PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

84 Acting early on NCDs The Partnership for Health System Sustainability and ResilienceFrance faces similar challenges despite introducing medical assistant positions to handle administrative tasks and care coordination. These assistants, prioritised for deployment in underserved areas, aim to free physician time for clinical care. Training and competency development Whilst countries maintain robust systems for general medical education that include chronic disease topics, the evidence suggests that preparation for comprehensive, integrated NCD management remains insufficient across studied health systems. Medical curricula typically address individual diseases but may not adequately prepare graduates for managing multimorbidity, prevention, and the psychosocial aspects of chronic care. Gaps in NCD-focused training Greece operates without national standards for how chronic disease management competencies should be integrated within medical curricula, leaving individual institutions to determine the depth and breadth of chronic disease training. The lack of any national policy focusing on training healthcare staff in the prevention, diagnosis and management of NCDs leads to inconsistent quality of care between regions, inadequate primary-care led services and increased pressure on hospitals. This compromises the health system’s ability to tackle the growing burden of NCDs, and results in rising long-terms costs to the health system. Poland’s National Health Programme 2021–2025 prioritises health workforce planning based on NCD trends, stressing improved competencies in cardiovascular disease, diabetes, and cancer prevention. Postgraduate and continuing education in these areas is available through medical universities, professional chambers, and the Centre for Postgraduate Medical Education. However, regional disparities and limited funding often restrict access to these programmes. The report from France suggests that while chronic disease management is incorporated within medical curricula, there may be insufficient focus on integrated management of multimorbidity. Communication skills, behaviour change counselling, and patient activation, which are essential for chronic disease management, receive less emphasis compared to diagnostic and procedural training. The report from Japan describes how medical education maintains traditional emphases on acute care and technical excellence, with more limited focus on prevention, health promotion, and integrated chronic disease management compared to what the ageing population requires. Geriatrics and palliative care remain marginal in curricula despite the ageing population. Educational approaches to training would benefit from incorporating interdisciplinary collaboration, care coordination, or the social determinants which are inherently linked to NCD outcomes. Task-shifting potential and barriers Task-shifting represents one of the most promising yet underutilised strategies for addressing workforce constraints, enabling non-physician providers to deliver services traditionally restricted to doctors. However, implementation faces substantial professional, regulatory, and practical barriers. In Canada, pharmacist prescribing authority has been expanded for minor ailments, particularly in Ontario and British Columbia, but the scope is limited, with few conditions relevant to NCDs (e.g., GERD, uncomplicated UTIs) (BC Ministry of Health, 2025; Ontario College of Pharmacists, n.d.). This highlights the challenge of extending task-shifting to chronic disease management, where clinical complexity is higher. Pharmacists themselves have noted that their training in medication management and chronic disease care is underutilised, yet regulatory restrictions and fee-for- service payment models limit their role (CIHI, 2023). Pilot programmes, including pharmacist-led diabetes management initiatives, have demonstrated outcomes equivalent to physician care, but