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PBPA2014-2015 (April 2016) 1 PA: 2.1 Noncommunicable Diseases

Programme budget 2014–2015 performance assessment

Programme area: 2.1 Noncommunicable diseases

OUTCOME 2.1. INCREASED ACCESS TO INTERVENTIONS TO PREVENT AND MANAGE NONCOMMUNICABLE DISEASES AND THEIR RISK FACTORS

I. OVERVIEW OF MAJOR ACHIEVEMENTS AND CHALLENGES 2.1.1 Multisectoral action Development of multisectoral plans and policies, and setting national targets, are two of the four time-bound commitments made by Heads of State and Government at the United Nations General Assembly in 2011, and in the 2014 High-Level Political Declaration on Noncommunicable Diseases. During the biennium, WHO reviewed and published international experience and successful approaches for multisectoral action in the Global status report on noncommunicable diseases 2014, and provided practical toolkits and technical support for Member States to develop and implement national action plans and national monitoring frameworks in line with the global and regional action plans and frameworks. WHO also contributed to raising the profile of noncommunicable diseases in the development agenda, facilitating national multisectoral action and coordinating the efforts of United Nations agencies with the support of the United Nations Interagency Task Force on the Prevention and Control of noncommunicable diseases and the Global Coordinating Mechanism on the Prevention and Control of Noncommunicable Diseases (GCM/NCD), through a “One WHO” integrated support approach to countries and to specific technical areas such as tobacco, physical activity, salt reduction and noncommunicable diseases management. This approach has facilitated the implementation of a set of cost-effective prevention and management interventions, improving health information on noncommunicable diseases and capacity-building. A WHO Framework for country action across sectors for health and health equity was approved at the Sixty-eighth World Health Assembly. Efforts have also continued to concentrate on advocating high-level political commitment to the prevention and control of noncommunicable diseases and integrating them into the agendas of global governing bodies of United Nations agencies and global health initiatives, including through the dialogues under the GCM/NCD and through the initiation and implementation plan for the 9th Global Conference on Health Promotion. Health promotion and Health in All Policies In the Regional Office for Africa, eight countries (Cameroon, Democratic Republic of the Congo, Ethiopia, Gambia, Mali, Mauritius, Nigeria and Zimbabwe) were supported to plan and conduct the global school-based student health survey and the global school-based health programmes and policies survey. A regional action plan – Oral Health: Action Plan for Promotion and Integrated Disease Prevention – has been developed in consultation with Member States and stakeholders. In the Regional Office for the Americas, in the Caribbean subregion, a forum of stakeholders was held to reignite the political commitment to noncommunicable diseases. An Inter-American Task Force on noncommunicable diseases has been developed to harness and leverage the resources and technical expertise for a multisectoral response to noncommunicable diseases, with agencies of the inter-American system. In the Regional Office for the Eastern Mediterranean, high-level advocacy was carried out throughout 2015 at various forums, including the 62nd session of the Regional Committee for the Eastern Mediterranean in October 2015, which viewed collaboration across sectors outside health, as well as collaboration between government and non-State actors, as key to the development of national strategies or plans and to the attainment of national targets. While 40% countries have developed a national multisectoral strategy or action plan for noncommunicable diseases (Iraq, Islamic Republic of Iran, Lebanon, Morocco, Oman, Qatar, Saudi Arabia, Sudan and the United Arab Emirates), only six countries (Iraq, Islamic Republic of Iran, Qatar, Saudi Arabia, Sudan and the United Arab Emirates) have set targets for 2025 based on WHO guidance. In the Regional Office for Europe, countries have established multisectoral mechanisms to discuss the potential contributions of each sector and have included noncommunicable diseases-specific indicators in their monitoring frameworks to assess progress on noncommunicable diseases control not only as a factor improving the health of the population (by health promotion, reducing risk factors and delaying or limiting premature mortality) but also as a development factor that recognizes health as human capital and the investment of the health sector in the economy.


The development of the multisectoral process has been carried out at high levels of national governments, and opportunities to discuss other aspects of Health in All Policies and the WHO Health 2020 policy frameworks have been used to catalyse synergies between agencies. In the Regional Office for South-East Asia, countries are making progress towards highlighting noncommunicable diseases in the development agenda and mobilizing multisectoral partnerships. Numerous consultations have been held at country level to sensitize key sectors about their roles in noncommunicable diseases prevention and control. As a result, 10 out of 11 Member States have developed national multisectoral action plans and have set national targets. The Health Promotion Unit in the Regional Office for the Western Pacific has developed a Regional Framework for Urban Health 2016–2020 aimed at promoting cross-cutting actions to address the Sustainable Development Goals (SDGs). It has also strengthened the health promotion infrastructure and sustainable financing mechanisms and scaled up settings-based approaches in a number of countries, including Cambodia, China (including the Hong Kong Special Administrative Region), Cook Islands, Fiji, Kiribati, Lao People’s Democratic Republic, Malaysia, Federated States of Micronesia, Mongolia, the Philippines, the Republic of Korea, Solomon Islands, Tonga, Vanuatu and Viet Nam. Efforts have been made in the Regional Office for the Western Pacific to convene high-level political leaders and policy-makers to noncommunicable diseases and health promotion events, including the 9th Global Conference on Health Promotion and the 2015 Small Island Developing States Conference on noncommunicable diseases in Samoa. Seven countries (Cook Islands, Fiji, Guam, Lao People’s Democratic Republic, Nauru, Palau and Viet Nam) have national multisectoral action plans drafted and endorsed. Eight countries (Cambodia, Marshall Islands, Nauru, Papua New Guinea, the Philippines, Tonga, Tuvalu and Vanuatu) have draft plans that are awaiting endorsement. 2.1.2 Prevention Efforts in WHO have concentrated on advocating high-level political commitment to the prevention and control of noncommunicable diseases, and integrating them into the global governing bodies of United Nations agencies and global health initiatives – especially with recognition of noncommunicable diseases in the 2030 S Sustainable Development Goals. In order to integrate noncommunicable diseases into United Nations Development Assistance Frameworks, the United Nations Interagency Task Force on noncommunicable diseases met four times during 2014–2015 to develop and implement a joint plan of work that included joint programming missions in 10 countries (Barbados, Belarus, Democratic Republic of the Congo, India, Jordan, Kenya, Mongolia, Mozambique, Sri Lanka and Tonga), which resulted in operational plans for the United Nations agencies to provide coordinated technical cooperation to accelerate national efforts to address noncommunicable diseases. The Interagency Task Force on noncommunicable diseases was formed by expanding the previous task force on tobacco to also include all other risk factors, whilst preserving a special focus on tobacco. In addition, WHO scaled up the joint WHO /International Telecommunication Union mHealth initiative – Be He@lthy, Be Mobile – to address both prevention of risk factors and disease management of selected noncommunicable diseases. The issues addressed by the initiative included tobacco use cessation, diabetes and cervical cancer. Initial work has commenced on pregnancy and tobacco; tuberculosis and tobacco; and ageing, wellness and hypertension. Diet and physical activity WHO supported the ongoing work of the WHO Commission on Ending Childhood Obesity (ECHO), the final report on which will be presented to the Director-General in 2016. Headquarters, in collaboration with the regions, has also continued the development of tools and the provision of technical support for the implementation of the Global Strategy on Diet, Physical Activity and Health within the context of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. This includes multisectoral planning, the implementation of a package of interventions for salt reduction, recommendations on marketing of foods and non-alcoholic beverages to children, fiscal measures for healthy diets, and promotion of physical activity. There has been regional planning of strategies to address the double burden of nutrition for the Regional Office for the Western Pacific and the Regional Office for South-East Asia, whilst in the Regional Office for the Americas, the Plan of Action for the Prevention of Obesity in Children and Adolescents was passed at the 53rd Directing Council of the Pan American Health Organization. The Regional Office for the Eastern Mediterranean held a high-level forum on physical activity and legislative measures, including restricting the marketing of foods and non-alcoholic beverages to children. In the Regional Office for Africa, a planning meeting on hypertension prevention through salt reduction and physical activity was conducted, involving multiple countries.


