By Adaudo Anyiam-Osigwe, Leah Ewald, and Maria Jose Pastor
The 4th Global NCD Alliance Forum (February 13-15, Kigali, Rwanda) took place just weeks after the widespread cancellation of U.S. foreign assistance to many low- and middle-income countries (LMICs). Among the community of experts, civil society, and government officials who convened in Kigali, voices of those directly impacted by noncommunicable diseases (NCDs), including cardiovascular disease, diabetes, and cancer, rang out urgently. They shared firsthand accounts of people unable to access lifesaving treatment—either due to prohibitive costs or lack of availability in their countries. Individuals spoke of loved ones forced to travel across the continent to seek treatment, far from their community and support networks, in search of critical expertise and care, often at devastating financial costs.
Finding solutions to finance quality NCD prevention, treatment, and care was a central and pressing point of discussion. While was recognition no single solution or "silver bullet" exists for this complex global challenge, one message was clear: NCDs won't wait for a perfect solution. Progress in health financing requires a hands-on approach: being on the ground, learning from other countries, adapting those lessons to fit local contexts, and taking decisive action.
Each year, around 41 million people die from NCDs, with the majority occurring in LMICs. The increasing burden of NCDs in these countries, particularly in Africa, has heightened pressure on fragile health systems that are already under-resourced to address the double burden of infectious diseases and NCDs. Financially, the costs are staggering: between 2011 and 2030, NCDs are projected to result in a $21.3 trillion[1] loss of economic output, accounting for 26% of total health spending. Countries like South Africa dedicate over half of their health budgets to NCDs, while families often bear more than 60% of these costs out of pocket, driving many deeper into poverty[2]. Tackling this dual health challenge is key to advancing global health equity.
Strengthening Health Financing Systems
Strengthening health financing systems is essential to addressing the financial challenges of NCDs. There is no universal answer—effective responses must be tailored to each country's unique context. However, innovative, locally relevant solutions are emerging, informed by the experiences of those working on the front lines of NCD care. A critical aspect of this effort involves rethinking how resources are mobilized and allocated. Effective health financing strategies include increasing resource generation, reducing fragmentation in funding streams, improving coverage and payments for NCD prevention and care, and enhancing governance, monitoring, and accountability in the distribution and utilization of resources. By strengthening these mechanisms , countries can ensure that funding reaches the most needed areas, making healthcare more accessible and financially sustainable.
Promising Financing Solutions for NCDs in Sub-Saharan Africa
NCD financing was one of three major themes at this year’s Global NCD Alliance Forum, reflecting the widespread global interest in addressing this issue. Two key sessions highlighted the urgent need for sustainable NCD financing in LMICs, showcasing promising strategies that are already making an impact.
The Financing Accelerator Network for NCDs (FAN) led a regional convening focused on a Sub-Saharan Regional Dialogue on NCD Financing, hosted by the African Institute for Development Policy (AFIDEP) and Results for Development (R4D). This event brought together government officials, global health experts, and key stakeholders working on NCDs, Universal Health Coverage, and Primary Health Care (PHC). Participants represented 11 countries and 29 organizations, fostering practical discussions on key challenges, successes, and priorities in the region.
A solution-focused session led by Access Accelerated, in collaboration with the World Bank, R4D, and AFIDEP, highlighted practical, scalable solutions being implemented across the region. Both sessions fostered learning, knowledge exchange, and solutions as countries shared their success stories regarding promising and sustainable NCD financing.
Kenya: Investment Cases for Diabetes and Hypertension
In Kenya, investment cases for diabetes and hypertension, developed by the World Diabetes Foundation in collaboration with the Ministry of Health, have played a crucial role in shaping policy and funding decisions. By presenting data-driven evidence on the economic and health benefits of early intervention and improved management of these conditions–and continuously engaging with policymakers- Kenya has been able to advocate for increased domestic financing and donor support. These investment cases not only highlight the cost-effectiveness of targeted NCD interventions but also help governments and stakeholders prioritize funding in a resource-constrained environment.
Uganda: Public-Private Partnerships Driving Change
Uganda is harnessing the power of public-private partnerships to expand access to NCD services. By bringing together government agencies, the private sector, and development partners, Uganda is creating sustainable financing models that improve service delivery. These partnerships have led to the integration of NCD services into primary healthcare, ensuring broader access to essential medicines and diagnostic tools. Notably, the government has established a dedicated NCD department within the Ministry of Health, which has improved funding and policymaking to tackle NCDs more effectively. Public-private collaborations, such as those with the Busoga Health Forum, have facilitated community outreach, research, and advocacy. Additionally, Uganda has developed national policies that promote PPPs in health, leveraging private sector resources and expertise to address service delivery gaps and enhance healthcare infrastructure. These efforts are helping to close critical health system gaps, ultimately expanding access to NCD prevention and treatment services across more communities.
