79 Acting early on NCDs The Partnership for Health System Sustainability and Resilience■ Embed prevention value in all resource decisions The benefits of prevention must be systematically considered in resource allocation, using appropriate time horizons that capture long-term value. This might involve treating prevention as investment rather than expenditure, or developing mechanisms that allow health systems to benefit from the broader savings their prevention activities generate. Health technology assessment and budget processes should evolve to properly value interventions that prevent future disease rather than focusing solely on treating existing conditions. ■ Create financing mechanisms that reward coordination and integration Payment systems should incentivise the coordination that effective NCD management requires, rather than perpetuating fragmentation through separate funding streams. This could involve population-based payments that encourage collaboration, bundled payments spanning multiple providers, or shared savings arrangements that reward collective achievement. Prevention and coordination activities need explicit recognition in payment systems rather than being expected as unfunded additions to clinical work. ■ Reform payment systems to align incentives with NCD management needs Countries should transition primary care from fee-for-service toward capitation-based models that provide predictable funding for prevention and chronic disease management. Where pay-for- performance is considered, careful attention to design is essential – including incentive size, level of application, whether to reward improvement or absolute performance, and safeguards against unintended consequences. Given the mixed evidence and design complexity, priority should go to removing perverse incentives in current systems, such as ensuring adequate reimbursement for consultation time and team-based care.

PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025