PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

68 Acting early on NCDs The Partnership for Health System Sustainability and Resilienceformal channels for lived experience to influence policy. However, the structured nature of these committees may also limit flexibility and responsiveness to emerging issues. Poland’s Public Health Council mandates comprehensive representation from professional chambers, employers’ organisations, and NGOs, creating a broadly inclusive governance structure. The 2015 Public Health Act requires stakeholder consultation for all major health programmes, though the quality and influence of this consultation varies. Professional chambers maintain significant influence, potentially overshadowing patient and public voices. Canada demonstrates sophisticated stakeholder engagement through patient-oriented research networks and strong advocacy organisations. The Strategy for Patient-Oriented Research (SPOR) networks embed lived experience into research and policy design (CIHR, 2021, 2023). Advocacy groups have directly shaped federal frameworks: Diabetes Canada drove the Framework for Diabetes in Canada (2022), while the HeartLife Foundation co-led the Heart Failure Policy Framework and supported the National Framework on Heart Failure Act in 2024 (Diabetes Canada, 2022; HeartLife Foundation, 2024a, 2024b). These outcomes highlight the effectiveness of government–civil society partnerships, but also reflect limited federal leadership where patient organisations have filled policy gaps. The report on Germany describes how the country’s Joint Federal Committee (G-BA), the highest decision-making body of self-government in healthcare, includes patient representatives in all sessions . They may propose agenda items and participate in deliberations, but voting rights rest with representatives of physicians, hospitals, and health insurance funds. This arrangement ensures patient perspectives are formally integrated into discussions. Accountability mechanisms Effective governance requires not just structures and processes but accountability mechanisms that ensure policies are implemented and objectives achieved. The evidence reveals systematic weaknesses in accountability across all studied countries. Most countries lack systematic monitoring of policy implementation. Whilst strategies may include targets, regular assessment of progress is often absent. Greece’s absence of indicator-specific action plans or accountability mechanisms means that strategic objectives remain aspirational. Spain’s regional autonomy creates particular accountability challenges, with no mechanisms to ensure national standards are met across all autonomous communities (Bernal-Delgado et al., 2024). Where monitoring exists, it rarely triggers corrective action. Italy’s documentation of extreme regional disparities in screening coverage has not produced effective interventions to address these inequities. This suggests that monitoring without consequences becomes a bureaucratic exercise rather than a driver of improvement. Financial accountability for NCD outcomes remains particularly weak. Despite NCDs representing the majority of healthcare expenditure, budget allocations rarely reflect performance in prevention or early intervention. Germany’s high rates of avoidable hospitalisations do not trigger financial consequences for regions or providers failing to manage chronic conditions effectively. Crisis preparedness plans The COVID-19 pandemic revealed fundamental weaknesses in governance structures for maintaining NCD services during health system shocks. Most countries lacked explicit governance mechanisms for NCD service continuity, with emergency response structures focused primarily on acute care surge capacity.