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.
