Ensuring equitable access to essential medicines and health technologies for noncommunicable diseases

Critical access to NCD medicines and health technologies

Equitable access to safe, effective, and quality-assured medicines and other health technologies is a cornerstone of health policies and programmes that leave no one behind. However, in the global effort to prevent, detect and treat noncommunicable diseases (NCDs), mental health and neurological conditions, limited access to medicines and health technologies remains a significant barrier.

Cardiovascular diseases including heart attacks and strokes, for example, cause at least 19 million deaths every year. High blood pressure, one of the major risk factors for cardiovascular diseases, affects an estimated 1.28 billion adults worldwide, yet very few people are able to keep it effectively under control.

Two-thirds of people living with high blood pressure live in low- and middle-income countries. Often, they only have limited access to antihypertensive medicines as the condition remains undiagnosed, testing facilities and follow-up programmes are missing, and procurement and supply-chain systems fail to deliver safe, effective, quality medication. To make matters worse, the cost for diagnosing and treating hypertension in lower-resource countries is largely paid out-of-pocket, posing substantial financial burden to people living with a health condition that may remain asymptomatic, yet require lifetime treatment.

Managing and treating diabetes, another major NCD affecting 830 million people worldwide, are similarly complicated by severe access and health equity challenges. In 2022, more than half of people living with diabetes did not take medication for their health condition, and treatment coverage is lowest in low- and middle-income countries.

Around the world, people living with NCDs, mental health and neurological conditions experience access challenges most when shelves in pharmacies and health facilities remain empty: One in five countries reported NCD medicines being out of stock in 2021. Stockouts of essential medicines and health technologies to prevent or treat NCDs concerned up to 41% of low-income countries, while only 4% of high-income countries reported similar supply issues.

Strategies to address and overcome access challenges

Access to medicines and health technologies is a multidimensional, health system challenge that is integral to achieving universal health coverage. For strategies to be effective, countries need to consider aspects of affordability, availability, accessibility and acceptability. Strengthening capacity building and promoting regulatory convergence and harmonization is equally important for access to safe, effective and quality assured health products.

To increase access, countries can implement policies to improve affordability and availability of essential medicines and health technologies, such as promoting the use of quality‑assured generic and biosimilar medicines. Additional pricing policy options, including internal reference pricing, mark‑up regulation, tendering, and lower patient co-payments can further reduce economic access barriers.

Better monitoring and increased transparency across the supply chain can support governments and manufacturers to detect production bottlenecks and vulnerabilities. Making use of innovative approaches such as strategic procurement and geographically diversified manufacturing has the potential to further improve supply security, while simultaneously strengthening health systems and resilience.

Timely, predictable, and sustained access to essential NCD medicines and health technologies is particularly critical for ensuring long-term treatment for chronic patients. Last-mile delivery to people living with such health conditions can be optimized through direct delivery strategies and multi-month dispensing for long-term treatment. Countries can also explore alternative dispensing, warehousing and distribution mechanisms, including decentralized models, remote delivery or distribution managed by community health workers.  

A worthwhile investment

Strategic investments in improving access to NCD medicines and health technologies yield significant returns for health systems and household budgets. Most of the out-of-pocket spending on NCDs and mental health is due to medicines – including those that are considered essential and thus should in principle be financially accessible to all.

Importantly, ensuring equitable access to essential NCD medicines and technologies can only succeed as part of a coherent health system response: Once identified, bottlenecks and access gaps need to be addressed through strong political will, continuous leadership, multisectoral coordination, and people-centred health programmes that leave no one behind.

Key messages

Three interconnected areas require focused action to advance equitable access to NCD medicines and other health technologies:

• Ensuring affordability and availability of NCD medicines and health technologies requires strengthening pricing policies, financial protection and increased use of quality-assured generics and biosimilars. Stronger evidenced-based decision making and patient-centered care models will improve last-mile delivery and ensure the right medicines reach those who need them most.
• Strengthening procurement and supply chains is essential to prevent shortages and ensure quality. This includes improving strategic procurement and supporting geographically diversified manufacturing.
• Advancing quality and innovation means strengthening regulatory systems, increasing harmonization, and greater regulatory convergence to ensure quality and safeguard against substandard and falsified medicines. Aligning intellectual property policies with global health needs and promoting best practices will drive improvements in NCD treatment and care worldwide.

Related resources 

Thematic Collection

Safe and effective, quality assured health products and technologies for NCDs and mental health conditions

About the series

This commentary is part of a series highlighting priority areas to accelerate progress in the global NCD and mental health response and address related global health equity challenges ahead of the Fourth High-Level Meeting of the United Nations General Assembly (UNHLM4) in 2025. Discover the full series on the Road to 2025 campaign webpage.