Health and Finance Leaders Call for Strengthened Primary Health Care to Tackle NCDs and Mental Health
Breast cancer screening in Nigeria
Breast cancer is among the many non-communicable diseases growing in lower-and-middle-income countries, where funding for prevention is often diverted to other health concerns.

When Felicia Knaul met Tonya Rosa, a Mexican woman undergoing chemotherapy for breast cancer, “she was there with a big smile on her face…even though her cancer had recurred.” 

But Rosa told Knaul that her first round of treatment had impoverished her family, “they had to sell their business, their home, their assets to be able to pay for her care.”

But now, she had a card that gives her access to Mexico’s public insurance to cover her treatments.

Rosa’s story was one of many shared at a two-day international financing dialogue for NCDs and mental health hosted by the World Health Organization (WHO) and the World Bank in Washington, DC. The meeting convened as part of the preparation for the United Nations High-Level on these issues in 2025.  

For Knaul, a global health economist, cancer researcher and advocate, providing care for NCDs and mental health patients requires “a health system that could deal with the whole gamut of issues that go through, from primary prevention all the way through to end-of-life care.”

Representatives from over 30 countries reiterated this call for strengthened, affordable health coverage as the means to address NCDs and bolster mental health. 

Adriana Alfonso, Director of Health Surveillance with Uruguay’s Ministry of Health, credits the country’s recent mental health successes to its decree in making psychiatric care obligatory in an affordable and universal manner at health centers. These interventions were only possible through concerted government cooperation and willpower. 

Primary care financing as a sustainable solution

Graphic on NCD financing
Health and finance leaders from over 30 countries met to discuss a path forward to sustainable NCDs and mental health financing.

“In the past, when we prepared annual budgets, we didn’t really take into account the mental health issues. In the case of Uruguay, we have a yearly budget that is discussed at the parliament level, and we needed to make sure that we had a mental health budget that was sustainable,” Alfonso noted. 

Providing dedicated funds for mental health has translated into co-payment reductions and increases in beds in mental health facilities and halfway homes. 

Lester Tan, director of Health Policy, Development, and Planning at the Department of Health in the Philippines, echoed this sentiment in describing the economics of mental health in the Philippines. 

In 2021, mental health conditions cost the Philippine economy an estimated $1.37 billion dollars, equivalent to 0.4% of GDP.  Yet, investing in more treatment of epilepsy and depression would have an incredibly high return on investment – 6.6 and 5.3 times respectively. 

“This evidence, together with the implementation of a mental health law passed in 2018 have contributed to the scaling up of mental health services in the country. There are now 362 mental health access sites nationwide, which have served 124,000 users in 2022,” said Tan.

These mental health successes hinge on expanded financing of primary health care, the “how” of NCDs and mental health care, as a panelist noted.

Tan notes that the Philippines benefitted from expanding the number of health professionals trained in mental health at the primary care level. “This capacity building prioritized depression, epilepsy, self harm and psychosis.”

A multi-sectoral approach to overcome ‘fragmentation’

School girls with caption on primary health care and mental health
Increased primary health care investment has the potential to reduce the global burden of NCDs through prevention, treatment, and care.

Other panelists noted the urgency for multisectoral approaches to financing NCDs and mental health care – working across government institutions and ministries. An NCD expert from the Tunisia Ministry of Health, noted that her ministry recruited the help of the Ministry of Youth, Sport, and Heritage to organize a national day of exercise. 

“During this National Day, everybody was invited to exercise, and we talked about the importance of physical activity. The Ministry of Health decided to do screenings for hypertension and diabetes on this day, and we, of course, had a very large media campaign and awareness raising campaign in the entirety of the country,” she said. 

Beyond the more straightforward partnerships between adjacent ministries, the health sector must work more closely with ministries of finance, noted Aleksandra Altievska, head of fund budgets at North Macedonia’s Ministry of Finance. “I recommend that every Ministry of Health always keep in mind that the Minister of Finance has other priorities.”

Working with ministries of finance to fund NCDs and mental health interventions is critical because, as Joanna Ralston of the World Obesity Federation explained, NCDs are challenges that “can’t be targeted by one sector.”

“We have a global health system that really was built around single vector diseases, just to oversimplify, and yet, now we’re coming in with something that has these commercial elements, [environmental] elements, all these factors, this great level of complexity that that has to be respected,” Ralston said. 

Obesity, as just one example, continues to impact nations across all age levels, because of the fragmentation of the response, said Ralston. “The increase of obesity is around 100% in the past couple of years, when the goal was a 0% increase.” Fragmented, under-resourced responses undermine progress on NCDs and mental health – something that advocates hope can be overcome by renewed multi-sectorial frameworks and partnerships. 

Leveraging patient experiences 

NCD finance conference in Washington, DC June 2024
Several panelists shared their own experiences living with an NCD at the Washington, D.C conference.

Knaul, who founded the Mexico-based breast cancer advocacy organization Cancer de mama: Tomatelo a Pecho, notes that the numbers alone won’t sway policymakers – bringing in patient narratives is paramount to the future of non-communicable disease prevention, treatment, and care. “Health systems repeatedly fail patients with cancer and other NCDs,” she said.

Engaging people with lived experiences of NCDs or mental health challenges bolsters local and international support, argued Charity Muturi, an NCDs and mental health policy advocate in Kenya. 

“When a national task force on mental health was formed, we felt that, as patients, our voices needed to be on the table,” said Muturi, who discussed her own challenges navigating mental health care in Kenya. 

Ralston summed up the struggle with communicating the burden of NCDs and mental health. “Evidence and narrative are what are needed to be successful. We need to be rooted in evidence, but we need to have a way of communicating that story to decision makers, policy makers, and the wider public. And that has been a challenge with NCDs.”

Image Credits: Roche, WHO.

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