Reviving the NCD Investment Agenda

Noncommunicable diseases (NCDs), like cancer, diabetes, and cardiovascular disease and stroke, represent a soaring 74% of global deaths. The legacy of chronic under-investment in NCDs has exacerbated the impact of the COVID-19 pandemic. In 2020, NCDs received only 1.6% of official development assistance (ODA) for health.

Given the complexities imposed by the pandemic on global health architecture, advancing the NCD investment agenda will require multiple innovative approaches. To this end, the NCD Alliance co-hosted two events: an in-person roundtable meeting in October 2021 in partnership with the Health Finance Institute (HFI) titled “Integrating NCDs in COVID-19 recovery agendas and mobilizing investment for NCDs”, and a virtual event in November 2021 in partnership with Sanofi and HFI titled “Building Forward Better: Catalyzing Investments for NCDs.”

Here we share some outcomes from those meetings.

Unlocking private sector investments

The private sector remains an indispensable part of the NCD equation, not only from a prevention angle, but also from a financing and investment angle. It is a very large and complex space that comprises multiple types of actors. While much attention goes to the part of the private sector that promotes and sells health-harming commodities, there is also the part of the private sector that develops innovative solutions to health problems that governments cannot address alone.

Companies that deploy drones to deliver health commodities to remote regions, companies that develop software to optimize health supply chain management, and companies that apply digital solutions to support primary care facilities are all good examples, and they remain largely underused in the NCD space. In addition, there is the private sector that holds significant capital and is considered a substantial financing avenue, if a well-rounded business model with clear return on investment is presented. There is a need to develop a robust private sector-facing business case to attract a wide range of actors to invest in NCD prevention and care.  

Integrating NCDs into other disease programs and global health security agendas 

There is an important window of opportunity to expand NCD funding through engaging with other global health programs and funding streams. For example, a key target has already been set for governments to provide NCD and mental health services to people living with HIV, which would be a major stride towards Universal Health Coverage. This target has an ambitious timeline to cover 90% of people living with HIV by 2025, so it is urgent to develop a clear plan for how it will be achieved. This presents an opportunity for the NCD community to collaborate with the HIV community in facilitating discussions on implementation, including funding implications to meet yearly milestones. 

The COVID-19 pandemic has also put the spotlight on the fragility of preparedness and response capacities across the globe, urging key political bodies to mobilize substantial funds dedicated to strengthening it. This was well demonstrated by the Co-Chairs of the G20 High Level Independent Panel on Financing the Global Commons for Pandemic Preparedness and Response in September 2021, where the panel proposed a new multilateral funding mechanism for global health security, the “Global Health Threats Fund” aiming to mobilize USD $50 billion over the next five years. This offers an opportunity to work directly with stakeholders on ensuring the inclusion of NCD prevention and care services under this fund as a key resilience factor in pandemic preparedness and response, building on guidance from the NCD Alliance’s Recovery Agenda. 

Empowering civil society at the national level

As far as health financing is concerned, public domestic resources should be the primary pillar of health spending and expenditure. While all global efforts to secure political commitments and expand official development assistance for NCDs are also extremely important, these should only serve to catalyze governments committing to the NCD financing agenda at the national level. Other disease focused programs have only seen breakthroughs in programming outcomes after creating national movements able to add significant pressure and generate substantial public demand for funding expansions for these programs. To this end, it is paramount for the NCD community to strengthen this technical advocacy capacity at the national level, building on the strong recent global campaign on meaningful involvement of communities. This is an opportunity to support national alliances in moving the needle on domestic resource mobilization for NCD services.      

Reinforcing the NCD investment case for the public finance sector

There is a chronic alignment gap between Ministries of Health and Finance, largely driven by the different agendas and priorities of both sectors. However, both sectors are critical to the success of one another. Simply put, strong health systems cannot be realized without sufficient financing, and strong economies cannot be realized without good health. Often times, health advocacy to Ministries of Finance still speaks the epidemiology and disease burden language, which simply isn’t the priority or interest of the public finance sector. In order for advocacy to the finance sector to be successful, finance language must be used. This translates into factors like economic impact and return on investment, all in a reasonable timeframe to ensure political appeal to Ministries of Finance, legislature, and political leadership. Although an investment case for NCDs was already made a few years ago, given the COVID-19 pandemic and related NCD impact on the course and outcome of the disease, it is worth revisiting the previously generated ROI figure of $7 for every $1 spent and factor in all indirect costs. A lesson from the pandemic is that the benefits of NCD action, or indeed the cost of inaction on NCDs, are far higher than previously thought.

As government representatives gathered in Geneva for the special session of the World Health Assemblyto discuss and negotiate a potential international treaty on pandemic preparedness and response, the catastrophic linkages witnessed between NCDs and COVID-19 demonstrated that health security extends beyond just neutralizing the threat of propagation of communicable diseases. We must act now to ensure that when the next pandemic hits, it meets healthy populations who are not suffering the debilitating impacts of NCDs, and resilient health systems that are not drained by the overwhelming burden of the world’s biggest killer.