The Physical Activity Strategy for the WHO European Region 2016–2025 was passed at the 65th session of the Regional Committee for Europe. These regional multisectoral strategies provide excellent stimulus for country action. Tobacco use WHO has continued to provide technical support to the Secretariat of the WHO Framework Convention on Tobacco Control (FCTC) to advance the tobacco control agenda of the Conference of the Parties (as well as working with Member States that are still not parties to the Convention). In particular, WHO worked closely and in full partnership with the Convention Secretariat for the successful running of the 2014 Conference of the Parties to the FCTC, held in Moscow. In 2014, WHO focused on taxation as the main theme of World No Tobacco Day. In 2015, in recognition of the slow ratification of the Protocol to Eliminate Illicit Trade in Tobacco Products, WHO, in consultation with the Convention Secretariat, focused the 2015 World No Tobacco Day on the issue of illicit trade. In 2015, WHO also worked closely with the Convention Secretariat, the United Nations Development Programme (UNDP), the World Bank and civil society to propose tobacco taxation as a means of public financing of the Sustainable Development Goals. In 2015, WHO published two important reports on tobacco use: (a) the WHO global report on trends in prevalence of tobacco smoking; and (b) the fifth WHO report on the global tobacco epidemic. In addition, WHO published two advisory notes and a technical report by the WHO Study Group on Tobacco Product Regulation: (a) Advisory note: global nicotine reduction strategy, which presents the conclusions and recommendations on a policy for limiting the sale of cigarettes to brands with a nicotine content that is not sufficient to lead to the development and/or maintenance of addiction; (b) Advisory note: waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators, which addresses growing concerns about the increasing prevalence and potential health effects of tobacco smoking with waterpipes, and provides a more thorough understanding of the health effects of waterpipe smoking for WHO Member States and research agencies; and (c) Report on the scientific basis of tobacco product regulation: fifth report of a WHO Study Group – WHO Technical Report Series 989, which includes topics on novel tobacco products, smokeless tobacco, reduced ignition propensity cigarettes and a non-exhaustive priority list of toxic contents and emissions of tobacco products. In 2015, WHO also scaled up country-level capacity-building activities to strengthen national tobacco cessation and treatment systems: (a) six national training workshops on brief tobacco interventions in primary care were completed using the WHO training package (two in Georgia and one each in Albania, India, Jamaica and Uzbekistan); (b) one workshop for quit line managers was completed in China using WHO-developed materials; (c) one subregional training workshop on specialized tobacco dependence treatment services for Gulf countries was completed in Qatar using the WHO training package; and (d) three training workshops on brief tobacco interventions for oral health professionals was completed in two cities of Japan using the WHO training package to promote tobacco cessation and oral health integration. During 2014–2015 WHO continued its work to build capacity for tobacco control at the national level, in close coordination and collaboration with the regional and country offices and the FCTC Secretariat, especially in countries with a high burden of tobacco use, such as Bangladesh, Belarus, Cambodia, China, India, Indonesia, Jordan, Mongolia, Russia Federation, Thailand and Turkey, through joint assessments (with host governments and high-level tobacco control champions) and technical cooperation, which included roadmap development and follow-up collaboration. ‎Working with countries included provision of technical advice and building in-country capacity for best-buy and good-buy policies to reduce tobacco use (the MPOWER policy package). Training activities under the initiative included (a) a bi-regional training workshop for the Regional Office for South-East Asia and the Regional Office for the Western Pacific, involving training of trainers for WHO staff in Member States; and (b) The Regional Office for the Eastern Mediterranean trainings on MPOWER and Article 5.3 of the FCTC, and multiple national trainings for public officials from Bangladesh, Brazil, Iraq, Jordan, the Philippines, the Russian Federation, Turkey and Viet Nam. Training was completed for “making cities smoke-free” in the Russian Federation. The work on producing and making available technical resources for in-country implementation of best-buy policies continued (the WHO report Smoke-free movies: from evidence to action was published). WHO also coordinated work around smoke-free and tobacco-free mega events, with direct technical ‎support to local and hosting authorities and WHO country offices, for example for the Sochi Winter Olympics in 2014, the Ice Hockey World Championship in Minsk in 2014, and the Tokyo Olympics in 2020. The WHO graphic health warnings online database was updated in collaboration with ministries of health and WHO country offices in 40 countries, with the publication of a new web resource for African countries. WHO provided significant scientific and leadership input to the World Conference on Tobacco or Health in Abu Dhabi, 2015, and continued its work in communicating with high-level authorities, encouraging them to further change policy and providing technical support to Member States on request (India and Thailand Minister of Health and Prime Minister, Indonesia Minister of Health and President, Russian President).


Alcohol Approaching this risk factor in a systematic and integrated way in conjunction with other noncommunicable diseases risk factors has helped to highlight the limited progress made on alcohol regulation and the need to strengthen the institutional capacity of health authorities to make necessary changes. WHO has continued to support Member States in the development of strategies and interventions to reduce the harmful use of alcohol. The global network of WHO national counterparts for implementation of the Global Strategy to Reduce the Harmful Use of Alcohol met once in the period and its Coordinating Council continues to work between major meetings. A thematic group on alcohol was established within the United Nations Interagency Task Force on noncommunicable diseases. In 2014, WHO launched the Global status report on alcohol and health 2014. This report included baseline measures for the WHO Global Monitoring Framework for Noncommunicable Diseases. WHO has developed a successful collaboration with UNDP in working with countries to develop intersectoral policies to reduce the harmful use of alcohol. Countries report increasing difficulty in getting national strategies adopted on alcohol, especially pricing policies and restrictions on marketing. Efforts to support countries in these areas should be increased. 2.1.2 Management Four strategic technical meetings were held to identify priority areas of action for cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. WHO supported noncommunicable diseases management with the addition of new implementation tools to the WHO package of essential noncommunicable disease interventions for primary health care in low-resource settings (PEN) to support NCD management in primary health care. Additionally, new WHO recommendations for cervical cancer primary and secondary prevention (two-dose HPV vaccination and screen-and-treat approaches) have been published. Implementation of cervical cancer prevention programmes was supported in 10 countries in Africa. A number of technical meetings were supported in all regions to review and scale up noncommunicable diseases management through health system strengthening. A Joint Global Programme on Cervical Cancer Prevention and Control was established with eight United Nations agencies, and will support participating countries in having in place a functioning and sustainable high-quality national comprehensive cervical cancer control programme with women accessing services equitably. Country-specific cardiovascular risk charts were developed and are being validated. The set of cost-effective interventions and other interventions in Appendix 3 of the Global Action Plan on noncommunicable diseases are being updated through a revised methodology. A WHO consultation was held to identify the priorities for research for noncommunicable diseases prevention and control and a draft guide for implementation research has been developed. Work on access to noncommunicable diseases medicines has been strengthened through collaborative activities and a survey in selected countries. An expert consultation on cancer early diagnosis and screening was organized and work is progressing on developing a model list of equipment for cancer treatment. The Secretariat is working on a range of tools to support Member States implement resolution WHA67.19 (2014) on palliative care. The interagency health kit for emergencies was updated to include more noncommunicable diseases medicines. 2.1.3 Surveillance and monitoring Major achievements for WHO in strengthening noncommunicable diseases surveillance and monitoring during this period have focused on promoting the adoption and broad implementation of the Global Monitoring Framework for noncommunicable diseases. Headquarters has developed and disseminated a number of new tools and guidelines on how to measure, calculate and report on the 25 indicators, 9 global targets and 9 Global Action Plan process indicators, including guidance on all the indicators’ definitions and specifications, and a tool to help with country-specific target setting based on the global noncommunicable diseases targets. These tools have been widely disseminated at all three levels of the Organization. The broad uptake of these tools has enabled country, regional and global reporting on progress in implementing prevention and control initiatives to reduce the noncommunicable diseases burden. WHO released two new comprehensive country profile reports during 2014 – one on noncommunicable diseases profiles, launched by the Director-General in New York in July 2014, and one on cancer profiles, launched at the World Cancer Congress in December 2014. The WHO Global status report on alcohol and health was launched in 2014, and the Global status report on noncommunicable diseases 2014 was published later that year and launched in January 2015. In 2015, the noncommunicable diseases Country Capacity Survey was implemented, which achieved a 91% response rate. The Country Capacity Survey data, along with other data available at headquarters, informed the WHO noncommunicable diseases Progress Monitor, which was launched at the United Nations General Assembly in September 2015. The WHO Global Survey on Progress in Alcohol Policy was also conducted during 2014–2015.


