Table 2.

Challenges of GHD for NCDs at the national level

Themes	Subthemes	Challenges	Solutions
Governance at the national level	Engagement	▪ Competition among government sectors ▪ Inadequate engagement of relevant government sectors in formulation and implementation stages	▪ Developing and implementing national NCD plans as a key WHO policy option to strengthen national capacity for NCD prevention and control ▪ Design national campaigns to strengthening partnerships engagement (Like national campaign to reduce salt intake in Thailand’s Bahrain, Kuwait and Qatar; Blood pressure campaign in Iran)
	Prioritization	▪ Complexity of prioritizing and implementing interventions to maximize their impact	▪ Strengthening partnerships both within the health sector (e.g., hospitals, clinics, and ministries/departments of health) and beyond the health sector (e.g., civil society, academia, media, and the private sector).
	Financing	▪ Insufficient funds (no budgetary allocation for NCD interventions, with most interventions being implemented within the health sector budget)	▪ More efficient use of existing resources and development of innovative funding mechanisms instead of creating a new global fund
	Legal Mandates	▪ Differing viewpoints and limited experience of governments in setting new regulations ▪ Lack of clear guidelines for engagement with other sectors	▪ Strengthening the role of the government in NCD prevention, developing multisectoral public policies and legal frameworks to reduce NCD risk factors, and strengthening health systems to respond to NCDS
Health Sector	Ministry of Health	▪ Inadequate access, lack of prevention and health promotion services, and lack of evidence-based interventions and medicines ▪ Power asymmetry, with health ministries and agencies being less powerful within their governments ▪ Lack of an NCD unit in about 50% of the world’s health ministries, and staff lacking key competencies, especially in LMICs ▪ Tendency of the health sectors in all countries to lead in the design and implementation of joint efforts with other sectors after policies are drafted	▪ Improving primacy health care for NCD prevention and treatment of high-risk individuals ▪ Strengthening health systems to address NCDs, including integration of NCD prevention and intervention into primary care; support for low-cost, sustainable prevention programs, including standardized curricula and digital training programs; development of equitable and affordable treatment; advocacy to raise awareness of NCDs through media campaigns
	Nature of NCDs	▪ Multiple diseases encompassing diverse risk factors, treatment regimens, and affected populations	▪ Generating multisectoral evidence
Civil Society	Weak Civil Society	▪ NCDs being neglected by most countries, development agencies, and foundations ▪ Most countries, development agencies and foundations are unaware of industry resistance to change ▪ National and international member societies being dominated by medical professionals and not significantly involving people ▪ Diverse social movements with no clear organizational leader	▪ Strengthening national NCD networks as the main driver of social engagement; ▪ greater focus on advertising via television and Internet