9 Acting early on NCDs The Partnership for Health System Sustainability and Resilience■ Invest in systematic demand reduction: Rather than assuming endless workforce expansion can meet growing NCD demands, develop evidence-based self-management programmes that genuinely enable patients to manage their conditions. Measure workforce time saved to justify continued investment. Use group consultations, peer support, and validated digital tools whilst avoiding simply shifting burden to patients, particularly those facing disadvantage. Medicines and technologies CURRENT LANDSCAPE: Innovation in access mechanisms shows progress: Italy’s €500 million Innovative Drugs Funds ensure breakthrough therapies reach patients, France’s ’direct access’ pilot provides immediate reimbursement for major therapeutic advances, and Germany’s DiGA framework pioneers digital therapeutic reimbursement. Yet systematic delays persist: Greece faces over 600 days from regulatory approval to reimbursement, while Japan sees 72.4% of US/EU- approved medications remain unavailable. Digital infrastructure adoption is widespread with near- universal EMR adoption in several countries, but interoperability failures prevent care coordination. The populations most affected by NCDs face systematic barriers to digital health adoption. RECOMMENDATIONS: ■ Accelerate access to high-value innovations: Reform approval and reimbursement pathways to reduce delays between regulatory approval and patient access, which can exceed 600 days in some countries. Implement fast-track processes for breakthrough NCD therapies with clear timelines, early access programmes bridging regulatory and reimbursement decisions, and dedicated innovation funds providing temporary coverage during price negotiations. Consider risk-sharing agreements for expensive therapies with uncertain benefits. ■ Ensure equitable diagnostic infrastructure: Address regional disparities in access to diagnostics, establishing minimum standards for technology availability, systematic renewal programmes with protected funding, mobile diagnostic units for underserved areas, and hub-and-spoke models linking rural to urban facilities. Expand coverage for molecular testing and precision diagnostics when results influence treatment decisions. ■ Build interoperable digital health infrastructure: Establish mandatory open standards enabling care coordination, addressing the current reality where countries with near-universal EMR adoption cannot share data between providers or regions. Create governance structures with genuine authority to enforce standards and resolve stakeholder disputes that have delayed progress for decades. Balance privacy protection with research needs through trusted environments and clear AI guidance. ■ Reform clinical trial and innovation infrastructure: Address barriers causing countries to lose competitive position despite strong infrastructure. Unify ethics approval processes to replace fragmented regional systems, streamline administrative requirements, and invest in clinical trial networks with sustainable funding. Develop real-world evidence capabilities leveraging electronic health records and improve patient recruitment through accessible information. ■ Bridge the digital divide for older adults with NCDs: Address evidence that half of citizens over 70 in some countries cannot use digital devices and most chronic patients over 70 lack autonomy with digital tools. Mandate accessibility standards for health interfaces, provide support services including helplines and in-person assistance, and maintain non-digital alternatives. Integrate digital literacy training with chronic disease management programmes.

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025