Developing a Digital Health-enabled Intervention to tackle Multimorbidity in Primary care in India One in four people seeking primary healthcare facilities in India is estimated to have multimorbidity, which is characterised by the co-occurrence of two or more medical conditions. People with multimorbidity are less likely to receive appropriate care for the individual diseases they have, primarily because clinical care systems are designed around single conditions or body systems. The overarching aim of this research proposal is to develop a digital health-enabled intervention for multimorbidity management in the primary care setting, test its feasibility, and pilot it for deriving inputs for planning a larger evaluation in future. The proposed research work will be carried out in the north-Indian state of Tripura in India. As part of India's National Programme on Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS), Tripura has established 40 Non-communicable Disease (NCD) clinics in the state. Over the past 29 months, the healthcare team in these NCD clinics has been using a digital health system namely the mPower Heart Digital Health System to compute the clinical management plan and maintain patient health record electronically. This digital health system is unique because the healthcare team used to capture information on presence/absence of 14 medical conditions that are frequently seen among people with chronic conditions such as hypertension, diabetes, dyslipidemia, chronic obstructive pulmonary diseases, alcoholism and tobacco use.   In the proposed research work, we will attempt discovering the most frequent multimorbidity patterns seen among patients who sought care for the past 29 months from 40 NCD clinics in Tripura. Using these inputs, along with advice from experts, we will develop a package of intervention, that involves modifying the mPower Heart digital health system for addressing most frequent and severe multimorbidity patterns. The development of the intervention package will be carried out involving experts, health administrators, members of the healthcare team and patients. The intervention development will consider the key components of the health system - such as service delivery, workforce, supply of essential medicines/diagnostics, health information system, financing, and governance/leadership - and other contextual factors that have a role in the successful implementation of the package in the health facilities. The intervention package will be piloted in two health facilities to assess its feasibility and acceptability in the real world helps design an evaluation that will work and be implemented in real-world health systems, rather than just an intervention that it is possible to evaluate in a research setting. We will be then developing a research proposal to evaluate the intervention in a large scale to know the impact of such an intervention in improving quality of care and patient outcomes. This work will have high scalability and national significance in reorienting the NPCDCS from a vertical, disease-oriented model into a holistic, patient-oriented care delivery model. The NPCDCS is providing access to millions of people with chronic diseases in India in primary care. Thus this proposal aligns with the UN sustainable development Goals (No -2: Good Health and Wellbeing) explicitly addressing the UNSDG Target 3.3 (fight communicable diseases) and Target 3.4 (Reduce mortality from non-communicable diseases and promote mental health). The Global Challenges Research Fund (GCRF) supports cutting-edge research to address challenges faced by developing countries. The fund addresses the UN sustainable development goals. It aims to maximise the impact of research and innovation to improve lives and opportunity in the developing world.