PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

64 Acting early on NCDs The Partnership for Health System Sustainability and Resilience6 Governance and accountability Effective NCD prevention and management requires governance structures that enable coordinated action across health system levels, government sectors, and diverse stakeholders. NCDs demand integration across ministries responsible for education, finance, agriculture, and urban planning, alongside mechanisms to hold multiple actors accountable for population health outcomes. This chapter examines the institutional arrangements through which countries develop and implement NCD policies, including ministerial structures, cross-sectoral coordination mechanisms, strategic planning processes, and accountability frameworks. It analyses how health systems use data to inform policy, engage stakeholders in decision-making, and monitor implementation. The evidence covers both routine governance and crisis response, revealing how governance structures determine whether policies translate into improved outcomes. Institutional arrangements Governance structures for NCD management vary considerably across countries, reflecting different administrative traditions, constitutional arrangements, and health system organisations. These institutional differences profoundly shape how policies are developed, implemented, and monitored. Japan operates through a highly structured approach with dedicated divisions within the Ministry of Health, Labour and Welfare for each major NCD category. These divisions are supported by expert committees that systematically integrate perspectives from medical professionals, patient representatives, and local government officials, ensuring that technical expertise, patient experience, and implementation capacity all inform policy development (MHLW, 2024f). This structured approach enables clear accountability lines and systematic policy development, though it may also create silos between disease categories that miss opportunities for integrated approaches. Canada exemplifies the coordination challenges inherent to federal governance structures. Responsibilities for health are shared between the federal government which oversees pharmaceuticals, regulation, and health promotion, and the provinces and territories, which administer and deliver most health services (Health Canada, 2024; Marchildon et al., 2021). This division produces wide variability across Canada’s 13 jurisdictions, with provinces and territories developing their own approaches to screening programmes, treatment protocols, and coverage decisions (NCCHPP-CCNPPS, 2018). Although mechanisms exist for intergovernmental coordination, such as First Ministers’ Meetings, the annual Federal/Provincial/Territorial Health Ministers’ Meeting, and the Pan-Canadian Public Health Network, their mandates are often broad and political, leaving implementation fragmented (Health Canada, 2025a; Pan-Canadian Public Health Network, 2025a). As a result, patients moving between provinces can encounter entirely different standards of care and eligibility rules for coverage. Italy’s approach centres on the Directorate for Health Prevention, which aims to provide centralised coordination designed to overcome the country’s significant regional fragmentation. However, this strategy requires further strengthening, as implementation remains uneven across regions with varying capacities and political priorities, presenting a key challenge to achieving equity in the prevention and management of NCDs. Stronger national coordination mechanisms with concrete levers are needed to ensure more consistent delivery of services across the country. The tension between national standards and regional autonomy creates ongoing challenges, with some regions exceeding national requirements whilst others struggle to meet minimum standards.