Noncommunicable diseases (NCDs), such as heart and lung diseases, stroke, cancer and diabetes, are the number one cause of disability and death over the world. The adverse physical, mental health conditions, social, environmental and economic consequences of NCDs affect all, but particularly poor and marginalised populations.

In India, NCDs are estimated to account for 66% of all annual deaths. Nearly 5.8 million people die from NCDs in the country every year, and one in four Indians are at risk of dying from an NCD before they reach the age of 70. NCDs also account for nearly 17,000 disability-adjusted life years (DALYs) per every 100,000 in India.


The-whole-of-society approach to NCDs

On the other hand, India has made substantial progress in NCD prevention and control. The National Multi-Sectoral Action Plan for Prevention and Control of Common NCDs - 2017-22 (NMAP) provides a blueprint of strategies and actions to achieve the ten national NCD targets by adopting a whole-of-government (all ministries/departments of central and state governments) and whole-of-society (community, civil society organisations, private sector) approach.

It’s becoming more widely recognized that a multi-stakeholder approach will be necessary to tackle a problem as big and as broad as NCDs. But it will also take investment. As in most countries and especially LMICs, NCDs are underfinanced in India. In fact, a 2019 review of recent budget documents of the Central and State governments highlighted that the total expenditure on NCDs and injuries by the two levels of government combined was less than 0.5% of gross domestic product (GDP).

This places a tremendous burden on households, forcing many into financial catastrophe each year. The recently released NCD Alliance policy brief makes reference to the findings of Lancet NCDI Poverty Commission’s in India, among other countries, highlighting that NCDs and injuries (NCDI) require disproportionately higher out-of-pocket spending than infectious diseases and maternal and child health. For instance, between 2017-2018, the mean expenditure by households where someone is living with an NCD in India in public hospitals was US$ 165, which is more than twice as much as households without NCDs (US$ 78). Of the households in India where someone is living with an NCD, around two-thirds faced catastrophic health expenditure.

These findings were reflected during Healthy India Alliance (HIA) community conversations conducted with people living with NCDs, which informed the India Advocacy Agenda. The cost barrier to seeking and continuing NCD care was among the most commonly cited.


The Healthy India Alliance: strengthening the NCD response

The NMAP is up for renewal from 2023, and HIA will leverage this opportunity to make a case for increased investments in NCD prevention and care services. This year, HIA plans to work with the local partner of the NCDI Poverty Network to build its capacity to garner multi-stakeholder support for scaling up investments for NCDs in the country. Given that one of the Poverty Network’s objectives is to examine the state of NCDI financing in the countries where the poorest billion live, HIA aims to decode NCD financing and investment from the perspective of CSOs and people living with NCDs.

HIA is planning to hold a stakeholder engagement event, including Indian representatives of the Lancet NCDI Poverty Network, with a focus on understanding the NCD investment and financing landscape in India. It will identify key players and decision-makers as well as the role of civil society organisations and people living with NCDs in generating a call for action for a substantial increase in financial resource allocation for NCDs across the continuum of care. A briefing note on “Making a case for increased investment for NCDs in India” based on deliberations with key stakeholders involved in NCD financing and community engagement will be developed and released to be disseminated to relevant stakeholders.


Putting people at the centre

With the NMAP, healthcare in India has advanced. However, a people-centric approach is lacking.

To help change this, HIA undertook a situational analysis with a focus on mapping the Universal Health Coverage landscape in India in 2020. Based on this, the India Advocacy Agenda of People Living with NCDs (2020) was developed and released as a part of the HIA partnership with the NCD Alliance to promote meaningful involvement of people living with NCDs in the NCD response, at the subnational, national, and global levels. The India Advocacy Agenda is now a valued document which puts forth the wants and asks of people living with NCDs.

HIA will also leverage the momentum of the Global Week for Action on NCDs, given this year’s theme is ‘Invest to Protect’. HIA envisions that these efforts will garner support from various national, regional and global partners and catalyse multi-pronged action to boost resource allocation for NCDs. This is the need of the hour in order to achieve Universal Health Coverage.

About the authors

Dr Shikha Bhasin is Senior Program Manager at HRIDAY and coordinates the Healthy India Alliance – HIA (India NCD Alliance) activities that foster engagement of multi-sectoral CSOs to address NCDs through meaningful engagement of CSOs, people living with NCDs and young people. She is a public health expert in the field of non-communicable diseases, RMNCH and health system strengthening with a Master’s in Public Health from University of Sheffield.

Ms Radhika Shrivastav is the Senior Director at HRIDAY and leads the Secretariat of the Healthy India Alliance – HIA (India NCD Alliance). She works towards addressing NCDs from a health and development perspective, particularly in the context of Goal 3.4 under the SDGs. She holds two Masters’ degrees in Nutrition and Public Health.