‘Health is an investment, not a cost’: 3 ways to expand NCD financing

Despite the looming threat of noncommunicable diseases, or NCDs, and their growing rates around the world, they remain vastly underfunded. While many organizations from both the public and private sectors have been working together to alleviate the burden, whether through new technology, projects, or research, they have struggled to achieve impact at scale.

“We know that despite the best intentions, a lot of the partnerships don't work out and may also not have had the impact that we wanted them to have,” said Marie Beille, director, population health, health care funding and financing at Roche Pharma. That needs to change, she added.

It is against this backdrop that 20 individuals from the private sector, multilateral organizations, intergovernmental forums, international NGOs, and finance institutions met on the sidelines of the World Health Assembly in Geneva on May 29 for a discussion co-hosted by Roche and Devex. The focus of the roundtable event titled Catalyzing change: NCD financing roadmap paving the way for sustainable health investments was to discuss the challenges of, and finding a path forward in, financing NCDs — one of the biggest causes of premature death globally.

As it stands, diseases such as heart disease, cancers, and diabetes kill approximately 41 million people annually, equating to 74% of all deaths. The majority of these are preventable and take place in low- and middle-income countries. More financing for health systems solutions could change that, roundtable attendees said. But how?

Here are three main takeaways from the discussion.

1. There is a need to reestablish political will

With over 50 countries holding an election in 2024 and another U.N. high-level meeting on the prevention and control of NCDs taking place next year, health financing should be prioritized at the political level, said attendees.

“We know that investment in health is an investment in societies and economic development, and yet we see a deprioritization of health globally,” said Tamara Schudel, vice president and head of global policy at Roche and a global ambassador for the G20 & G7 Health and Development Partnership.

"We also need to be better in conveying to policymakers and the public that the earlier you diagnose and treat diseases such as cancer, the further the investment goes and better the outcomes for patients and society,” Schudel said. “We need to continue demonstrating this with data, but also conveying in a meaningful way that resonates with decision-makers and the public.”

If there were more data available on the difference successful interventions can make and if people stopped talking in sector-specific jargon, that might change, attendees said. As it stands, there’s too much focus on the wording of certain health declarations, with organizations taking a disease-specific rather than an overall NCD approach, said Hatice Beton, executive director of the G20 & G7 Health Development Partnership.

“We are at a time where no one cares so much about health anymore,” she said, adding that there is even a fear the G20 finance ministers may abolish the health agenda from their working groups. “We fought so hard to establish that dialogue between health and finance ministers so we can change, find new financing models … But now we are at that tipping point where we could lose that momentum because we are getting too narrowed down on which wording we want for what.” More should be done to make it clear that health is an investment, not a cost, she added.

2. There is a need to set financial targets for NCDs

There are financial targets for other disease areas, such as HIV/AIDS and tuberculosis, that stipulate how much needs to be invested in the issue to provide adequate diagnosis, prevention, and treatment. Why not have this for NCDs? posited Alison Cox, policy and advocacy director of NCD Alliance. “Targets can be and have been impactful tools for accelerating action; it’s clear that what gets measured gets managed,” she said.

Historically, the community’s approach has been to talk about the need for more investment, but without specific details, said Cary Adams, CEO of the Union for International Cancer Control. “As a career banker for 24 years, if anyone comes into my bank and says ‘I want money,’ they're not going to get it,” he shared, adding that the sector needs to do its research and then push for a specific number backed with analysis on how the number was reached and what interventions the money will be spent on. This would help governments and private sector entities wanting to invest in tackling NCDs.

There is also a need to be able to find innovative ways of leveraging the kind of concessionary financing that's available at a bank, said one participant. The global financing facility Every Woman, Every Child, an instrument hosted at the World Bank, was highlighted as an example that has been used in a transformational way to leverage official development assistance resources across countries to the extent that maternal, newborn, and child health financing and priorities have become elevated to the top of the agenda. If we are going to take this issue seriously, we might begin to learn from such platforms, the participant added.

Yet one challenge in galvanizing more support, said Téa Collins, lead of the global NCD platform at the World Health Organization, is that it is difficult to attribute progress in NCDs to a specific public-private partnership, organization, or policy. “I think we need to have a good grasp of what each actor can realistically contribute to this, and then we will have improvement. … But we also need to live with the uncertainty of imperfect estimates,” she said.

3. There is a potentially unrealistic emphasis on domestic financing

Six years ago at the Global Dialogue on Partnerships for Sustainable Financing of NCD Prevention and Control in Denmark, there was a lot of focus on public-private partnerships and innovative financing mechanisms. Now the focus is on domestic resource mobilization and country-led processes with countries setting their own priorities and addressing their own disease burdens, attendees said. But domestic-funded initiatives across all countries could be far off given the sovereign debt position in LMICs, Adams said. As it stands, many are in a debt crisis, paying out more than they receive in grants and loans.

This is where the private sector has a role to play, providing immediate health financing support to countries as they work to tackle NCDs. For example in Nigeria in 2020, Roche launched a private-sector coalition which, with the support of the International Finance Corporation, led to the creation of the Nigerian Cancer Health Fund that provides standard of care cancer treatment to underprivileged populations.

Key recommendations

The importance of multipartner platforms emerged as a key theme during the discussion, with Access Accelerated — a collective of biopharmaceutical and life science companies — City Cancer Challenge — a multisectoral initiative supporting city-led solutions in the design, planning, and implementation of cancer treatment — and SCBF, a public-private platform funding local inclusive finance initiatives, cited as successful examples. By convening global resources and fostering collaboration between the private sector and local governments, such platforms can deliver concrete and measurable impact across health systems.

Looking ahead, participants said the health sector must create an NCD financing road map, setting out public and private stakeholders’ roles and recommendations — including tangible ideas — prior to the high-level meeting next year.

Some of those tangible ideas were presented at the roundtable. Adams, for example, suggested that the NCD community come together to fund work around “collective levers,” such as universal health coverage and tobacco control, which help a large proportion of people, rather than honing in on something specific such as diabetes that impacts a smaller number. “When we pull together and we put funding in, we can have a ripple effect with regard to the attention given to these specific areas in LMICs,” he said.

Beton talked of a debt-for-health swap for LMICs, which would involve extending a country’s sovereign debt with the condition it invests in health instead while several participants highlighted the need for national policies to be implemented in order to create a global stable regulatory environment where countries can trade and have flexible medicine supply chains. The G20 & G7 Health Development Partnership group is currently working on creating a legislators’ group on NCDs and drafting a model resolution so that there is also more accountability for initiatives. “Let's think outside of the box,” Beton urged.

Such ideas were submitted to WHO as part of their consultation process ahead of the International Dialogue on Sustainable Financing for NCDs and Mental Health taking place on June 20 and 21 and will be taken forward in future roundtable discussions and an upcoming content series on NCD financing, hosted by Devex and its partners. By convening key players, the aim is to identify and present concrete, innovative financing solutions that can be scaled, replicated, and provide input for upcoming high-level discussions on health financing.

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