Expanding differentiated service delivery from a HIV treatment model to a platform for broader healthcare in Sub-Saharan Africa

Differentiated service delivery (DSD) models have transformed HIV care by optimizing resource allocation and improving patient outcomes through tailored service delivery. This model, initially designed to streamline HIV treatment, has the potential to enhance the management of other chronic and non-communicable diseases (NCDs), including diabetes, hypertension, and cardiovascular diseases, particularly in Sub-Saharan Africa (SSA), where healthcare resources are limited. We conducted a narrative review to explore the feasibility, benefits, and challenges of expanding DSD into broader healthcare systems, and to identify strategies for integrating DSD into primary healthcare, ensuring equitable, sustainable, and patient-centered health services across diverse populations, with a focus on Sub-Saharan African Countries. By integrating DSD into primary healthcare systems, care for individuals with chronic conditions can be streamlined, reducing the burden on overburdened health facilities while ensuring continuity of care. Successful examples, such as multi-month medication dispensing for NCDs, community-led monitoring, and decentralized treatment models, highlight the feasibility of this approach. However, implementation barriers, including inadequate health infrastructure, supply chain constraints, policy gaps, financial limitations, and workforce shortages, must be addressed to realize the full potential of DSD beyond HIV care. This paper proposes a strategic, equity-informed expansion of DSD into broader healthcare frameworks through policy innovations, resource investments, and multi-sectoral collaboration. By leveraging lessons from HIV care, DSD can become a cornerstone of more resilient, efficient, and patient-centered healthcare systems.