Yet fundamental challenges persist across all health systems examined. Disease-management programmes typically remain disease-specific, creating fragmented care for populations with multimorbidity. Despite rising levels of complex multimorbidity in all of the countries in scope, none has developed comprehensive clinical guidelines for multimorbidity management. This results in clinicians navigating complex decisions without evidence-based guidance, often defaulting to treating each condition in isolation. This gap between health system organization (structured around single diseases) and population needs (increasingly characterized by multiple interacting conditions) represents perhaps the most fundamental misalignment in contemporary chronic disease management. Even for single conditions with well-established treatment protocols, substantial gaps exist between clinical guidelines and actual practice. Evidence from heart failure and CKD management demonstrates that a significant proportion of diagnosed patients do not receive guideline- directed medical therapy, with therapeutic inertia and fragmented care pathways contributing to suboptimal medication optimization.52,53 This means a significant lost opportunity to improve outcomes. –Develop guidelines for multimorbidity with practical decision support: Move beyond single-disease guidelines to address common disease combinations explicitly, providing frameworks for prioritizing interventions when recommendations conflict and protocols for deprescribing when risks exceed benefits. –Scale disease-management programmes with systematic enrolment: Shift from voluntary participation to opt-out enrolment, ensuring programmes reach those most in need. Combine with demand projections and corresponding capacity investment. Link funding to achieving both high coverage and quality outcomes. –Strengthen medication management for complex patients: Implement regular comprehensive medication reviews considering all conditions together. Embed pharmacists within primary care multidisciplinary teams, with decision support tools identifying potentially harmful interactions, particularly for older adults with polypharmacy. –Invest in structured self-management support: Develop programmes that go beyond information provision to build practical skills, with ongoing support systems. Recognize self- management support as an essential clinical service requiring dedicated resources, including peer-support networks and validated digital tools. –Build crisis-resilient chronic disease care: Establish explicit protocols for maintaining essential NCD services during emergencies. Develop remote management capabilities that can be rapidly activated, ensure supply chain resilience for essential medications and incorporate lessons from COVID-19 into permanent preparedness plans. –Implement continuous quality-improvement systems: Establish mechanisms ensuring implementation through regular audits with feedback to providers and quality indicators reflecting patient outcomes rather than just process measures. Embed quality improvement in routine practice with continuous performance monitoring.Policy levers Acting Early on Non-Communicable Diseases: A Framework for Health System Transformation 14

Acting Early on Non-Communicable Diseases 2026