4 Acting early on NCDs The Partnership for Health System Sustainability and Resilience■ Expand screening programmes with explicit equity targets: Since NCDs disproportionately affect underserved populations, screening programmes must include mandatory coverage targets for these communities. Healthcare systems should implement opt-out enrollment with proactive recall, deploy mobile screening units for rural areas, and offer flexible scheduling including evenings and weekends. Regions should face be incentivised to reach participation thresholds among disadvantaged groups. While engaging high-risk underserved populations requires additional 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, following evidence that greater autonomy improves treatment initiation without increasing misdiagnosis. Ensure payment systems recognise and reimburse opportunistic screening activities performed during routine visits. Improve access to essential diagnostic tools including spirometry for respiratory disease, ECG capabilities for cardiovascular conditions, and point-of-care testing for diabetes and kidney disease. ■ 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 ■ Develop systematic protocols for managing abnormal findings: Establish clear pathways for abnormal findings identified during routine encounters, with defined timeframes for follow-up and diagnostic confirmation including fast-track referrals for suspected cancer. 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. This must cover not just screening tests but the full pathway from abnormal results through diagnosis to treatment initiation. ■ Address implementation barriers beyond programme design : The persistent gap between programme availability and population participation requires systematic evaluation of why eligible populations do not participate. Invest in targeted awareness campaigns, simplify patient pathways, engage communities, and adapt programmes based on findings rather than assuming that availability equals access. Tertiary prevention: Referral & access to specialist care CURRENT LANDSCAPE: Referral pathways from primary to specialist care vary widely across countries, from structured gatekeeping to fragmented self-referral systems. While some countries guarantee specialist access timeframes and others have developed coordination protocols, implementation remains uneven. Information sharing between providers faces persistent barriers despite widespread digitalisation, with most systems unable to exchange data across care settings. Geographic disparities in specialist availability create substantial access challenges, particularly for rural populations facing longer waits and travel distances. Critically, comprehensive monitoring of complete pathway times from referral through treatment remains absent, limiting health systems’ ability to identify and address bottlenecks that delay necessary care.

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025