Kenya and Ghana: Improving Resource Allocation Transparency
Kenya and Ghana are leading the way with the NCD Navigator, an innovative tool designed to improve the tracking, coordination, and financing of NCD programs with PATH’s ongoing technical support. This platform supports governments, donors, and implementing partners align their efforts by providing real-time data on funding flows, service delivery gaps, and program impact. By improving transparency and efficiency in resource allocation, the NCD Navigator is supporting countries to optimize their financing strategies and ensure that investments are directed where they are needed most.
Kenya: Investing in Primary Health Care for NCDs
Kenya has undertaken significant health financing reforms, particularly in strengthening PHC as a sustainable strategy for tackling NCDs. The country's PHC Fund aims to integrate NCD care into existing health service delivery, ensuring that communities have access to essential services at the lowest levels of care. This model emphasizes efficiency gains—pooling resources to optimize costs and integrating NCD care into a broader health package to reduce the overall financial burden on the health system. The Fund also co-funds stipends for the community health workers that form the backbone of the health system.
Additionally, Kenya has leveraged health taxes on unhealthy products such as alcohol and tobacco to generate funds for health initiatives. However, stakeholders at the symposium raised concerns about whether these revenues are adequately earmarked for NCD prevention and control, highlighting the need for more transparent allocation mechanisms.
Rwanda: Strengthening Health Systems Through Data-Driven Decision-Making
Rwanda has made significant investments in digitization; however, in 2023, only 10% of the data collected daily was utilized. To address this, the country established the Rwanda Health Intelligence Center to analyze data and inform decision-making on healthcare expenditures. A key priority is aligning expenditures with disease burden, leading to the recent inclusion of cervical and breast cancer in community-based insurance. Additionally, PHC is beginning to implement capitation-based payments.
Call to Action
These examples showcase diverse and promising strategies being implemented across Sub-Saharan Africa to finance and enhance NCD care. During the sessions in Kigali, key discussion focused on the following critical priorities to advance effective NCD financing:
- Data and Evidence for Decision-Making: Creating investment cases, optimizing resource allocation, tracking funds, and incorporating user feedback to ensure informed decisions.
- Strong and Meaningful Stakeholder Engagement: Sustainable solutions require active involvement from all sectors, including communities, governments, and the private sector.
- Coordinated Pooling or Consolidation of Financing: Efficiently consolidating and streamlining funding sources to maximize resources.
- Leadership: Strong leadership at all levels—including government, private sector, and community—is crucial to maintaining accountability for outcomes.
Shaping the Future of Health: FAN’s Innovative Approach to NCD Financing
The 4th NCD Alliance Forum highlighted financing success stories from countries committed to addressing one of the greatest challenges in health. Stories highlighting promising solutions, while facing a few critical challenges could be surmountable with collective knowledge sharing and problem solving. To build on these successes, countries urgently need platforms and opportunities to share knowledge, try new approaches, and come together with their regional communities of policymakers, experts, civil society advocates, and other stakeholders. By working together, countries can identify promising practices, problem solve, adapt solutions to local contexts, and learn.
The FAN, a new initiative launched by Access Accelerated and the World Bank in collaboration with R4D, aims to support governments and implementers through regional NCD Financing Accelerators – the first launched in Sub-Saharan Africa with AFIDEP as host, facilitating cross-country learning, providing catalytic seed funding, and developing evidence-based strategies to support countries advance sustainable financing for NCDs. The efforts of FAN underscore the importance of localized collaboration in addressing these complex issues. This model offers a strong foundation for building resilient health financing systems that can adapt to global health and economic challenges. Through strategic partnerships with governments and stakeholders in LMICs, FAN is dedicated to strengthening sustainable NCD financing mechanisms for long-term, practical solutions.
Interested in joining FAN as a partner or country member? Contact the FAN team at info@ncdfinancing.org.
[1] WHO. Global Health Observatory. Noncommunicable diseases: Mortality
[2] Stenberg K et al. (2019). Guide posts for investment in primary health care and projected resource needs in 67 low and middle-income countries: a modelling study. Lancet Global Health, 1500 - 10.