The crucial role of civil society and lived experience for sustainable financing of NCDs and mental health: A call to action by NCD Alliance

NCD Alliance | 05 Apr 2024

The under-funding of NCDs and mental health is not just an issue at national level. Today, NCDs cause 41 million deaths per year – 74% of all deaths globally - and are the leading cause of disability. 17 million of these NCD deaths occur prematurely - between the ages of 30 and 70 – with 86% of those deaths occurring in low- and lower-middle-income countries (LLMICs), a disproportionately high percentage. Yet, in the last three decades, NCDs have received less than 2% of all development assistance for health, indicating a fundamental mismatch between the healthcare needs and the rights of people living with NCDs, and the global resources allocated to respond.

If we believe that “what measured gets done”, we must improve data, transparency, and accountability around the funding flows nationally and in development assistance and ensure that better tracking systems accompany them. Some investments that benefit NCD and mental health care may be hidden in plain sight because they are part of integrated health services and multisectoral action, and therefore are not recorded as NCD interventions.

One of NCD Alliance’s priorities is to push for the establishment of global financing targets. For too long we have been looking for stakeholders to drive NCD investment forward, but with little progress being made. Inspired by the commitments at the UN HLMs on HIV/AIDS and on TB, we are specifically asking for the Financing Dialogue’s outcomes to commit to the development of financing targets ahead of the political declaration process for the 4th UN HLM on NCDs in 2025.

Tried and true approaches to domestic resource mobilization 

In the NCD Alliance policy brief outlining our advocacy priorities on Sustainable Financing for NCDs and Mental Health, we highlight several tried and true approaches to domestic resource mobilization that all governments should adopt. These include developing and implementing costed national NCD strategies, aligning health spending with national disease burdens, and adequately implementing fiscal measures such as excise taxes on health-harming products like tobacco, alcohol, and unhealthy foods. 

It is also important to recognize and act on the interconnections between NCDs and mental health with other health agendas, like achieving Universal Health Coverage with a focus on primary care to fill the gaps in existing health systems. And there are major opportunities to build synergies with other development agendas, such as poverty reduction, by strengthening social and financial protection schemes to minimize the out-of-pocket health expenditures that are driving millions of people living with NCDs and mental health conditions into or deeper into poverty every year.

Placing civil society at the fore of resource mobilization advocacy

Civil society plays a critical role in all health systems, and some rely heavily on service provision by civil society organizations (CSOs). Civil society can reach and represent marginalised people, work closely with communities of which they are often members themselves, and provide care for deprioritized health conditions.

By taking the lead in advocacy, CSOs can draw attention to pressing issues, rally the general public, leverage political support, and hold governments and other stakeholders accountable to their promises. 

A key role of civil society advocacy is also to elevate the voices of those with lived experience, which is critical to the development of responsive and person-centered policies.

Making use of the tools and frameworks for meaningful engagement

There are a number of tools and frameworks for meaningful engagement that have been developed by both the World Health Organization and civil society. 

These include the WHO Framework for Meaningful Engagement of People Living with NCDs, Mental Health Disorders, and Neurological Conditions; the Global Charter for Meaningful Engagement of People living with NCDs from the NCD Alliance; and the Global Mental Health Peer Network’s Guidelines on Lived Experience Engagement and Consultation for Policymakers.

Governments must ensure that civil society and people living with NCDs and mental health conditions are key participants in priority setting, implementation, and monitoring and evaluation of financing and resource mobilization efforts for NCDs and mental health. This also entails investing in developing civil society’s capacity, creating demand for person-centered services and more resilient health systems, and increasing recognition from governments of the role of civil society in service delivery, public budget development and budget tracking. 

The International dialogue on sustainable financing for NCDs and mental health offers an opportunity formuch-needed technical policy recommendations. But to ensure real change for the millions of people living with NCDs including mental health and neurological conditions lacking access to care, or driven into poverty by care costs, it must also build politicalengagement with the key stakeholders and decision-makers who can help put these recommendations into action.


This article is part of a series of calls to action and position papers by civil society actors and people with lived experience ahead of the International dialogue on sustainable financing for NCDs and mental health in June 2024. The text summarizes remarks by Alison Cox, NCD Alliance, at the WHO Multistakeholder Briefing on the WHO/World Bank International dialogue on sustainable financing for NCDs and mental health.