Prioritizing health-sector interventions for noncommunicable diseases and injuries in low- and lower-middle income countries: National NCDI Poverty Commissions

Abstract

Health sector priorities and interventions to prevent and manage noncommunicable diseases and injuries (NCDIs) in low- and lower-middle-income countries (LLMICs) have primarily adopted elements of the World Health Organization Global Action Plan for NCDs 2013–2020. However, there have been limited efforts in LLMICs to prioritize among conditions and health-sector inter- ventions for NCDIs based on local epidemiology and contextually relevant risk factors or that incorporate the equitable distribution of health outcomes. The Lancet Commission on Reframing Noncommunicable Diseases and Injuries for the Poorest Billion supported national NCDI Poverty Commissions to define local NCDI epidemiology, determine an expanded set of priority NCDI conditions, and recommend cost-effective, equitable health-sector interventions. Fifteen national commissions and 1 state-level com- mission were established from 2016–2019. Six commissions com- pleted the prioritization exercise and selected an average of 25 NCDI conditions; 15 conditions were selected by all commis- sions, including asthma, breast cancer, cervical cancer, diabetes mellitus type 1 and 2, epilepsy, hypertensive heart disease, intra- cerebral hemorrhage, ischemic heart disease, ischemic stroke, ma- jor depressive disorder, motor vehicle road injuries, rheumatic heart disease, sickle cell disorders, and subarachnoid hemorrhage. The commissions prioritized an average of 35 health-sector inter- ventions based on cost-effectiveness, financial risk protection, and equity-enhancing rankings. The prioritized interventions were esti- mated to cost an additional US$4.70–US$13.70 per capita or ap- proximately 9.7%–35.6% of current total health expenditure (0.6%–4.0% of current gross domestic product). Semistructured surveys and qualitative interviews of commission representatives demonstrated positive outcomes in several thematic areas, includ- ing understanding NCDIs of poverty, informing national planning and implementation of NCDI health-sector interventions, and im- proving governance and coordination for NCDIs. Overall, national NCDI Poverty Commissions provided a platform for evidence- based, locally driven determination of priorities within NCDIs.