WHO produced new and updated country-comparable estimates of key selected risk factors for noncommunicable diseases, including physical inactivity in adults and adolescents, harmful use of alcohol, overweight and obesity in adults, raised blood pressure and raised blood glucose in adults. WHO has engaged in a number of technical missions and workshops to countries to support development of noncommunicable diseases targets and indicators, and to support planning and implementation of noncommunicable diseases risk factor surveys for both adults and adolescents. Ongoing technical support and guidance has also been provided by WHO staff at headquarters to regional and country offices, and national focal points on noncommunicable diseases surveillance in Member States. This support has enabled over 65 Member States to plan for or implement surveys using the WHO STEPwise approach to chronic disease risk factor surveillance (STEPS) (adults) or the global school-based student health survey approach (adolescents). Resourcing of noncommunicable diseases surveillance and monitoring work, particularly at the country level, to allow for routine, institutionalized monitoring integrated in national health systems reporting, remains a challenge. The major challenges faced in the development and implementation of national multisectoral plans for prevention and control of noncommunicable diseases are inadequate fiscal and legislative measures and a need for an investment framework; regulatory capacity at country level and an increased focus on health and law; weak health systems in low- and middle-income countries; and the increasing burden of noncommunicable diseases. Other major issues that have hampered noncommunicable diseases prevention and control include inadequate implementation of existing health policies, strategies, plans and a set of very cost-effective interventions; insufficient financing of the health sector, especially in addressing noncommunicable diseases; and an inadequately trained health workforce. Moreover, vested interests, for example from the tobacco and alcohol industries and their front groups, remain a major challenge.

II. OUTPUT MEASUREMENT

Output 2.1.1 Development of national multisectoral policies and plans for implementing interventions to prevent and control noncommunicable diseases facilitated

Output indicator

Baseline

Target

Achieved value

Number of countries that that have established national multisectoral action plans for the prevention and control of noncommunicable diseases

80 115 72 responding countries to 2015 Country Capacity Survey: action plans must be “operational”, “multisectoral” and must cover the 4x4 (exception for alcohol according to national context)

Overview of achievements and challenges

• WHO reviewed and published international experience and successful approaches for multisectoral action in the Global status report on noncommunicable diseases 2014 and also published a set of papers in a special issue of Health Promotion International to support the implementation of a Health in All Policies approach.

• WHO has also provided practical toolkits and technical support for Member States to develop and implement national action plans; assisted with national monitoring frameworks in line with the global and regional action plans and frameworks; raised the profile of noncommunicable diseases in the development agenda; facilitated national multisectoral action and coordinated the efforts of United Nations agencies, with the support of the United Nations Interagency Task Force on noncommunicable diseases and the GCM/NCD, through “One WHO” integrated support to countries as well as in the specific technical areas of tobacco, harmful use of alcohol, physical activity and salt reduction; facilitated implementation of a set of very cost-effective prevention and management interventions;


improved health information on noncommunicable diseases; and built capacity in specific areas of noncommunicable diseases. A WHO Framework for country action across sectors for health and health equity was approved at the Sixty-eighth World Health Assembly.

• Efforts have also continued to concentrate on advocating high-level political commitment to the prevention and control of noncommunicable diseases and integrating them into the global governing bodies of United Nations agencies and global health initiatives, as well as through the dialogues under the GCM/NCD and through the initiation and implementation plan for the 9th Global Conference on Health Promotion.

• Practical toolkits and technical support were provided to several countries and an noncommunicable diseases tool web page was established to increase access to the WHO guidelines and tools. The intent was to aid Member States in mobilizing multisectoral action and developing and implementing national noncommunicable diseases policies and multisectoral action plans in line with the Global Action Plan on noncommunicable diseases and the commitments of the Political Declaration of the High–level Meeting of the General Assembly on the Prevention and Control of noncommunicable diseases.

Achievements and challenges in countries

WHO headquarters supported a number of training seminars that were held in all WHO regions to assist Member States in developing and implementing multisectoral national policies and plans and to strengthen their political, financial and technical commitment to preventing and controlling noncommunicable diseases. In addition, WHO supported noncommunicable diseases training courses through the WHO collaborating centres in Lausanne and Oxford Universities, in Moscow and Helsinki respectively.

An noncommunicable diseases tool web page to increase access to tools and guidelines developed by WHO was established, including a toolbox on how to achieve target 9 (of the Global Action Plan) on access to essential medicines and technology, and a toolbox on multisectoral planning and action.

WHO has provided technical support to Member States for developing and implementing national noncommunicable diseases multisectoral action plans either through integrated approaches or through individual specific disease or risk factor approaches. More specifically, WHO has worked closely with Barbados, Bhutan, the Islamic Republic of Iran, Nepal, Sri Lanka and Turkmenistan, in collaboration with the regional offices and country offices, focusing on key areas of planning for noncommunicable diseases prevention and control, including comprehensive assessment of the situation, engagement with stakeholders, setting noncommunicable diseases targets and setting priorities for action, and improving implementation and accountability of national noncommunicable diseases multisectoral action plans. In addition, technical support was provided for prioritizing the national noncommunicable diseases multisectoral action plan in Sri Lanka, and the costing of the national noncommunicable diseases multisectoral action plans in Barbados and Nepal.

Ten joint programming missions were undertaken by the United Nations Interagency Task Force on noncommunicable diseases, which resulted in noncommunicable diseases being given greater priority within United Nations country teams, with advocacy for multisectoral action across government and other development partners in Barbados, Belarus, Democratic Republic of the Congo, India, Kenya, Mongolia, Mozambique, Sri Lanka and Tonga.

Challenges

realization of the commitments to setting national targets and developing and implementing national noncommunicable diseases multisectoral action plans made by Heads of State and Government;

lack of capacity for budgeting and national investment cases and the need for an investment framework;

lack of institutional mechanisms for multisectoral implementation of plans in most countries;

lack of knowledge on how to engage with the private sector in accordance with paragraph 44 in the United Nations Political Declaration on noncommunicable diseases of 2011;


limited allocation of significant funds in many countries to scale up noncommunicable diseases interventions;

insufficient data to establish the national figures for the global targets, and scanty sources of data;

instability and competing emergencies in some countries.

