NCD governance, policy, plan and coordination
Countries in South-East Asia Region have shown their commitment to NCDs through national NCD multisectoral plans. These plans guide a “whole-of-government” approach. They should be updated regularly and should guide focused implementation of policies to prevent NCDs. National mechanisms may be established, as appropriate, to maintain the momentum on multisectoral action.
There should be continued advocacy for a multisectoral approach within countries to address NCDs, including the allocation of adequate finance and human resources. Capacity development initiatives aimed at health and non-health partners and at developing return-on-investment cases for other sectors with a joint analysis of outputs can help in actions from all sectors (27).
There are many noncommunicable diseases and multiple risk factors, requiring the involvement of a wide range of interventions, platforms for action and stakeholders. A strong governance structure is essential to implement, sustain and monitor policies and action plans. A national group can help distil the information and data from many sources and feed it into the national NCD response. A good example is the Country Coordinating Mechanism, a national committee that submits funding applications to the Global Fund and oversees grants on behalf of their country (28). A similar approach could be considered for NCDs. National NCD alliances could support the coordinating mechanism by providing platforms for engaging multiple stakeholders. WHO Global Coordination Mechanism (29) is supporting this work and will be producing more guidance (30).
NCD risk factor control
Progress in tobacco control in the Region, as indicated by the MPOWER progress report (31), is to be maintained and further strengthened. More focus and targeted actions are needed to address tobacco chewing and electronic nicotine delivery systems.
Interventions to reduce the harmful use of alcohol show a mixed picture, and bans on advertising and reducing the physical availability measures need to be sustained. Illicit alcohol consumption must be addressed in the local context. The Action plan (2022–2030) to effectively implement the global strategy to reduce the harmful use of alcohol as a public health priority was approved by the Seventy-fifth World Health Assembly, 2022, and will provide further guidance in this area (32).
Rising rates of obesity is a problem across the Region, and a key risk factor for diabetes and other NCDs. Overweight and obesity are of concern, especially in school-aged children, and overweight is fast replacing underweight as a problem in the adult population, especially in urban areas. Focus areas include actions to address the diets of infants and young children, and initiatives on diet and physical activity to address all forms of malnutrition. WHO recently developed recommendations for the prevention and management of obesity over the life course, including additional process targets. The accompanying acceleration plan to control obesity will help countries in prioritizing context-specific actions to address obesity (33).
Health promotion and healthy settings
Population-level changes will take time to manifest. However, global experience and the scenario in many countries are pointers that strong policy actions are urgently needed. These policies will help to protect the current and next generation. Policies, legislations, regulations and fiscal measures will have to be taken up to overcome the commercial determinants.
Healthy settings, including cities, workplaces and schools are good platforms for mounting multiple interventions to reduce NCD risk factors and promote wellbeing. Setting up of regional platforms (such as exchange programmes and online platforms) for sharing of best practices for implementing the multisectoral action plan would be useful. Interventions for reducing these risk factors need a “whole-of-government” and “whole-of-society” approach, and the updated Appendix 3 of the Global action plan for the prevention and control of noncommunicable diseases 2013–2020 (34), presenting cost-effective interventions to address NCDs, will provide more guidance. Implementing these interventions at scale and with impact is essential. Health promotion, the encouragement of health literacy and the creation of healthy settings are approaches that help to maximize the implementation of risk-reduction strategies.
WHO South-East Asia Region adopted the regional plan for implementation of the global strategy on health, environment and climate change at the Regional Committee in 2019 (35). Countries in the Region can address air pollution through a multipronged approach and learn from experience within the region.
Strengthening health systems to combat NCDs
Primary health care is the foundation of an NCD-ready health system. Most of the NCDs can be prevented, detected early and optimally managed to prevent complications and premature death within a well-performing primary health care. Countries in the Region have all shown progress in hypertension and diabetes control and cervical cancer screening, and the measures adopted can be scaled up. Tracer indicators, such as hypertension control at different levels of the care cascade, can tell the story and help in taking the right decisions. Vaccination for HPV is a powerful intervention for supporting the elimination of cervical cancer as a public health problem. Civil society engagement using a rights-based approach to NCD services can help to strengthen the demand side of health services.
Universal health coverage is the means to ensure equitable and affordable health care. A context specific NCD intervention package should be part of the universal health coverage benefit package. Countries can identify the interventions relevant to them and strengthen the building blocks of their health systems at primary, secondary and tertiary level to ensure that NCD services can be delivered equitably without financial burden to the people. Timely and appropriate referral, with options to manage complications of NCDs, including diagnostic and therapeutic capacity, is important. Deaths from heart attacks and stroke can be reduced with optimal referral systems. Reducing delay in cancer diagnosis and treatment can lead to improvement in cancer survival and quality of life.