Publication: Delivering Primary Care for Non-communicable Diseases: A Compendium of Service Delivery Models in Low and Middle-income Countries
Loading...
Files
520 downloads
238 downloads
123 downloads
Published
2025-06-13
ISSN
Date
2025-06-13
Author(s)
Editor(s)
Abstract
The global prevalence of noncommunicable diseases (NCDs) continues to escalate, leading to a substantial burden of disease. NCDs account for 74 percent of all global deaths, causing approximately 41 million fatalities annually, with cardiovascular diseases (CVDs), cancers, chronic respiratory diseases, and diabetes being the main contributors. Low- and middle-income countries (LMICs) bear a disproportionate share of this burden, experiencing around 82 percent of premature NCD-related deaths. Yet, many health systems in low- and middle-income countries are inadequately prepared to deliver comprehensive care for major NCDs, as primary health care (PHC) services mainly focus on the provision of acute and episodic care, leaving gaps in coverage and quality of essential services for the prevention, diagnosis, treatment, and long-term management of NCDs across the care continuum. While a broad range of cost-effective, equitable, and evidence-based interventions to address the growing burden of NCDs have been identified, the challenge lies in effectively delivering these interventions, particularly in health systems facing significant resource constraints. Integrating NCD care into primary health care (PHC) services is key to expanding access to care closer to communities, supporting health promotion and facilitating NCD prevention and control, and alleviating the burden of care at higher-level facilities. New strategies and innovative solutions are needed to achieve this approach and improve outcomes across the care continuum, from reducing risk factors to sustainably managing chronic conditions at the PHC level.
Link to Data Set
Citation
“World Bank. 2025. Delivering Primary Care for Non-communicable Diseases: A Compendium of Service Delivery Models in Low and Middle-income Countries. © World Bank. http://hdl.handle.net/10986/43336 License: CC BY-NC 3.0 IGO.”
Digital Object Identifier
Associated URLs
Associated content
Other publications in this report series
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Challenge of Non-Communicable Diseases and Road Traffic Injuries in Sub-Saharan Africa : An Overview(World Bank, Washington, DC, 2013-06)This report draws on a comprehensive review of the literature and on input from policy makers, researchers, and practitioners to address four questions: (1) how is the growing burden of non-communicable diseases (NCDs) and road traffic injuries (RTIs) changing the epidemiology of Sub-Saharan Africa? (2) What determines and drives this burden, and what are the commonalities with communicable diseases? (3) What is the rationale for public intervention? (4) How could resource-constrained governments approach NCD prevention and treatment and road safety in a comprehensive, effective and efficient way? The data show that action against NCDs and RTIs in Sub-Saharan Africa is needed, together with continued efforts to address communicable diseases and maternal and child health as well as to reach the Millennium Development Goals (MDGs). The report suggests that NCDs and RTIs should not be tackled separately as a vertical program, nor should they displace communicable diseases as priorities. Instead, given resource constraints, and some shared determinants, characteristics, and interventions, there is scope for an integrated approach focusing on functions (prevention, treatment, and care) rather than on disease categories. Examples are cited of potential opportunities to integrate and add NCD prevention and treatment into existing services and programs. Proven, cost-effective, prevention interventions are clearly needed, many of which (such as tobacco and alcohol taxes, road safety measures, and fuel-efficient ventilated cook-stoves) require action beyond the health sector. These can deliver broader development benefits in addition to their benefits for health. Selective, evidence-based actions to reduce NCDs and RTIs will address the changing disease burden in Africa and achieve a more sustainable improvement in health outcomes, more efficient use of resources, and better equity across patients and populations.Publication Effective Responses to Non-communicable Diseases : Embracing Action Beyond the Health Sector(World Bank, Washington, DC, 2011-09)Effective responses to non-communicable disease: Embracing action beyond the health sector focuses on solutions, indicating opportunities for the prevention and control of non-communicable diseases (NCDs) and the kinds of actions that will achieve it. NCDs exact a heavy toll on individuals and society. They cause disease, disability, and death, and reduce productivity which is vital for development. They also impose hefty costs on health services, particularly since NCDs frequently lead to ongoing disability and need for long-term care. Prevention that results in healthy aging and the reduction of morbidity is far more cost-effective and financially sustainable than treatment alone. A small number of proven prevention measures could stem the rise of the NCD epidemic. Data indicate the potential of affordable, potent, prevention tools focused on five key areas: tobacco, alcohol, diet, exercise and nutrition. Together, programs targeting these areas could reduce the burden of NCDs by more than half, while costing only a tiny fraction of current health spending. Since successful prevention involves multiple sectors and actors, countries will need to adopt a framework that clearly sets out the different levels of accountability of each role