Rethinking NCD and mental health financing for equity and impact

Noncommunicable diseases, or NCDs, account for 75% of nonpandemic-related deaths globally — even though an estimated 80% of these are preventable. Despite this alarming discrepancy, NCDs only receive between 1%-2% of global health funding — a juxtaposition that’s becoming increasingly difficult to ignore. And, with the economic toll of NCDs alone projected to exceed $47 trillion by 2030, action is desperately needed.

While a political declaration emphasizing integrated care and robust primary health systems failed to reach a final vote following the Fourth high-level meeting of the United Nations General Assembly on NCDs and mental health, or HLM4, it is expected to pass a vote in the General Assembly in the coming weeks. But translating words into action hasn’t come easy in the long fight to combat NCDs.

“We need the mindset to change so that governments really view health as an investment and not a cost,” Dr. Pamela Cipriano, co-chair of the UHC2030 Steering Committee, told Devex on the sidelines of the 80th U.N. General Assembly, or UNGA80.

Cipriano was among a group of influential policymakers, health leaders, donors, civil society, and private sector players that participated in an extensive workshop hosted by Devex in partnership with Boehringer Ingelheim, Access Accelerated, and AstraZeneca on the sidelines of UNGA80.

The session, a fitting capstone to Devex’s Accelerating Action series on financing the future of NCD prevention and control, explored how stakeholders can move from commitments to sustainable impact by rethinking NCD and mental health financing strategies for resilience, equity, and impact.

Mobilizing domestic resources for sustainable financing

One of the resounding messages from the workshop was that domestic financing must take center stage. With donor budgets stretched — or being cut — and a slew of global health priorities competing for attention and resources, governments will need to expand fiscal space for NCDs and mental health.

Health taxes, such as those on tobacco and alcohol, have proven successful in both discouraging harmful consumption and raising revenue. More recently, several countries have expanded this approach to levies on sugary beverages.

Dr. Mary-Ann Etiebet, president and CEO of Vital Strategies, noted that in South Africa, one such levy generated over $300 million to support health systems while also reducing sugar consumption by nearly 30%. “This is a new generation that’s growing up … to be at less risk for NCDs, [and] they're going to live longer and healthier lives,” she said.

Participants noted that these measures are most effective when directly linked to health insurance schemes or earmarked for NCD prevention. Indonesia’s combination of a tax-based insurance system covering nearly its entire population and increased health-specific taxation was cited as a promising example.

But raising revenue is only half the equation. Workshop participants noted that spending resources effectively — prioritizing “best buys” such as prevention and diagnostics — is essential not only to secure funding but to help sustain it in the long term.

From there, political will and even healthy regional competition are what some believe could be game-changing factors, if efforts are not taken in isolation. Participants discussed how peer pressure among neighboring countries in regions such as Southeast Asia and Latin America, has spurred reforms and increased commitments to sustainable development.

“We need coalitions. We need to learn from our neighbors and from one another. We need healthy competition,” Amanda Folsom, managing director of Results for Development, said in summation of her workshop group’s discussion on mobilizing domestic resources. “It’s not enough to just implement well — it’s ensuring everyone buys in.”

Breaking silos through integrated primary care

Another main theme that emerged from the session was the need to move away from vertical, disease-specific programs and toward integrated approaches rooted in primary health care. Often — and especially for low- and middle-income countries, or LMICs — this means designing financing models that strengthen existing health platforms rather than creating parallel structures.

At the community level, participants emphasized the need for unified protocols for health workers and the expanded use of task-shifting — enabling frontline staff to take on a broader range of responsibilities. Digital tools, including telemedicine and AI, can help triage patients and extend reach, but must be paired with adequate training and resourcing.

For example, panelists highlighted the Alliance for Primary Healthcare in the Americas for providing efficient yet effective care to indigenous populations in Latin America and the Caribbean. “Instead of building a hospital or health care facility in an urban area, we encourage governments to focus on those populations that are very hard to reach,” Dr. Rhonda Sealey-Thomas, assistant director at the Pan American Health Organization, or PAHO, said, referring to the initiative. “It may not be building a health center in the Andes, but providing telemedicine, for example, that can reach millions of people who would not have been able to access that care before.”

Breaking silos also means engaging beyond the health sector. Involving associated ministries (such as agriculture), education systems, and local businesses can expand both funding sources and implementation capacity. And business leaders at the workshop argued that companies have a vested interest in healthier workforces and should be active partners in financing solutions.

Innovative models and partnerships that scale

The workshop also highlighted the potential of innovative financing mechanisms and multisectoral partnerships to bridge gaps in funding.

Participants pointed to a range of tools, including debt swaps, which have previously been deployed in the fight against HIV and tuberculosis, as well as results-based financing models that tie funding to measurable outcomes. While these approaches are not new, their application to NCDs and mental health has been limited.

But scaling up will require thinking bigger, which could involve a more aggressive “entrepreneurial approach to health care,” as Pradeep Kakkattil, CEO of the Health Innovation Exchange, said. “You need to be creating more jobs,” he said. ​“You need to be investing in creating structures and capacities that continue beyond the [initial] project.”

Partnerships were repeatedly cited as being indispensable to financing and delivering solutions at scale. Participants noted that, while governments often need to lead efforts, the private sector, civil society, and multilateral institutions all bring valuable resources and expertise.

“It's really about getting away from just pure donorship to co-creation [and] collaboration,” Serge De Ruysscher, the global lead of public and government affairs at Boehringer Ingelheim, said. “We need to align all acting partners on shared objectives and priorities.”

For that alignment to succeed, engagement must extend beyond ministries of health. By involving other subsets of government — such as ministries of finance and foreign affairs — from the outset, stakeholders can help secure domestic resources and embed health commitments in national budgets.

As PAHO’s Sealey-Thomas noted, it is essential to “[translate] those commitments into language and legal-based instruments that ministers of finance can actually understand,” bridging the gap between health ambitions and financial realities. Cipriano reinforced this point: NCD financing is ultimately a “collective all-of-government and all-of-society effort” — one that requires not only public-private partnerships, but also broad public buy-in to shift systems “from being ‘illness systems’ to ‘health systems.’”

She also pointed to the importance of building creative coalitions — “financing schemes that bring together partnerships; likely partnerships and maybe unlikely partnerships,” underscoring the need for new configurations that can unlock resources and political support.

“Partnerships really matter — stable, long-term partnerships that countries can really count on to support learning, and that’s where public-private partnerships play a fantastic role,” Kimberly Green, global program leader of primary health care at PATH, said. “They can bring forward catalytic ideas, experimentation, new learning through strong partnership with governments and with communities on trialing something on a small scale … building in those early learnings, and applying them incrementally toward scale.”

The political declaration on NCDs and mental health, expected to be passed later this month, will only mark the first step in addressing the growing burden. Turning its commitments into real impact will require countries to expand domestic financing, strengthen integrated primary health care, prioritize interventions that deliver results, and look to innovative, cross-sector, and long-term partnerships. The work begins now — and success will depend on how quickly stakeholders can act together.

Watch the key takeaways here.

Visit Accelerating Action — a series highlighting pathways for funding NCD prevention and control, spotlighting innovative financing models and cross-sector collaborations.

This content is sponsored by Boehringer Ingelheim as part of our Accelerating Action series. To learn more about this series, click here.