Intended for healthcare professionals

Analysis Solutions for Prevention and Control of Non-communicable Diseases

One size does not fit all: implementation of interventions for non-communicable diseases

BMJ 2019; 367 doi: (Published 06 December 2019) Cite this as: BMJ 2019;367:l6434
  1. João Breda, head1,
  2. Kremlin Wickramasinghe, technical officer1,
  3. David H Peters, professor2,
  4. Ivo Rakovac, programme manager1,
  5. Brian Oldenburg, professor3,
  6. Bente Mikkelsen, director4,
  7. Ruitai Shao, programme manager5,
  8. Cherian Varghese, coordinator5,
  9. Téa Collins, adviser, global coordination mechanism on non-communicable diseases5,
  10. Kristen Wall, intern1,
  11. Jill Farrington, coordinator4,
  12. Nick Townsend, associate professor6
  1. 1WHO European Office for Prevention and Control of NCDs, Moscow, Russia
  2. 2Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA
  3. 3WHO Collaborating Centre on Implementation Research for Prevention and Control of Noncommunicable Diseases, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
  4. 4Division of Noncommunicable Diseases and Promoting Health through the Life-course, WHO Regional Office for Europe, Copenhagen, Denmark
  5. 5World Health Organization, Geneva, Switzerland
  6. 6Department for Health, University of Bath, Bath, UK
  1. Correspondence to: K Wickramasinghe wickramasinghek{at}

Implementation of evidence based interventions for non-communicable diseases is slow in many countries, and João Breda and colleagues call for more support to help them adapt the recommendations to their local context

Non-communicable diseases (NCDs) are recognised to be a major barrier to human health and development, and there have been global policy commitments to prevent and control them.1 Most notably, NCDs were included in the United Nation’s sustainable development goals (SDGs), with a target of reducing premature mortality by a third by 2030.2 However, the current global rate of decline of premature mortality from NCDs is not enough to meet this target.3 This is disappointing as international consensus is that premature mortality from NCDs can largely be avoided if evidence based interventions such as the World Health Organization’s best buys are implemented.345

Country responses to NCDs have been uneven. Although in many instances policies are drafted and in place, countries do not have the capacity to implement the interventions at scale. The focus on preventing and combating NCDs globally must therefore move from gaining policy support to the implementation of this evidence informed policy. The UN and WHO have called for countries to be held accountable for the delivery of outputs and outcomes stated in endorsed documents13 and for ongoing monitoring, surveillance, and reporting.

Contextual factors have hampered implementation in many cases, particularly in low and middle income countries. An intervention or policy needs to fit the specific social, cultural, economic, political, legal, and physical environments in which it is being implemented, as well as the institutional settings if it is to be effective.6 Obtaining context specific technical knowledge for each country, however, is time and resource intensive for both expert bodies and states. Stakeholders from all levels of policy …

View Full Text