player. Such a framework will require strong national buy-in, but there are tools, examples, and support agencies available to facilitate this. Middle- and low-income countries can seize the opportunity and act now to tackle NCDs and the underlying risk factors of these diseases. If they do so, these countries will greatly increase their prospects of reaping the full benefits of their demographic dividend, and of ensuring sustained economic development, greater equality, and a better quality of life for their people in the years ahead.Publication Integrating Noncommunicable Disease Management into Primary Health Care(Washington, DC: World Bank, 2024-04-05)Non-communicable diseases (NCDs) are increasingly placing significant health and economic burdens on low- and middle-income countries (LMICs). Primary care serves as the initial point of contact for individuals seeking medical assistance and plays a pivotal role in promoting health, preventing diseases, and managing chronic conditions like cardiovascular diseases, diabetes, cancer, and respiratory illnesses. By embedding NCD services within primary health care (PHC) settings, individuals receive timely screening, diagnosis, treatment, and ongoing support, leading to improved health outcomes and reduced healthcare costs. The World Bank has significantly increased its investments in NCD management, particularly over the past decade. The aim of this report is to collate real-world examples showcasing the integration of best practices for managing NCDs within PHC systems. This anthology accompanies the NCD system assessment tool, which aims to support World Bank country teams to a rapidly (~3 months) assess gaps implementation of a set of best practices for NCD prevention and management. Specifically, the tool evaluates health systems against 43 best practices - practical policies, plans, programs or structures - recommended by global consensus panels or proven to be effective in meta-analyses, systematic reviews and Cochrane reviews. These best practices that make up the assessment tool are the foundation of the case studies in this anthology. Drawing on desk-based review of available data, peer-reviewed and grey literature, and a small set of key informant interviews, the cases in this anthology detail the successes, challenges, and lessons learned from the adoption of these best practices in diverse country contexts.Publication Non-Communicable Diseases in Jamaica(Washington, DC, 2012)Jamaica is a Caribbean country that has initiated comprehensive programs to address Non-Communicable Diseases (NCDs). The government created the National Health Fund (NHF) to reduce the cost of treatment of NCDs and finance some prevention programs. The main objective of this study is to learn from Jamaica's experience in tackling major NCDs and related risk factors, to provide policy options for Jamaica to improve its NCD programs and to share with other countries the lessons learned from its experience. The study attempts to answer three questions: a) whether the NHF and its drug subsidy program have reduced out-of-pocket spending on NCDs; b) whether access to treatment of NCDs has improved; and c) what the economic burden on NCD patients and their families is. The report presents an overall picture of the epidemiological and demographic transitions in Jamaica, its current burden of NCDs, and the change in the trend of NCDs in the past decade, using publicly available data, particularly data from the Jamaica living condition household surveys. It assesses the risk factors and analyzes Jamaica's response to NCDs with emphasis on the impact of the NHF on people's lives. Estimates of the economic burden of NCDs are provided and policy options to improve Jamaica's NCD programs are suggested. This study focuses on Jamaica's experience in addressing major NCDs and their related risk factors with the objective of learning from Jamaica and providing policy options to Jamaica to improve its programs.Publication The Economic Implications of Non-Communicable Disease for India(World Bank, Washington, DC, 2010-01)This report contributes to the literature on the economic implications of non-communicable disease (NCDs) in developing countries by focusing on the case of India. First, the authors examine available evidence on the economic impact of NCDs in India. Second, the authors present new estimates of impact of NCDs, both on household economic well being as well as on aggregate economic outcomes in India. India is a worthwhile case to study for many reasons, beginning with the large numbers involved. In the year 2004, an estimated 8.1 million Indians died from all causes. Based on WHO data on the distribution of deaths by cause, estimated deaths from non-communicable conditions (including injuries) amounted roughly to 4.8 million, or about 59.4 percent of all deaths in the year. Moreover, about 24 percent of these deaths from non-communicable conditions occurred in the 35-64 age groups as per data from medically certified deaths from hospitals located in urban areas of India. Available data also indicate that 34 percent of all injury-related deaths occurred among individuals in the 35-64 year age group. India's population is also ageing over time, an issue of concern given the higher incidence of NCDs in older age groups. All of these developments are occurring in a setting where health expenditures are growing rapidly led by an unregulated private sector and where health insurance and pension coverage are still limited. These financial concerns are further exacerbated by the emerging evidence that the India's poor are at heightened risk of acquiring NCDs owing to high rates of smoking and tobacco use, occupational risks, and residential living conditions.
