How to Respond (cont...)

The framework was used as a basis to assess country capacity and achievements in program implementation for NCDs that are necessary to formulate and implement policy options. Rather than a comprehensive assessment, the focus was on finding strengths that might be enhanced and deficits that could be addressed. Inevitably, gaps in progress were revealed. In the Assess stage, surveillance andburden assessments are receiving generally low levels of efforts and no country is reviewing the evidence base.

* In the Plan stage, some countries have NCD cells and national overarching policies.

* In the Develop and Implement stage, some countries have policies and measures in place, but often their implementation and enforcement has been slow or stalled. For community-based interventions, activity is evident in all countries but efforts and the adoption of explicit policies, especially those for tobacco, are highly variable. For individual-based interventions, less progress is evident.

* In the Evaluate stage, the least progress was noted with little commitment directed in this area.

Country-level policy options align with the needs and the capacity and accomplishments made by each country. There were areas where countries are struggling with common issues including developing surveillance systems and assessing the evidence base for interventions.

Developing Regional Strategies

Harmonizing health policies and strategies at a regional level enhances NCD prevention and control efforts, especially for tobacco and food. Indeed, failure to harmonize on tobacco may cause harm,because the tobacco industry tends to target its marketing efforts at countries with fewer restrictions,and where tobacco is taxed less and is easier to buy. Marketing from countries with fewer restrictions can therefore penetrate into countries with more restrictive policies. Also, countries with low cigarette prices relative to their neighbors increase the incidence of smuggling.

Three types of situations may benefit from cross-country or regional collaboration:

1) when such collaboration generates positive or negative externalities.
2) when it secures economies of scale and scope.
3) when it renders far more effective the production (or prevention) of a good.

On the basis of some guiding principles for regional collaboration, rationales for a regional approach for various areas were identified. Some policy options and actions are specific for risk factors, while some strategies are broader and target the wider health system, yet are critical to strengthening the overall NCD response.