The Non-Communicable Disease System Assessment Tool for Identifying Priorities for Investment

Non-communicable diseases (NCDs) impose an increasingly heavy health and economic burden on low- and middle-income countries (LMICs). The World Bank’s investments in NCD management have increased steadily, with the greatest increases occurring in the past decade. A team at the World Bank has developed this NCD system assessment tool for identifying priorities for investment, to assist task-team leaders (TTLs) in the preparation, monitoring, and or restructuring of NCD related projects. The tool’s main focus is on preventing and managing NCDs through a primary health care (PHC) approach, but it also examines the availability of some hospital-based NCD services. The tool evaluates health systems against 43 best practices - practical policies, plans, programs or structures - recommended by global consensus panels or proven to be effective in meta-analyses, systematic reviews and Cochrane reviews. The tool looks for evidence of a strategic approach to managing NCDs, such as: strengthening primary health care, a plan with targets and timeframes for improving NCD care; policies on unhealthy behavior such as smoking, alcohol or unhealthy foods; universal health coverage for core drugs, tests and medical procedures; and intersectoral cooperation to address determinants of health. At the most granular level, it examines the model of care and workflows in primary care for items such as: clear, consistent procedures for screening, a process to ensure all recommended clinical practices are adopted, timely adjustment of medications, process to bring in patients lost to follow-up; triaging and intensive management of high-risk patients; community outreach and home visit services, patient education and self-management supports. To ensure best practices are adopted, the tool also searches for decision support tools, quality improvement teams and examples of successful improvement projects. The tool is intended to do a rapid assessment based on document reviews, key informant interviews and site visits conducted over a brief period.