In some countries, there may be limited capacity to mobilize different sectors to implement a multisectoral action plan for noncommunicable diseases prevention and control, though the programme is gaining momentum. Some sectoral policies and plans may have objectives that are not consistent with the country’s public health and long-term sustainable development goals. For example, tobacco production may be promoted under the development plan, though this would not be aligned to national public health goals. WHO regional offices have highlighted policy incoherence when the opportunity has arisen, and have provided technical advice to ensure health remains a priority and is considered in all policies and plans. Achievements and challenges at regional and global levels

• WHO has reviewed international experiences and successful approaches for multisectoral action on noncommunicable diseases, with a special focus on global noncommunicable diseases targets, and published them in the Global status report on noncommunicable diseases 2014, launched by the Director-General on 19 January 2015.

• The WHO GCM/NCD established two Working Groups and convened a series of dialogues in order to recommend ways and means of encouraging Member States and non-State actors to realize the commitments included in paragraphs 44 and 45(d) of the 2011 United Nations Political Declaration on noncommunicable diseases. The GCM/NCD also provided web-based platforms and communities of practice for advocacy and raising awareness, and for disseminating knowledge and information.

• The Economic and Social Council adopted a resolution on the work of the United Nations Interagency Task Force on noncommunicable diseases in June 2015. Solid progress has been made in implementing the Task Force’s work plan 2014–2015, including alignment of NCD-related policies between member United Nations agencies. As a result the number of United Nations partners has increased to 25 entities. A guidance note to include noncommunicable diseases in United Nations Development Assistance Frameworks was developed.

• Two dialogues under the GCM/NCD with multistakeholder participants resulted in reports with recommendations on how to encourage the continued inclusion of noncommunicable diseases in development cooperation agendas and initiatives, internationally agreed development goals, economic development policies, sustainable development frameworks and poverty reduction strategies, and how to strengthen international cooperation on noncommunicable diseases.

• An initiation and implementation plan for the 9th Global Conference on Health Promotion was developed, the memorandum of understanding was signed, scientific and organizing committees met, the programme was outlined and concept notes for the main theme (the Sustainable Development Goals) were completed.

• WHO published a set of papers in a special issue of Health Promotion International (Vol. 29 No. S1, 2014) to support the implementation of a Health in All Policies approach.

• The WHO Framework for country action across sectors on health and health equity was developed and finalized, and was approved at the Sixty-eighth World Health Assembly. Country-level support was provided to implement the framework, for example in Suriname.

• Critical appraisal was undertaken of best practices for prevention and management of noncommunicable diseases in various settings, including a review of healthy cities and a technical meeting on school health that features what works, what doesn’t, and how to make it work.

• A toolkit was developed for the integration of oral health into primary health care and noncommunicable diseases prevention, including fluoride use, tobacco cessation and amalgam phase-down, and collaboration with UNEP on the initiative led to joint publications.


• Evidence reviews of multisectoral action to reduce physical inactivity (promote physical activity), reduce population consumption of salt and sodium, and prevent of childhood obesity are under way. WHO collaborating centres and consultants are engaged in evidence reviews and mapping of experiences in all parts of the world, especially in low- and middle-income countries. Outcomes of the work package will provide evidence for the update of Appendix 3 of the Global Action Plan on noncommunicable diseases and support to Member States for development of multisectoral action to reduce risk factors.

• An noncommunicable diseases tool web page has been established and WHO tools for developing a national multisectoral action plan have been published on the WHO website, including the tools to support attaining target 9 on access to essential medicines and technology, multisectoral planning and implementation of salt reduction, obesity prevention, and promotion of physical activity and tobacco control.

• Specific support was provided for national multisectoral planning and field testing of the tools with regard to population interventions in a few countries per region, for example in the areas of childhood obesity prevention (Kenya and Tajikistan), specific physical activity planning (Kuwait, South Africa) and salt reduction (Croatia, Kiribati, Mongolia).

• A project for implementation research for noncommunicable diseases prevention and control has been initiated and an expert consultation was held to identify priority areas. Implementation research was considered as a priority and a draft guide for implementation research developed.

• Several multi-agency initiatives took place under the United Nations Interagency Task Force on noncommunicable diseases including a joint programme to catalyse multisectoral action for noncommunicable diseases operating in a selection of low- and middle-income countries, a joint cancer control programme, a joint programme on cervical cancer prevention and control operating in selected low- and middle-income countries, the mHealth joint programme (Be He@lthy, Be Mobile), a thematic group on alcohol, and workshops on intersectoral action to reduce harmful use of alcohol.

• A guidance note on how to include noncommunicable diseases in United Nations Development Assistance Frameworks was developed.

Challenges • It has proved challenging to move from advocacy and planning to action by improving national

capacity in realizing political commitment, mobilizing multisectoral action and increasing investment for noncommunicable diseases.

• There is a lack of institutional mechanisms for multisectoral implementation of plans in most countries.

• Capacity is also lacking for budgeting and national investment cases, and there is a need for an investment framework.

• Limited capacity is available in WHO country offices and at national level.

• The development and finalization of the WHO Framework for country action across sectors for health and health equity, the approval of the framework at the Sixty-eighth World Health Assembly and country-level support to implement the framework, for example in Suriname, has presented challenges. Additional work on Health in All Policies has been undertaken in Benin, Ireland, Morocco, the Russian Federation, Sudan and Viet Nam.

• In the Regional Office for South-East Asia mobilizing and sustaining commitment from non-health sectors is a major challenge, as well as the lack of sufficient domestic and international funds to implement action plans.

• In the Regional Office for the Americas two of the biggest challenges are the development of effective national programmes to address noncommunicable diseases and risk factors and the promotion of intersectoral work, given that addressing category 2 themes requires approaches that go well beyond the health sector, such as increasing regulatory capacity and legislation enforcement capabilities.

• In the Regional Office for the Eastern Mediterranean there is a lack of fully operationalized and sustained intersectoral and multisectoral collaborative mechanisms for scaling up effective prevention and control responses to noncommunicable diseases.


Risks and assumptions

Risks • lack of high-level political commitment to address noncommunicable diseases;

• lack of availability of funds at the national, regional and global levels;

• limited capacity and commitment for noncommunicable diseases prevention and control programmes, jeopardizing effective implementation of noncommunicable diseases multisectoral action plans;

• weak coordination among various sectors at national level and lack of coordination among international partners;

• vertical programmes, particularly in donor-driven agendas.

To mitigate the major risks:

• High-level advocacy was conducted.

• Capacity was built at different levels.

• Resources were mobilized for national capacity assessment.

Assumptions

• Member States would take action to address noncommunicable diseases.

• Member States would allocate resources for the prevention and control of NCDs.

Gender, equity and human rights, and social determinants of health

Gender, equity and human rights, and social determinants of health were addressed as part of the development of national multisectoral policies and plans for the prevention and control of noncommunicable diseases by addressing the risk factors, such as tobacco, alcohol, diet and physical inactivity, and through management of noncommunicable diseases at a primary health care level.

