Aligning Policy Options with Burden and Capacity

Policy options in some key areas will vary among countries depending on country capacity and burden.For this, understanding the relationship between the country-level noncommunicable disease (NCD) burden and country health system capacity is useful for tailoring the policy options developed from this framework and prioritizing efforts that align with country capacity.

Thus, a general estimate of countrylevel burden and capacity and a map of their relationship was developed (Box A4.1). Using this capacity index score and mapping it with the percentage of the total country burden due to NCDs (in forgone disability-adjusted life
years [DALYs]), a generally increasing capacity with increasing NCD burdens is seen as a distribution, relative to South Asia, of countries from lower burden/capacity to higher burden and higher capacity).

Box A4.1 Mapping the relationship between burden and capacity

For country-level NCD health burdens across the region, we use the share of the total forgone DALYs that are lost to NCDs from Chapter 2 of the main text. Generating a simple, comparable, and internally consistent index of capacity is more difficult than a burden index.

Here we use a composite index that measures two capacity aspects. First is a measure of the level of resources available in the sector as reflected by the proportion of total expenditures on health from public sources.

The second is a measure of how well these resources are generally used for which we used two standardized indicators of global governance: government effectiveness in delivering all services, and regulatory quality for all sectors. These latter two measures of governance, along

with other governance indicators, were developed a decade ago and since then have been used globally to track country-level governance (Kaufmann 1999 and 2008).

For South Asian countries, between five and sources from four types of respondents (business, household surveys, nongovernmental organizations, and public sector data providers) are aggregated to estimate country-level performance on a comparable scale. The logic behind the first capacity measure is that the extent to which many of the policies, strategies, and

actions that will be carried out by the government will have to be commensurate with the level of public resources available for the health sector and its fiscal space.

Thus, in principle, within South Asia the more public spending on health the better the country is resourced for taking on more actions related to NCD prevention and control. However, governments may have a high share of total health spending but that is poorly spent due to different factors such as weak institutional capacity and corruption.

Since we could not find an internationally recognized measure that reflects these aspects for the health sector in the region, we opted for the broader governance indicator that reflects the government’s effectiveness and quality of regulation as a proxy for the health sector. This will potentially enable the public sector to be effective in providing services, regulatory efforts, and other activities relevant to NCDs.