Adapting the implementation roadmap to strengthen the national response to NCDs

The strategic directions of the roadmap provides guidance which can be adapted to the national context. Countries can consider establishing a national “think tank”, or a Country Coordinating Mechanism (a national committee that submits funding applications to the Global Fund and oversees grants on behalf of its country) to ensure commitment and functional synergies across sectors (28).

More energetic advocacy is required, including from civil society, for NCDs to be addressed in a multisectoral manner. Country-specific national strategic plans can be developed using the roadmap as a guide.

Member States can assess the status of NCD prevention and control, using data on NCD mortality, risk factor prevalence, country capacity surveys and health system capacity. Measures that can be taken include conducting a SWOT analysis and identifying areas for improvement and areas that are working well; holding a national workshop with relevant stakeholders to present the data and to get more insights into programme implementation; and studying the financial utilization in the programme and identifying bottlenecks.

The South-East Asia Region NCD impact simulation tool (40) can be used to study different interventions: their impact on premature mortality reduction at varying levels of coverage, and the costs associated with it. This exercise will help to identify some priority interventions that can be scaled up. This will also help in addressing the challenges and be preparation for scaling up other interventions. The roadmap will be available through the web portal to facilitate easy access to the tools and resources.

The South-East Asia Region NCD impact simulation tool can also be used to prioritize high-impact and feasible interventions using relative burden and cost-effectiveness as criteria. Based on feasibility and impact, it is important to increase the depth and reach of interventions to achieve the desired impact.

The South-East Asia Region NCD toolkit provides links to over 50 WHO guidance documents and online tools (see Annex).

WHO will work closely with Member States and partners in the South-East Asia Region to operationalize the roadmap in the national context. At the global level, WHO is updating the menu of policy interventions through cost-effectiveness analysis and will update the set in 2022. Global initiatives on NCDs will also provide guidance on specific areas. The Regional Office for South-East Asia will bring out the roadmap as a web app to make it easy to access the different tools and resources. WHO will update the NCD data portals and will also work on country-specific NCD data portals for easy access to data. At the national level, WHO will work with national governments and partners to adapt the steps in the roadmap with technical support. There will be opportunities to learn across countries and from global good practices.

Menu of actions for a national response

Governance, plans, partnership, coordination

1. Raise public and political awareness, understanding and practice about prevention and control of NCDs.
2. Integrate NCDs into the social and development agenda and poverty alleviation strategies.
3. Strengthen international cooperation for resource mobilization, capacity-building, health workforce training and exchange of information on lessons learned and best practices.
4. Assess national capacity for prevention and control of NCDs and develop and implement a national multisectoral policy and plan for the prevention and control of NCDs through multi-stakeholder engagement.
5. Strengthen national capacity including human and institutional capacity, leadership, governance, multisectoral action and partnerships for prevention and control of NCDs.
6. Engage and mobilize civil society and the private sector, as appropriate, and strengthen international cooperation to support implementation of the actions at national level.

Reducing risk factors

1. Reduce tobacco use.
   1. For the Parties to the WHO Framework Convention on Tobacco Control (WHO FCTC):
      1. Strengthen the effective implementation of the WHO FCTC and its protocols.
      2. Establish and operationalize national mechanisms for coordination of the WHO FCTC implementation as part of national strategy with specific mandate, responsibilities and resources
   2. For the Member States that are not Parties to the WHO FCTC:
      1. Consider implementing the measures set out in the WHO FCTC and its protocols, as the foundational instrument in global tobacco control.
      2. Scale up the implementation of “best buys” and other recommended interventions as per the national context.
2. Reduce the harmful use of alcohol.
   1. Implement the WHO global strategy to reduce harmful use of alcohol through multisectoral actions in the recommended target areas.
   2. Strengthen leadership and increase commitment and capacity to address the harmful use of alcohol.
   3. Increase awareness and strengthen the knowledge base on the magnitude and nature of problems caused by harmful use of alcohol by awareness programmes, operational research, improved monitoring and surveillance systems.
   4. Adapt the global action plan (2022–2030) to effectively implement the global strategy to reduce the harmful use of alcohol as a public health priority.
3. Reduce unhealthy diet.
   1. Implement the global strategy on diet, physical activity and health.
   2. Implement the WHO recommendations on the marketing of foods and non-alcoholic beverages to children.
   3. Adapt and implement the WHO technical packages on salt reduction and elimination of trans fat.
4. Reduce physical inactivity.
   1. Implement the global strategy on diet, physical activity, and health.

Strengthening health systems for NCD management and universal health coverage

1. Integrate very cost-effective noncommunicable disease interventions into the basic primary health care package with referral systems to all levels of care to advance the universal health coverage agenda.
2. Explore viable health financing mechanisms and innovative economic tools supported by evidence.
3. Scale up early detection and coverage, prioritizing very costeffective high-impact interventions, including cost-effective interventions.
4. Train the health workforce and strengthen the capacity of health systems, particularly at the primary care level, to address the prevention and control of noncommunicable diseases.
5. Improve the availability of the affordable basic technologies and essential medicines, including generics, required to treat major noncommunicable diseases, in both public and private facilities.
6. Strengthen and orient health systems to address noncommunicable diseases and risk factors through people-centred health care and universal health coverage.
7. Develop and implement a palliative care policy, including access to opioid analgesics for pain relief, together with training for health workers.

Surveillance and monitoring

1. Strengthen human resources and institutional capacity for surveillance and monitoring and evaluation.
2. Establish and/or strengthen a comprehensive noncommunicable disease surveillance system, including reliable registration of deaths by cause, cancer registration, periodic data collection on risk factors and monitoring national response.
3. Integrate noncommunicable disease surveillance and monitoring into national health information systems.
4. Evaluate progress of the programme implementation and provide guidance for action.

Cross-cutting areas

1. Promote digital health as an integral part of health priorities and benefit people in a way that is ethical, safe, secure, reliable, equitable and sustainable.
2. Develop and implement a prioritized national research agenda for noncommunicable diseases, with a focus on implementation research.
3. Strengthen human resources and institutional capacity for research.