Guiding Principles for Regional Collaboration(cont...)

Guiding principles developed by the World Bank (Development Committee 2007) established the following criteria where global collaboration should be considered:

(i) there should be an emergent consensus in the international community that global action is required;

(ii) there should be an institutional gap that international agencies could help fill to encourage global action;

(iii) international agencies should have the requisite capabilities and resources to be effective;

(iv) global action by international agencies could catalyze other resources. Governments in South Asia could use these principles to decide what activities they want to pursue regionally. Some of the very practical factors (such as which international agency is willing to take the lead in developing an agenda) may direct the focus on and resolution of a specific issues. Assuming that there is consensus, capacity, resources, and feasibility (see Common Challenges for Tackling NCDs in Chapter 5),

Three types of situation can justify a regional approach.

1) It is when positive or negative externalities may occur. Examples of the former

are knowledge management for addressing NCDs that leads to better prevention and control policy resulting in lower NCDs burdens; the latter might include smuggling and inconsistent tobacco taxation among countries with common borders such that exposure to tobacco increases secondary to the tax policy.

2) The second is when there are economies of scale and scope in working regionally. For example, this may occur when the marginal cost of supplying the good to multiple countries in the region is negligible.Group purchasing is an especially relevant issue for small countries, which do not have the purchasing power of larger nations. Also, in South Asia, a few countries (mainly Bangladesh and India where the pharmaceutical industry is rapidly developing) may be well positioned to supply the good and could do it more efficiently through regional agreements.

3) The third type of situation is when the production (or prevention) of a good is more effective if all countries participate, including collective bargaining for group purchase of drugs, food labeling, tobacco labeling, comparative effectiveness studies, and research. An example is food labeling and regulated contents of processed foods where it may be less costly for industry to have a uniform approach to the entire region than to label and process a product differently for each country (Roos et al. 2002).

Using the above guiding principles, the following potential areas for collaboration within the region are outlined. Some of these regional strategies are specific to NCD risk factors; others are broader and affect the health system as a whole, yet are critical to strengthening the overall NCD response. A rationale for each strategy is also presented.