The innovative care for chronic conditions framework in turn influenced the development of WHO's integrated management of adolescent and adult illness programme65 (panel 4). Several related approaches are being used to guide the provision of chronic care in specific countries.67, 68, 69 Although details vary, they emphasise the central importance of primary health care in chronic disease prevention and management. Other models of chronic disease management that have had international influence include a stepped-care approach, best-known as the “Kaiser Pyramid”;70 the chronic disease self-management programme71 (known in the UK as the expert patient programme); and WHO's service organisation pyramid for an optimal mix of services for mental health