Scaling Up Action Against Noncommunicable Diseases: How Much Will It Cost?
(2011; 51 pages)

This paper describes a new financial planning tool developed by the World Health Organization (WHO) to assist low- and middle income-countries in scaling up a core set of interventions to tackle noncommunicable diseases (NCDs), such as heart disease and stroke, diabetes, cancer and chronic lung disease. NCDs currently kill 36 million people per year, and the burden continues to escalate, particularly in low- and middle-income countries. These countries often lack resources and capacity to tackle these diseases, and therefore need to adopt an incremental approach as they move to address the gaps in NCD prevention and control.

To prevent disability and death, it will be important to act on two levels - through population-wide measures to reduce exposure to risk factors such as tobacco use, and through interventions targeting individuals who already have NCDs or are at high risk for developing them. A wide range of health interventions is available for both purposes. One challenge is to assess which interventions will bring the most benefit for the lowest cost - in other words, what are the "best buys". A further challenge is to assess the cost of their scaled-up implementation.

The WHO tool aims to help countries make that assessment. It is a tool for financial planning (over the period 2011-2025) that can be used to forecast resource needs at national and sub-national levels. The tool can enhance traditional budgeting mechanisms in countries and provide new information to development agencies about the resources needed to tackle the growing burden of NCDs.

The tool has been used to produce a "price tag" for a combined set of population-based and individual level "best buy" NCD interventions that have been identified as priority actions by WHO. The average yearly cost for all low- and middle-income countries is estimated to be US$ 11.4 billion (an overall cost of US$ 170 billion over the period 2011-2025).

The cost per head of population is low. It represents an annual investment of under US$ 1 in low income countries, US$ 1.50 in lower middle-income countries; and US$ 3 in upper middle-income countries. Expressed as a proportion of current health spending, the cost of implementing such a package amounts to 4% in low-income countries, 2% in lower middle-income countries and less than 1% in upper middle-income countries.

Population-based best buy interventions address tobacco and harmful alcohol use, as well as unhealthy diet and physical inactivity in low- and middle-income countries. The cost for these approaches US$ 2 billion yearly. In low-income and lower middle-income countries, the median cost per head of population amounts to less than US$ 0.20 per year, while for upper-middle income countries the median value is close to US$ 0.50. These amounts represent less than 1% of total per capita spending on health. Individual-based best buy interventions are delivered in primary health care settings and include, for example, counselling and drug therapy for persons with or at high risk of cardiovascular disease, plus measures to prevent cervical cancer. For these interventions the cost averages more than US$ 10 billion yearly. Over the scale-up period 2011-2025, the annual cost per head of population falls below US$ 1 in low-income countries, less than US$ 1.50 in lower-middle income countries and averages US$ 2.50 in upper-middle income countries.

Note: It is important to mention that the tool used for this study required a number of data sources and assumptions to be made about which interventions are scaled up, at what pace and to what level of coverage. These may not coincide with a particular country’s intentions or health system capacities and not all countries will agree with the various assumptions used to develop the estimates of costs of the interventions package reported in this document. However, the tool has been developed in such a way that it can be used by country investigators to estimate costs based on their specific epidemiological, economic and political contexts as well as their policies and capacity of their national programmes in implementing the key prevention and control measures.

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