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Analysis Solutions for Prevention and Control of Non-communicable Diseases

Asking the right question: implementation research to accelerate national non-communicable disease responses

BMJ 2019; 365 doi: (Published 20 May 2019) Cite this as: BMJ 2019;365:l1868
  1. David H Peters, professor1,
  2. Michael A Peters, doctoral student1,
  3. Kremlin Wickramasinghe, technical officer2 ,
  4. Patrick L Osewe, chief health sector expert3,
  5. Patricia M Davidson, dean4
  1. 1Johns Hopkins University Bloomberg School of Public Health, USA
  2. 2World Health Organization European Office for Prevention and Control of NCDs, Russian Federation
  3. 3Asian Development Bank, Philippines
  4. 4Johns Hopkins University School of Nursing, Secretariat, World Health Organization Collaborating Centres of Nursing and Midwifery, USA
  1. Correspondence to: D H Peters, dpeters{at}

Non-communicable disease programmes can be strengthened by systematically identifying implementation challenges and translating them into questions that can be answered through appropriate research, say David H Peters and colleagues

Faced by the global growth of non-communicable diseases (NCDs), national governments are finding ways to develop, finance, and respond to protect their people’s health.1 The 2018 United Nations General Assembly high level meeting on NCDs set an agenda from strategy to action.2 Each country faces challenges in implementing NCD policies, programmes, and interventions effectively. This is particularly difficult in countries where there are limited data about NCDs, and where resources are limited. For example, many of the “best buys” in NCDs have not been assessed in low and middle income countries, which are facing an abrupt rise in the burden of these diseases.3 Implementation research provides a useful set of theories, approaches, and tools to turn strategies into implemented programmes. It creates solutions in a wide variety of settings.456 This article examines ways to identify implementation bottlenecks and opportunities and translate these into questions about policy that can be answered through research.

Many governments have developed national NCD policies and strategies since the World Health Organization’s global action plan was adopted.1 These plans recognise that many NCDs are strongly influenced by social determinants of health and have major social, political, and economic consequences. Each country is concerned whether their NCD plans will achieve ambitious targets. In many instances this requires challenging not only social norms but also business and policy to deal with social determinants of health. Building capacity to work across public and private sectors and overcoming vested interests for the common good are not easy tasks.

There are many barriers to carrying out NCD plans. Overcoming these barriers may require organisational change, …

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