Acting early on NCDs The Partnership for Health System Sustainability and Resiliencesignificantly influence disease risk but are frequently underrepresented in current risk models. Tailoring screening frequency, modality, and follow-up intensity based on comprehensive risk segmentation will enhance early detection and resource allocation, ensuring that high-risk populations are appropriately identified and managed. ■ Expand screening programmes with explicit equity targets Since NCDs disproportionately affect underserved populations – including those in remote areas and lower socioeconomic groups – comprehensive screening programmes for cancer, cardiovascular-metabolic, kidney, and respiratory diseases must include mandatory coverage targets for these communities. Healthcare systems should implement opt-out enrolment with proactive recall systems, deploy mobile screening units to reach rural populations, and offer flexible scheduling including evenings and weekends. Regions should face financial consequences for failing to meet minimum participation thresholds among disadvantaged groups. While engaging underserved, high-risk populations requires additional health system resources, this investment is essential for detecting disease when interventions can still be curative or disease-modifying. ■ Strengthen primary care as the foundation for opportunistic detection Expand primary care authority and capabilities to independently diagnose and initiate treatment for common NCDs such as diabetes, hypertension, and COPD that can be effectively managed at this level once confirmed. Clear protocols should specify which conditions primary care can diagnose independently versus those requiring specialist confirmation, ensuring appropriate use of specialist resources while maintaining continuity of care. Payment systems must recognise and reimburse opportunistic screening and diagnostic activities performed during routine visits. ■ Invest in diagnostic capacity to improve earlier diagnosis of NCDs Improve access to essential diagnostic tool for major NCDs: spirometry for respiratory disease, CT scans, MRI scans, and endoscopy to improve early diagnosis of cancer, ECG capabilities for cardiovascular conditions, point of care blood glucose testing, and urine testing for proteinuria ■ Implement systematic protocols for opportunistic detection Develop clear pathways for managing abnormal findings identified during routine encounters, with defined timeframes for follow-up and diagnostic confirmation, including fast-track referrals for suspected cancer symptoms. Protocols should specify which conditions primary care can diagnose independently versus those requiring specialist confirmation, avoiding both unnecessary referrals and dangerous delays. ■ Ensure sustainable financing for screening programmes Move beyond temporary funding that undermines programme effectiveness and population trust. Establish dedicated, long-term funding integrated into regular health budgets rather than dependent on external or time-limited sources like Recovery and Resilience Funds. This includes covering not just screening tests but the full pathway from abnormal results to diagnosis and treatment initiation. ■ Address implementation barriers beyond programme design The consistent gap between screening programme availability and population participation requires understanding and addressing specific barriers including convenience, cultural factors, and trust in healthcare systems. This means investing in awareness and education campaigns, simplifying patient pathways, community engagement, and systematic evaluation of why eligible populations do not participate, then adapting programmes based on findings rather than assuming availability equals access.

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025