Output 2.1.2 High-level priority given to the prevention and control of noncommunicable diseases in national health planning processes and development agendas

Output indicator

Baseline

Target

Achieved value

Number of countries that have integrated work on noncommunicable diseases into their United Nations Development Assistance Framework

83 100 113


Actions necessary to reduce the impact of noncommunicable diseases require countries to develop national coordination mechanisms and multisectoral actions, including engagement with development planning. In all, 113 countries have included noncommunicable diseases in their development processes. Four strategic technical meetings were held to identify priority areas of action for cancer, cardiovascular diseases, diabetes and chronic respiratory diseases. WHO supported noncommunicable diseases management with the addition of new implementation tools to the WHO package of essential noncommunicable diseases interventions (PEN) to support noncommunicable diseases management in primary health care. Additionally, new WHO recommendations for cervical cancer primary and secondary prevention (two-dose of human papillomavirus vaccination and screen-and-treat approaches) have been published. Implementation of cervical cancer prevention programmes was supported in 10 countries in Africa.


A number of technical meetings were supported in all regions to review and scale up noncommunicable diseases management through health system strengthening. A Joint Global Programme on Cervical Cancer Prevention and Control was established with eight United Nations agencies, and will support participating countries in having in place a functioning and sustainable high-quality national comprehensive cervical cancer control programme with women accessing services equitably. Country-specific cardiovascular risk charts were developed and are being validated. The set of cost-effective interventions and other interventions in Appendix 3 of the Global Action Plan on noncommunicable diseases are being updated through a revised methodology. A WHO consultation was held to identify the priorities for research for noncommunicable diseases prevention and control and a draft guide for implementation research has been developed. Work on access to NCD medicines has been strengthened through collaborative activities and a survey in selected countries. An expert consultation on early diagnosis and screening of cancer was organized and work is progressing on developing a model list of equipment for cancer treatment. The Secretariat is working on a range of tools to support Member States implement resolution WHA67.19 (2014) on palliative care. The interagency health kit for emergencies was updated to include more noncommunicable diseases medicines.

Achievements and challenges in countries Achievements (prevention)

WHO has developed tools and country guides to assist countries set up and implement the joint WHO International Telecommunication Union Be He@lthy, Be Mobile initiative across both the prevention and control of noncommunicable diseases. Engagement has been activated with Costa Rica, Egypt, India, Mauritius, Norway, the Philippines, Senegal, Tunisia, Turkmenistan, the United Kingdom and Zambia. Diet and physical activity With regional-driven initiatives and WHO headquarters participation, physical activity strategic and action plans have been developed or incorporated into existing national plans in some countries, including Barbados, Kuwait and South Africa, as part of their obesity prevention plans, as detailed below. Obesity prevention plans have been developed for Barbados, Jamaica, Kenya, Mongolia, the Philippines, Tajikistan and Viet Nam with support from WHO, in addition to others carried out by regional offices. Salt reduction plans have been developed as part of field testing the salt reduction toolkit in Croatia, Indonesia, Kiribati, Kuwait, Mauritius, Mongolia, Vanuatu and Viet Nam with WHO support. These either exist as stand-alone plans or are incorporated into national noncommunicable diseases multisectoral plans. Tobacco control Best-practice policies in the following tobacco control areas were adopted with headquarters support to regional and country offices and Member States. WHO headquarters has provided support through regional offices: • protecting people from tobacco smoke in Jamaica, the Russian Federation and Suriname;

• large pictorial health warnings in Bangladesh, India, Jamaica, and the Philippines;

• advertising, promotion and sponsorship bans in the Russian Federation;

• tobacco excise taxes in Bangladesh, China, Gambia, India, Kenya, the Philippines, Uganda and Zambia.

WHO also supported regional offices and the WHO FCTC Secretariat in: • capacity-building for an illicit trace protocol in countries of East Africa and the Association of South-

East Asian Nations (ASEAN);

• trade law and investment and tobacco industry interference tactics in all WHO regions, through regional workshops and more than 15 national workshops;

• participation in two capacity/needs assessments with the WHO FCTC Secretariat and capacity assessment follow-ups.


Harmful use of alcohol Technical support has been provided – directly from hea, through the regional offices and through multiregional workshops – on the development of national strategies on alcohol and their integration into noncommunicable diseases strategies, in order to set alcohol targets in the noncommunicable diseases framework and to develop selected interventions, especially “best buys”. Innovative portals on alcohol and health, with a web-based self-help intervention tool, have been further developed with support by WHO to strengthen the links between alcohol and noncommunicable diseases in four pilot countries: Belarus, Brazil, India and Mexico.

Achievements (management) • Technical support to noncommunicable diseases management was prioritized. Key areas for action

were identified through expert consultations. Additional tools and guidance were developed and distributed to strengthen adaptation and implementation of the WHO PEN. Regional and country offices have adapted and developed technical tools to meet the regional context. Country offices have helped to demonstrate the feasibility of noncommunicable diseases management through assessment of facilities, capacity-building and service delivery. With this background the coming biennium will focus on scaling up interventions. Access to essential medicines and basic technologies is a priority. Focus will also be on supporting countries to achieve the progress indicators of having evidence-based guidelines and provision of drug therapy and counselling for people at high risk for cardiovascular diseases.

• Countries have modified and adapted the cost-effective interventions and the PEN in primary health

care. The WHO PEN tool was used to assess and manage cardiovascular disease risk and diabetes in 26 low-resource countries. Economic and health ministers of the Pacific Island countries agreed to improve the efficiency and impact of existing health budgets for targeted primary and secondary prevention of cardiovascular disease and diabetes, including through the implementation of the WHO PEN.

• Three coordinated implementation research projects on cervical cancer management are being

implemented. The “Reducing cervical cancer burden in selected high-burden countries” project runs in 10 countries. The “Improving data for decision-making in global cervical cancer” programme runs in five additional countries. The “Cervical cancer screening and preventative therapy via reproductive health networks” programme runs in four countries.

• The WHO/International Atomic Energy Agency (IAEA) Programme of Action for Cancer Therapy (PACT)

joint missions to 13 countries helped to identify the current status and priority actions in developing national cancer plans and programmes.

• Since 2014, a number of Member States have developed new national strategies for palliative care,

including France, Malawi, the United Republic of Tanzania and Zimbabwe. The Secretariat has supported Member States to include palliative care in national action plans for noncommunicable diseases, and has also provided support to countries developing specific national strategies and guidelines on palliative care, including Botswana, India and Lebanon. The Secretariat provided support to South Africa for the development of national guidelines for palliative care for people with multidrug-resistant tuberculosis, and specific technical assistance to Tajikistan and Ukraine.

Challenges

• limited national technical capacity in some Member States and their WHO country offices;

• limited allocation of significant funds and human resources in many Member States;

• deficit of political will and lack of sustained collaboration across non-health sectors;

• considerable bottlenecks at country level with regard to the formulation and implementation of pricing policies and policies to regulate alcohol marketing, with the result that countries are asking for assistance from WHO for the development of national alcohol strategies, particularly with regard to implementation of pricing policies and restrictions on marketing;

• weak health systems in low- and middle-income countries, lack of financial and human resources and lack of essential medicines, acting as barriers to scaling up noncommunicable diseases management;

• outbreaks and competing priorities.


Achievements and challenges at regional and global levels

Achievements (prevention)

Diet and physical activity • Insufficient physical activity: Sector-specific toolkits for the promotion of physical activity through

sports, primary health care, mass media, schools and workplaces have been tested in three countries and two regional forums, and reviewed by regional focal points for proof of concept.

• Reduction of salt intake: The salt reduction toolkit is now finalized as the “SHAKE the salt habit” package. Support for national planning or specific national initiatives was provided through field testing of the salt reduction toolkit in a country in each region.