Users also downloaded
Showing related downloaded files
Publication Comoros Country Climate and Development Report(Washington, DC: World Bank, 2025-06-18)The Union of the Comoros (The Comoros) has significant vulnerability to climate change-related risks but has considerable opportunities to strengthen preparedness and resilience against these challenges. According to the Notre Dame Global Adaptation Index, the Comoros is the 29th-most vulnerable country to climate change and the 163rd most ready to adapt (out of 191). The Comoros archipelago is exposed to many natural hazards that adversely affect the country’s natural capital, people, and physical infrastructure. In 2014, the economic cost of climate-related disasters was estimated at 5.7 million dollars annually, equivalent to 9.2 percent of Gross Domestic Product (GDP). Between 2018 and 2023, as many as 11 tropical depressions or cyclones impacted the country, with Cyclone Kenneth causing the greatest damage, equivalent to 14 percent of GDP, resulting in total economic growth falling from 3.6 percent in 2018 to 1.9 percent in 2019. More than 345,000 people (40 percent of the population) were affected by the cyclone, with 185,000 people experiencing severe impacts and 12,000 people displaced. However, there is an opportunity for the country to grow more robust and shock-responsive, and to establish pre-positioned funding mechanisms to enhance future crisis response efforts. For the Comoros, adaptation and climate-resilient development are the key climate change focus areas, with the country projected to face 836 million dollars 2050 in additional costs due to climate-related impacts. Current plans to adapt to the impacts of climate change in the Comoros include efforts to improve water management, strengthen coastal protection, and develop climate-smart agriculture practices. Given the country’s reliance on its natural resource base for economic growth and mobility, protection of these resources from climate change will be essential for promoting resilient growth and development. In addition to growing the adaptive capacity of the country’s natural resource sectors, strategic economic diversification will be important to help minimize future climate impacts, and development activities will need to be undertaken in such a way as to attract low-carbon co-benefits. The Union of the Comoros is committed to addressing climate change through its Nationally Determined Contribution (NDC) and national priorities. The country’s NDC (which was revised in 2021 for a ten-year horizon) sets ambitious targets, with a goal of reducing greenhouse gas emissions by 23 percent by 2030. The country also plans to significantly increase the share of renewable energy in its energy portfolio, reaching 33 MW by 2030. This will not only promote low-carbon development but also reduce the country’s dependency on imported oil and coal, which currently make up 95 percent of the energy mix. Additionally, the Comoros has declared its intention to increase CO2 removals by 47 percent by 2030, compared to BAU.Publication Kyrgyz Republic Country Climate and Development Report(Washington, DC: World Bank, 2025-11-03)This Country Climate and Development Report (CCDR) on the Kyrgyz Republic aims to support the country’s development goals amid a changing climate. The CCDR considers two policy scenarios up to 2050: the business-as-usual (BAU) and high-growth scenarios. As it quantifies the likely impacts of climate change on the Kyrgyz economy between now and 2050, the report highlights key government actions to best prepare for and adapt to climate impacts (referred to as “with adaptation” measures), with a particular focus on the time horizon up to 2030. The CCDR also outlines a path to net zero emissions by 2050 (referred to as “with mitigation” measures, “decarbonization,” or, simply, “net zero 2050”), highlighting associated development co-benefits.Publication Gabon Country Climate and Development Report(Washington, DC: World Bank, 2025-11-01)Gabon has a unique opportunity to drive inclusive growth, reduce poverty, and build a resilient post-oil economy, with climate action accelerating progress toward these goals. The country’s main development challenge is achieving higher growth and poverty reduction, as stronger growth is needed regardless of projected climate shocks to create jobs, raise living standards, and enable a viable post-oil economy. While pursuing growth-promoting economic reforms, climate action that prioritizes people must remain central to its development pathway. However, climate change risks exacerbating poverty