PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

85 Acting early on NCDs The Partnership for Health System Sustainability and Resiliencescaling remains slow due to inconsistent provincial regulation and resistance from some medical associations (Diabetes Canada, 2023; Lavergne et al., 2018). Japan’s initiative for “specified acts” training enables nurses to expand their scope of practice, potentially addressing workforce shortages through task-shifting (MHLW, 2024j). However, nurses report being unable to find colleagues to cover their regular duties during training periods, and workplace infrastructure often lacks protocols for utilising new skills after training completion. Without organisational support and clear role definitions, the initiative may not translate into an effective expansion of nursing roles and practices. Germany has expanded the role of medical assistants (MFAs) through advanced training, enabling them to conduct home visits and take on delegated tasks such as spirometry, long-term ECGs, blood sampling, and selected cancer screening activities (KBV & GKV-Spitzenverband, 2015). Practices that employ certified MFAs receive supplementary reimbursement, creating incentives for task delegation in outpatient care and to overcome professional protectionism (KBV, 2023b; Mangiapane et al., 2022). Poland has introduced regulatory frameworks for 15 medical professions including new roles such as prevention specialists, health promoters, and care coordinators. These roles aim to fill gaps in the current workforce, particularly in prevention and chronic disease management. However, educational programmes for these new professions remain underdeveloped, and integration into existing teams faces resistance from established professions protecting traditional boundaries. Geographic disparities in training Geographic disparities in training opportunities mirror and perpetuate workforce maldistribution. Japan’s concentration of training infrastructure demonstrates this challenge starkly: Tokyo has 39 training facilities whilst most other prefectures have only 1-2, forcing healthcare workers from underserved areas to travel for professional development and further depleting local workforce capacity during training periods (MHLW, 2023d). This geographic concentration of educational resources creates self-reinforcing cycles where areas with the greatest training needs have the least access to training opportunities. Rural practitioners miss advances in NCD management, perpetuating quality disparities. Given the lack of training opportunities, young professionals may avoid rural areas and other underserved regions. The concentration of academic medical centres in cities means that new care models and innovations rarely reach rural areas where needs may be greatest. Canada’s distributed medical education model attempts to address this through regional campuses and rural training sites (Health Canada, 2025; CIHI, n.d.). Evidence shows that students who complete rural rotations are more likely to practise in rural areas, though the overall supply of rural practitioners remains insufficient to meet population needs (Health Canada, 2025; CIHI, n.d.). The quality of rural training sites varies, with some offering excellent community-based experience whilst others struggle to provide adequate supervision and case variety. Strategies for workforce development Countries have introduced various targeted responses to address workforce imbalances, though most remain limited in scope and impact relative to the scale of challenges identified. Educational reforms and capacity expansion Germany’s “rural doctor quotas” (Landarztquote) have been introduced in 11 of 16 federal states, reserving a portion of medical school places for applicants who commit to working as general practitioners in underserved rural areas for at least 10 years (Rottschäfer, 2024). In return, students