Introducing the Policy Options Framework(cont...)

Table 5.1 Policy options framework for prevention and control of NCDs

Source: Authors’ conclusions. The above is a guide to focus policy discussion and actions in key areas. The context of the setting will dictate final options and decisions.

The rationale and activities for each program management stage are as follows.

Access stage

At the Assess stage information is collected that will facilitate efficient and effective planning and preparation, and help strategically target actions and prevention and control efforts.

plan stage

The Plan stage entails analyzing information collected from assessments, engaging key stakeholders for prevention from inside and outside the health sector (e.g., transportation, agriculture, commerce, urban planners, and business leaders) for treatment in both public and private sectors.

NCD stakeholders extend from government and ministries of health to private sector providers, from individuals to communities, nongovernmental organizations (NGOs), health care providers, academia, and donor partners. Consensus and ownership are all needed for plans to be widely advocated, adopted, financed, and eventually institutionalized.

Develop and Implement stage

The Develop and Implement stage is where broad implementation of prevention policies and scaling up clinical interventions strain all health sectors and, potentially, non-health sectors. Developed-country experiences provide some grounding. However, major revamps, and in many cases innovation, will be needed to develop effective policies for both individual- and population-based health promotion in developing countries. Currently, in terms of clinical services, only a few care delivery models exist and their effectiveness remains unclear.

Health services delivery will need retooling, clinical quality assessment procedures require development and implementation, and drug policies need to assure quality, availability, and affordability of essential medications. Other major challenges in the Develop and Implement stage are human resources and financing population-based policies as well as clinical prevention and treatment services.

These measures can impose a substantial cost burden on governments. The importance of the Evaluate stage becomes clear when one understands that countries are currently spending substantial resources on NCDs, especially on individual-based treatment. As capacity rises,

programs launch, and investments grow, evaluating progress at all levels is essential to assure that goals are reached.

For NCDs, the track record is short, experience is limited, but some new initiatives have

already been launched or are being planned. Decision makers will greatly benefit from evaluating

progress and health systems performance as utilization patterns evolve in the future.

For some stages, such as Assess and Plan, the framework will produce country-level policy options and actions, as well as strategies, which will be similar for each country across the region.

However, Develop and Implement and Evaluate will tend to be more country-specific, depending on the burden and capacity. Some important elements may lie beyond the capacity of a country acting alone and are not feasible at the country level, such as efforts in comparative effectiveness assessments for new service delivery interventions. Big-country lifestyle messages and food and tobacco policies, such as those emanating from India, can have a large influence on small countries, also suggesting regional approaches for some elements. Chapter 7 explores when regional strategies may be a feasible alternative.