach.
For a country where the treatment gap for common mental disorders and other NCDs remains vast, SUSTAIN offers a rare, integrated model designed not as a research trial, but as a route to real, lasting change in how primary care is delivered.
Written by Harriet Evans Tang (UoY), Fakiha Salam (The Initiative), and Syeda Nadia Bokhari (AKU).
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