and regional inequalities in a country already facing long-term challenges in expanding economic opportunities and basic public services, especially in rural areas. Climate shifts compound these challenges, making stronger private sector-led growth driven by reforms essential for resilience, diversification, job creation, and poverty reduction, though targeted investments in adaptation will still be required to mitigate climate shocks. Using a whole-of-economy approach, the Gabon Country Climate Development Report (CCDR) estimates that climate change impacts could result in GDP losses of 3.5 to 5.3 percent per year through 2050 compared to a business-as-usual baseline trajectory.Publication Tajikistan Country Climate and Development Report(Washington, DC: World Bank, 2025-03-28)The Tajikistan Country Climate and Development Report (CCDR) explores the impact of climate change and global decarbonization on Tajikistan’s development. It identifies key areas to enhance climate resilience and deepen decarbonization and outlines priority recommendations for a successful green transition in Tajikistan, requiring structural reforms, climate-conscious policies, and inclusive strategies for a resilient and sustainable future. Despite economic growth and poverty reduction over the past two decades, Tajikistan's reliance on natural resources and remittances has led to unsustainable development, depleting natural capital and limiting job creation. The government’s green transition plan focuses on renewable energy, promising energy security, economic growth, and regional electricity exports. However, further efforts are needed for a resilient development path, including a complementary reform program to bring significant economic benefits, climate adaptation, and low-carbon development that will benefit Tajikistan and Central Asia's electricity systems. Climate change poses significant risks, threatening water security, agricultural productivity, and infrastructure, potentially reducing GDP per capita by 5-6% by mid-century and pushing 100,000 people into poverty. Additional adaptation measures are crucial, focusing on water management, resilient landscapes, climate-smart agriculture, and disaster risk management. A low-carbon development pathway offers a more resilient and prosperous future, with near net-zero emissions in energy and waste sectors by 2050, boosting economic growth, and job creation and reducing air pollution. Achieving these goals requires substantial investments and institutional reforms to mobilize private capital and attract green foreign investment. Development partners can provide financial assistance, technical expertise, and capacity building.Publication Jobs in a Changing Climate: Insights from World Bank Group Country Climate and Development Reports Covering 93 Economies(Washington, DC: World Bank, 2025-11-05)The World Bank Group’s Country Climate and Development Reports (CCDRs) provide a crosscutting look at how countries’ development prospects, and the job opportunities they offer to their people, can be threatened by climate impacts and supported by climate policies. Climate change and policies affect jobs through impacts on productivity, energy and material efficiency, and physical, human, and natural capital. They can also transform employment opportunities, especially through complementary measures that help workers and firms adapt to and benefit from new technologies and production practices. Prepared by the World Bank, the International Finance Corporation (IFC), and the Multilateral Investment Guarantee Agency (MIGA), CCDRs integrate country perspectives, climate science and economic modeling, private sector information, and policy analysis to assess how countries can successfully grow and develop their economies and create jobs despite increasing climate risks and while achieving their climate objectives and commitments. Each CCDR starts from the country’s development priorities, opportunities, and challenges, and is developed in close consultation with governments, businesses, and civil society, ensuring the recommendations reflect national priorities. By combining evidence on adaptation, resilience, and emissions pathways, CCDRs highlight where climate action can reinforce development and job creation, and where targeted policies are needed to manage risks and smooth labor market transitions. Taken together, these elements can help create local jobs, ensure economic transitions are just and inclusive, and equip workers and firms to navigate the disruptions and opportunities of a changing climate and changing technologies.