PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

59 Acting early on NCDs The Partnership for Health System Sustainability and ResiliencePatient education and self-management support Effective chronic disease management increasingly requires active patient participation in self- management, yet support for developing these capabilities remains limited across most countries. Disease management programmes typically include patient education and shared decision making components, but these often focus on information provision rather than skill development. Canada’s experience with diabetes self-management illustrates both needs and gaps. Despite the importance of self-monitoring and lifestyle modification, many patients face significant out-of- pocket costs for supplies and devices, and lack access to structured education programmes or ongoing community-based support (Diabetes Canada, 2023; Government of Canada, n.d.). Fragmentation between clinical care and community services contributes to inconsistent guidance and leaves many without adequate support for daily management decisions (Marchildon et al., 2021). France’s therapeutic patient education programmes (éducation thérapeutique du patient) represent a more systematic approach, with structured curricula and trained educators. However, these programmes reach only a fraction of eligible patients, with access varying by region and condition. The time-intensive nature of effective education programmes conflicts with productivity pressures in clinical settings. Maintaining access during crises The COVID-19 pandemic provided an unprecedented test of health system resilience, revealing how the coordination failures and implementation gaps identified during routine operations become magnified during crisis periods. Several countries lacked specific plans for maintaining essential NCD services during the pandemic, leading to significant disruptions in routine chronic disease management. The Spain report finds that there was no specific national plan to ensure the continuity of NCD services during crises, though various regulations and health strategies indirectly addressed this issue, including Royal Decree 463/2020 and Law 2/2021 which established rules for prevention and containment during health emergencies. The France report indicates that emergency preparedness proved insufficient for maintaining care continuity. The country’s emergency White plan predominantly focused on increasing available human and material resources for treating Covid patients, mainly in hospitals, yet did not adequately consider the effect of interruptions to routine and chronic care. The French health authority (HAS) had to publish recommendations for maintaining NCD care a month into the first national lockdown (HAS, 2020a). Later, they stipulated that NCD patients be prioritised for vaccination (HAS, 2020b). These gaps in preparedness resulted in widespread service disruptions. In Spain, many patients experienced suspended or delayed appointments for check-ups and diagnostic tests, affecting the early detection of diseases such as cancer and diabetes. France experienced severe impacts, with cancer screening, surgeries and other treatments severely affected by the first lockdown and to a lesser degree during the second (Le Bihan Benjamin et al., 2022). In Canada, diagnostic imaging wait times increased substantially, with MRI scan wait times at the 50th percentile rising from 42 days in 2019 to 57 days in 2024 (CIHI, 2025). The Italy report documents that delayed treatments, missed screenings, and postponed surgeries resulted in worsening health outcomes with an increase in preventable complications, hospitalisations, and mortality due to untreated chronic conditions. The disruptions to cancer screening programmes created lasting consequences. In France, an excess mortality of between 1000-6000 is expected in coming years due to gaps in cancer screening and treatment during the pandemic (Blay et al., 2021). Even temporary service interruptions can have lasting impacts on population health, particularly for those with existing chronic conditions who depend on regular monitoring and treatment adjustment.