• Obesity: In addition to noncommunicable diseases plans, specific national childhood obesity prevention planning was supported by WHO in a total of nine countries. There were seven regional and subregional consultations under the Commission on Ending Childhood Obesity (ECHO), with representatives from 118 Member States and areas in total. There were two bi-regional (the Regional Office for the Eastern Mediterranean and the Regional Office for Europe, the Regional Office for South-East Asia and the Regional Office for the Western Pacific) training workshops facilitated by headquarters, with the regions covering a total of 23 countries, on the marketing of foods and non-alcoholic beverages to children. An expert meeting and tool development has been initiated on fiscal measures to promote healthy diets.

• There has been great momentum at regional level, with planning of strategies to address the double burden of nutrition for the Regional Office for the Western Pacific and the Regional Office for South-East Asia, whilst in the Regional Office for the Americas the Plan of Action for the Prevention of Obesity in Children and Adolescents was passed at the 53rd Directing Council of the Pan American Health Organization.

• The Regional Office for the Eastern Mediterranean held a high-level forum on physical activity and legislative measures, including restricting the marketing of foods and non-alcoholic beverages to children.

• In the Regional Office for Africa a planning meeting on hypertension prevention through salt reduction and physical activity was conducted, involving multiple countries.

• The Physical Activity Strategy for the WHO European Region 2016–2025 was passed at the 65th session of the Regional Committee for Europe.

• These regional strategies and mandates should drive further action in countries on diet and physical activity.

• Nutrient profiling is the science of classifying foods according to their nutritional composition for reasons related to preventing disease and promoting health. Nutrient profile models are tools that can be used to implement public health strategies and interventions to promote healthy diets, such as marketing of food and non-alcoholic beverages to children, procurement of foods in public institutions (for example schools), nutrition labelling (including front-of-package labelling) and fiscal policies (for example taxation, subsidies).

• As part of the efforts in developing tools to translate WHO guidelines and guidance on promoting healthy diet, during 2014–2015, WHO headquarters, in close collaboration with the regional offices, developed nutrient profile models to support the implementation of the marketing of food and non-alcoholic beverages to children in the European, Eastern Mediterranean, Americas and Western Pacific Regions.

Tobacco control • WHO prepared nine discussion papers for the sixth session of the Conference of the Parties to the

WHO FCTC in Moscow in response to decisions made by the Conference of the Parties at its fifth session. This included a position paper on the need to regulate electronic nicotine delivery systems. In addition, WHO, as requested, presented fact sheets on reduced ignition propensity cigarettes and ingredients in tobacco products. These fact sheets are now available on the Tobacco Free Initiative’s website. WHO also reported on the progress of the work of its Tobacco Laboratory Network (TobLabNet), which had been requested by the Conference of the Parties in 2008 to internationally validate cigarette-testing methods for nine tobacco toxicants so that regulators could start implementing Article 9 of the WHO FCTC. The work of TobLabNet has increased national and regional capacities to test and disclose tobacco contents and emissions, pursuant to the WHO FCTC.


• WHO provided technical assistance to more than 70 countries on tobacco control “best buys”, including a World No Tobacco Day campaign in 2014 to raise tobacco taxes, and in 2015 to encourage ratification of the WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products. Additionally, WHO, in collaboration with the FCTC Secretariat, engaged with countries through regional and national workshops to increase their awareness of the intersections between trade and tobacco control, to promote ratification of the Protocol to Eliminate Illicit Trade, and to increase their readiness to face related tobacco industry interference. WHO worked with the United Nations Conference on Trade and Development (UNCTAD) to generate tobacco growing and trade country fact sheets for all WHO Member States.

• In 2015, WHO released two important reports on tobacco use. In March 2015, WHO released the WHO global report on trends in prevalence of tobacco smoking, which provided an analysis of trends in smoking since 2000 and analysed prospects for countries to meet the 2025 noncommunicable diseases tobacco target. The report identified that prevalence of tobacco smoking was declining in all WHO regions except for the Regional Office for Africa and the Regional Office for the Eastern Mediterranean. In July 2015, WHO released the fifth WHO report on the global tobacco epidemic, with an emphasis on raising taxes, as well as addressing the demand reduction measures included in the WHO FCTC. The report shows that more than half of the world’s countries, covering 40% of the world’s population, have implemented at least one demand reduction measure (mPOWER) at the highest level of achievement.

Harmful use of alcohol A thematic group on reducing the harmful use of alcohol as part of the United Nations Interagency Task Force on noncommunicable diseases was established in October 2015. WHO and UNDP organized an intersectoral capacity-building workshop in Windhoek, Namibia, in June 2015 with more than 60 representatives from nine countries. A capacity-building workshop on alcohol pricing policies was held in South Africa in 2014 for civil servants of health and finance sectors from seven countries. An implementation toolkit for the Global Strategy to Reduce the Harmful Use of Alcohol was introduced, with concrete guidance on the 10 areas for national policy development, a resource book on alcohol taxation and a series of fact sheets. The second meeting of the global network of WHO national counterparts for implementation of the Global Strategy to Reduce the Harmful Use of Alcohol took place at WHO in Geneva, 12–14 May 2014. During the meeting, particular attention was given to sharing experiences in implementing the policy options at national and international levels and capacity-building using the WHO tools and training materials developed for this purpose. The Coordinating Council for the implementation of the Global Strategy, with representation from 14 Member States, met twice in the period to further develop collaboration with Member States in this area.

Achievements (management) • Four strategic technical meetings were held to identify priority areas of action in cancer,

cardiovascular diseases, diabetes and chronic respiratory diseases. WHO supported noncommunicable diseases management with the addition of new implementation tools to the PEN to support noncommunicable diseases management in primary health care.

• New WHO recommendations for cervical cancer primary and secondary prevention (two-dose HPV vaccination and screen-and-treat approaches) have been published, and implementation of cervical cancer prevention programmes was supported in 10 countries in Africa.

• A number of technical meetings were supported in all regions to review and scale up noncommunicable diseases management through health system strengthening.

• A Joint Global Programme on Cervical Cancer Prevention and Control was established with eight United Nations agencies and will support participating countries in having in place a functioning and sustainable, high-quality, national comprehensive cervical cancer control programme with women accessing services equitably.

• Country-specific cardiovascular risk charts were developed and are being validated.

• The set of cost-effective interventions and other interventions in Appendix 3 of the Global Action Plan on noncommunicable diseases are being updated through a revised methodology. A technical consultation in June 2015 identified the methodology, and the timeline for completing the work by 2017 was approved by the WHO Executive Board in January 2016.


• A WHO consultation was held to identify the priorities for research for noncommunicable diseases prevention and control, and a draft guide for implementation research has been developed.

• Work on access to noncommunicable diseases medicines has been strengthened through collaborative activities and a survey in selected countries.

• The Secretariat is working on a range of tools to support Member States implement resolution WHA67.19 (2014) on palliative care.

• Regional consultation meetings on palliative care were conducted in four WHO regions in 2015.

• The interagency health kit for emergencies was updated to include more noncommunicable diseases medicines.

• WHO cardiovascular risk prediction charts have been updated and final drafts of country-specific charts will be ready for release in 2016.

• The WHO Essential Medicines List, 2015, has been updated with 26 new medicines for managing cancers.

• A series of communication tools for palliative care were produced in all six official languages, including a corporate fact sheet, infographics and an updated website.

• A global report on psoriasis was drafted in fulfilment of resolution WHA67.9 (2014).

• Cardiovascular disease risk assessment and management was included in the consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection released in November 2015.

