PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

69 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceThe absence of clear governance for NCD services during the pandemic led to ad hoc decision- making that often deprioritised chronic disease management. Screening programmes were suspended without clear criteria for resumption, routine appointments cancelled without systematic triage of those most at risk, and treatment decisions delayed without accountability for consequences. NCD patients, despite representing the majority of those at risk from COVID-19 experienced the greatest service disruptions. Few countries have since developed explicit governance structures for NCD services during future emergencies. Spain’s regional autonomy complicated pandemic response, with different regions adopting conflicting approaches to NCD service continuity. The absence of national coordination mechanisms meant that learning from successful regional innovations was limited. POLICY LEVERS: GOVERNANCE AND ACCOUNTABILITY Despite diverse governance structures, all countries demonstrate similar weaknesses: absence of genuine cross-sectoral coordination, strategic planning gaps for major NCDs, and accountability mechanisms without consequences. The disconnect between comprehensive data collection and policy response, exemplified by persistent regional disparities despite systematic monitoring in many countries such as Italy and Spain, reveals that evidence alone doesn’t drive change without enforceable accountability. Most concerning is the complete absence of governance frameworks for maintaining NCD services during emergencies, exposed catastrophically during COVID-19. These governance failures mean that even well-intentioned policies fail to translate into improved population health outcomes. Based on the evidence examined, countries should consider the following approaches to strengthen governance and accountability: ■ Establish multi-sectoral coordination NCD prevention bodies Countries should create cross-ministerial coordination bodies with clear mandates, adequate resources, and genuine authority to align policies across health, education, finance, agriculture, and urban planning sectors. Lessons can be learnt from national antimicrobial resistance (AMR) policy, where multi-sectoral coordination committees coordinate across human, animal, and environmental health. These bodies must move beyond advisory roles to have real influence over resource allocation and policy priorities, with formal accountability for achieving cross-sectoral objectives. ■ Develop comprehensive NCD registries to monitor progress and outcomes Countries need integrated, interoperable systems and registries that can track NCD incidence, risk factors, treatment patterns, and outcomes across the entire care continuum. This requires not only technical investment in systems and standards but also governance frameworks that mandate data sharing whilst protecting privacy, enabling evidence-based decision-making at all levels. ■ Ensure investments in NCD policy are monitored and return on investment estimated Countries should require that return on investment from NCD policies is monitored and evaluated ensuring that funding decisions explicitly reference national health data, burden of disease assessments, and effectiveness evidence. This includes strengthening health technology assessment for NCD interventions, and mandating evaluation of cost-effectiveness for existing and novel NCD programmes.