Challenges • mixed messages on alcohol and noncommunicable diseases in health sectors and insufficient

resources to support the work on addressing the harmful use of alcohol in noncommunicable diseases settings;

• failure of many countries to put in place WHO FCTC demand reduction measures (mPOWER) at the highest level, though they have the ability to implement strong tobacco control policies;

• tobacco industry interference with tobacco control policies, including lobbying and litigation at the domestic and international levels;

• slow ratification of the WHO FCTC Protocol to Eliminate Illicit Trade in Tobacco Products, which does not allow its entering into force;

• lack of recognition and resources directed towards physical activity as an independent risk factor for noncommunicable diseases, slowing specific progress;

• lack of resources to support major work on salt reduction in the face of competing priorities and conflicting evidence from academia;

• lack of legal capacity in countries for specific obesity prevention strategies (for example, recommendations on marketing of foods and non-alcoholic beverages to children), resulting in slow progress; and

• lack of access to essential medicines and technology for noncommunicable diseases, requiring action from national governments, industry and civil society.

Risks and assumptions

Assumptions Noncommunicable diseases act as key barriers to poverty alleviation and sustainable development, and improving noncommunicable diseases outcomes in countries requires: • moving from political commitment to action by prioritizing high-impact, affordable interventions;

• setting national noncommunicable diseases targets and being accountable for attaining them;

• establishing structures and processes for multisectoral and intersectoral collaboration;

• investment in health systems;


• strengthening institutional and human resource capacities and financial resources for noncommunicable diseases prevention and control;

• adopting a gender, equity and human rights approach;

• combating the deficit of awareness of the benefits of a gender, equity and human rights approach; and

• increasing priority for noncommunicable diseases at the national level and the availability of simple and effective packages to help to raise domestic resources.

Risks (summary based on risks that need immediate remedial action according to risk register) • political and governance risks, including slowness in creating synergies with external and internal

WHO collaborators, resulting in duplication, conflicts and inefficiencies;

• lack of appropriate funding for key areas of technical cooperation at all levels of WHO to address all noncommunicable diseases risk factors and provide management services for the control of noncommunicable diseases leading to inadequate numbers of skilled staff, especially for doing country-level work; and

• lack of adequate resource and technical capacity, with negative impacts on implementation.

Gender, equity and human rights, and social determinants of health Gender, equity and human rights-based approaches were considered in all activities.

Output 2.1.3 Monitoring framework implemented to report on progress in realizing the commitments made in the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases and the Global Action Plan for the Prevention and Control of Noncommunicable Diseases (2013–2020)

Output indicator

Baseline

Target

Achieved value

Number of countries reporting on the nine voluntary targets

27 51 53 of responding countries to 2015 Country Capacity Survey; countries had to have answered “yes” to having system in place for collecting mortality data and indicate that they have done adult risk factor surveys on each of the following in the past five years (i.e. 2010 or more recent): alcohol, physical activity, tobacco, glucose, blood pressure, overweight/obesity and salt (exception for alcohol according to national context)


Support for the implementation of the Global Monitoring Framework for noncommunicable diseases was ongoing during 2014–2015 to enable reporting at country, regional and global levels on progress on the commitments made in 2011 and reiterated in 2014 at the United Nations high-level meetings on noncommunicable diseases and on implementing the Global Action Plan on noncommunicable diseases. WHO produced new tools and guidance on how to measure, calculate and report on the 25 indicators, 9 global targets, and 9 Global Action Plan process indicators, which have been widely disseminated. WHO developed new country-comparable estimates on noncommunicable diseases mortality and key noncommunicable diseases risk factors (tobacco, physical inactivity, overweight and obesity, raised blood pressure and raised blood glucose), and a process of country consultation to agree these new estimates was undertaken in 2014.


In July 2014, WHO launched an updated report on noncommunicable diseases country profiles for 2014. This report included estimates for each country on the current burden of and recent trends in noncommunicable diseases mortality, prevalence of selected major risk factors, and the capacity of national systems to respond to the noncommunicable diseases challenge. The WHO Global status report on alcohol and health 2014 was finalized and launched in 2014. The Global status report on noncommunicable diseases 2014 was also published later that year and launched in January 2015. The WHO cancer country profiles were developed by WHO and launched during the World Cancer Congress in December 2014. Following agreement on the 10 progress indicators that the Director-General will report on by the end of 2017 to the United Nations General Assembly, providing information on the progress achieved in the implementation of the four time-bound commitments included in the 2014 United Nations Outcome Document on noncommunicable diseases, an indicator definition document was developed and published in mid-2015. The 2015 noncommunicable diseases Progress Monitor, launched at the United Nations General Assembly in September 2015, reported on these 10 progress indicators for all Member States. The noncommunicable diseases Progress Monitor drew heavily on data collected in the fifth round of the NCD Country Capacity Survey, which was implemented from May to August 2015. The Country Capacity Survey, to which 177 Member States responded, is a means to monitor countries’ progress and achievements in expanding their capacity to respond to the epidemic of noncommunicable diseases. Results from the Global Survey on Alcohol and Health were analysed in the period and the WHO Global Survey on Progress in Alcohol Policy was conducted. An additional survey on unrecorded alcohol consumption was used to improve the estimation of unrecorded consumption in 42 countries. The Global Information System on Alcohol and Health has been updated and further developed throughout the period. During 2014–2015, 36 Member States were supported by WHO to implement new or repeat surveys using STEPS, and an additional 32 were supported to implement new youth risk factor surveys using the global school-based student health survey approach. Both STEPS and the global school-based student health surveys enabled countries to obtain data to report against their national noncommunicable diseases targets and indicators and the nine voluntary global targets. Support was provided predominantly via technical missions to provide advice, guidance and training to Member States establishing or expanding their adult or youth multi-risk factor surveillance systems. Member States were also supported to conduct topic-specific surveys, such as the Global Youth Tobacco Survey (30 countries) and the Global Adult Tobacco Survey (14 countries).

Achievements and challenges in countries Achievements

• There was increased commitment and engagement of Member States in monitoring the noncommunicable diseases burden and situation, and multiple examples of countries (for example India and South Africa) setting national targets and indicators to monitor and report on the NCD situation at country level, with technical guidance and input from WHO.

• There was increased emphasis in countries on strengthening their national noncommunicable diseases surveillance systems, based on technical tools developed by WHO.

• For 17 countries implementing noncommunicable diseases risk factor surveys using the WHO STEPS approach, the survey represented a ground-breaking first effort for any national NCD surveillance in the country. For roughly half of these countries the surveys have already been completed, and the rest are in the advanced planning stages. In the period 2014–2015, WHO, working in close collaboration with the Centers for Disease Control and Prevention (CDC) Office on Smoking and Health, identified financial resources and trained 30 countries in the conduct of the Global Youth Tobacco Survey. Of these countries, 2 have completed the whole survey cycle, have reported and are using the results for their tobacco control efforts; 7 have completed data collection and are benefiting from extra technical data analysis support; 9 are still in the field; and the remaining 12 are still in the planning phase. In the same period, WHO and the CDC have trained 14 countries to undertake the Global Adult Tobacco Survey. Fieldwork has been completed in 4 of the countries and planning is still under way in the remaining 10 countries. These countries include China, India and the Russian Federation, which between them account for 40% of the world’s smokers. In addition, 7 countries that had undertaken the Global Adult Tobacco Survey in the previous biennium received data analysis capacity-building support and have all reported on the results of their surveys and are using the knowledge created for their tobacco control efforts.


• New country-comparable estimates developed by WHO are available for all countries to understand their baseline for selected noncommunicable diseases risk factors and to help with monitoring future noncommunicable diseases risk factor progress.

Challenges

• Significant challenges still remain, including limited technical capacity in some Member States in the area of noncommunicable diseases surveillance and monitoring; lack of investment in noncommunicable diseases surveillance systems; lack of integration of noncommunicable diseases surveillance into national health information systems; fragmentation of national surveillance systems and some parallel data collection; weak civil registration systems making noncommunicable diseases relevant mortality data difficult to report; lack of national commitments to set up cancer registries; and insufficient data in some countries to establish the national figures for the global targets.

Achievements and challenges at regional and global levels

Achievements • new tools and guidance developed by WHO and made available to support implementation of

monitoring and surveillance activities at country level;

• updated information on noncommunicable diseases trends in mortality and selected risk factors;

• further dissemination of information to help guide and report on progress at regional and global levels, such as the completion of the noncommunicable diseases Country Capacity Survey and the launch of the 2015 noncommunicable diseases Progress Monitor.

Challenges • lack of financial and technical resources to deliver on all commitments;

• competing priorities, leading to difficulty in meeting the growing country demands for nationally representative population-based surveys, such as STEPS, particularly in the area of capacity-building for data management.

•

Risks and assumptions Assumptions

• availability of funds at the national, regional and global levels to support planned activities;

• high level of political commitment to address noncommunicable diseases and their risk factors, as evidenced by appropriate allocation of financial and human capacity for the noncommunicable diseases programme at the country level.

Risks

• lack of resourcing and technical capacity in headquarters, with a negative impact on implementation.

Strategies to address risks

• designation of additional WHO Collaborating Centres in related areas;

• improved coordination with other related programmes and closer linkages to ongoing initiatives to maximize the use of available resources.

Gender, equity and human rights, and social determinants of health Surveillance data are routinely disaggregated by sex, age and other relevant factors, as this provides critically important detail on the burden of noncommunicable diseases.


III. SUMMARY OF FINANCIAL IMPLEMENTATION FOR THE PROGRAMME AREA

2014-2015 (US$ 000) AFRO AMRO SEARO EURO EMRO WPRO HQ Total

WHA approved budget 48,000 13,200 15,900 16,400 16,300 28,200 54,100 192,100

Funds Available (as at 31 Dec 2015)

Flexible Funds 24,052 6,103 9,753 4,917 7,616 11,094 27,420 90,955

Voluntary Contributions Specified 5,830 1,407 2,529 6,861 1,071 8,636 16,852 43,186

Total 29,882 7,510 12,282 11,778 8,687 19,730 44,272 134,141

Funds available as a % of budget 62% 57% 77% 72% 53% 70% 82% 70%

Staff costs 18,646 4,244 4,496 5,339 3,797 7,397 25,506 69,425

Activity costs 9,889 3,226 6,969 5,095 4,816 11,678 13,663 55,336

Total expenditure 28,535 7,470 11,465 10,434 8,613 19,075 39,169 124,761

Expenditure as a % of approved budget 59% 57% 72% 64% 53% 68% 72% 65%

Expenditure as a % of funds available 95% 99% 93% 89% 99% 97% 88% 93%

Staff expenditure by Major Office 27% 6% 6% 8% 5% 11% 37% 100%

Major financial implementation issues that affected programme delivery

• noncommunicable diseases are an underfunded and a relatively new area of health focus. Building capacity at country level remains a challenge and an impediment to achieving the goals of the 2011 Political Declaration on noncommunicable diseases.

• There is limited ability to respond to the increasing burden of noncommunicable diseases.

IV. LESSONS LEARNED AND OUTLOOK FOR 2016–2017 Lessons learned in 2014–2015

• Human and financial resources remain insufficient at national and global levels to tackle the noncommunicable diseases agenda and the challenges posed by local conditions, such as political instability, conflicts, natural disasters and chronic emergencies.

• Noncommunicable diseases are an underfunded and relatively new area of health focus. Building capacity at country level remains a challenge and an impediment to achieving the goals of the 2011 Political Declaration on noncommunicable diseases.

• Integration of noncommunicable diseases in primary health care needs to be enhanced in all settings, but in particular in low- and middle-income countries and countries with emergency situations.

• Partnership with all noncommunicable diseases actors, United Nations agencies and the donor community is key to implementing the Global Action Plan on noncommunicable diseases, and needs to be strengthened.

• Investment is needed in capacity-building at national level for noncommunicable diseases development, programme management and surveillance, but also at all levels of the Organization. WHO capacity at regional and country levels is also inadequate to meet country demand.

• High-level leadership and coordination at national level are key for engaging non-health sectors and optimizing implementation of multisectoral activities to scale up noncommunicable diseases interventions.

• Efforts are needed to streamline noncommunicable diseases -specific surveys into one integrated noncommunicable diseases survey.


• High-level advocacy needs to be sustained to continue to mobilize support and action at all levels.

• Highlighting and promoting successes and champions from outside the health sector (for example finance) and from local government entities (for example mayors) is proving effective in advocating work on noncommunicable diseases and is stimulating engagement.

Impediments due to any outbreak and emergency response, including the response to the Ebola crisis

• Activities related to the management of noncommunicable diseases were delayed during the biennium due to the deployment of staff on the Ebola response. Tobacco control activities in Africa were also impacted for the same reason.

• The Health Promotion Unit supported the Ebola response crisis for three months in 2014–2015, thus affecting regular noncommunicable diseases activities.

Outlook for 2016–2017: planning for the Sustainable Development Goals (SDGs) The following work is under way in category 2 to support countries in three different ways:

1. Providing support to governments to reflect the noncommunicable diseases -related Sustainable Development Goal targets in national development plans and policies.

2. Supporting countries to accelerate progress on noncommunicable diseases -related Sustainable Development Goal targets. In this, WHO is making use of its experience since the first United Nations High-level Meeting on noncommunicable diseases (2011) to help countries move from commitments to action.

3. Making WHO’s policy expertise across the three levels of the Organization on noncommunicable diseases available to governments at all stages of noncommunicable diseases policy development, which are part of national Sustainable Development Goals responses.

Inclusion of the harmful use of alcohol in Sustainable Development Goal target 3.5 on substance abuse, together with narcotic drugs, implies a significant increase in the priority level of WHO activities in this programme area, with significant implications for policies, procedures and practices. Harmful use of alcohol is not only a risk factor for noncommunicable diseases, but also for a broad array of communicable and noncommunicable conditions, with considerable implications for development. Links therefore need to be strengthened with other areas of work, and improvements need to be made not only in prevention coverage, but also in health services response and treatment coverage. The 9th WHO Global Conference on Health Promotion (Shanghai, 21–25 November 2016) will examine the role of health promotion in the implementation of the health-related Sustainable Development Goals. It is expected that the Conference will result in an outcome document that may be endorsed by the World Health Assembly in May 2017.

A roadmap showing how the third United Nations High-level Meeting in 2018 will lead to attaining the global noncommunicable diseases targets for 2025 and the noncommunicable diseases -related Sustainable Development Goal targets for 2030 will be developed. A description of this roadmap is included in document EB138/10. The results will be included in the Director-General’s report to the United Nations General Assembly in September 2017 summarizing the progress made in the implementation of the 2011 United Nations Political Declaration on noncommunicable diseases and the 2014 United Nations Outcome Document on noncommunicable diseases. This report will provide an opportunity to summarize the preliminary progress made in attaining the noncommunicable diseases -related targets in the Sustainable Development Goals.