The investment case as a mechanism for addressing the NCD burden: Evaluating the NCD institutional context in Jamaica, and the return on investment of select interventions

Abstract

Noncommunicable diseases (NCDs) are a broad challenge for decision-makers. NCDs account for seven out of every 10 deaths globally, with 42 percent occurring prematurely in individuals under age 70. Despite their heavy toll, NCDs are underfunded, with only around two percent of global funding dedicated to the disease set. Country governments are responsible for funding targeted actions to reduce the NCD burden, but among other priorities, many have yet to invest in the health-system interventions and policy measures that can reduce the burden. This article examines “investment cases” as a potential mechanism for catalyzing attention to—and funding for—NCDs. In Jamaica, using the UN inter-agency OneHealth Tool, we conducted an economic analysis to estimate the return-on-investment from scaling up strategic clinical interventions, and from implementing or intensifying policy measures that target NCD risk factors. In addition, we conducted an institutional and context (ICA) analysis, interviewing stakeholders across sectors to take stock of promising policy pathways (e.g., areas of general consensus, political appetite and opportunity) as well as challenges to implementation. The economic analysis found that scaling up clinical interventions that target CVD, diabetes, and mental health disorders, and policy measures that target tobacco and alcohol use, would save over 6,600 lives between 2017–2032, and avert JMD 81.3 billion (USD 640 million) in direct and indirect economic costs that result from mortality and morbidity linked to NCDs. The ICA uncovered government economic growth targets and social priorities that would be aided by increased attention to NCDs, and it linked these targets and priorities to the economic analysis.

Tailored support for national NCD policy and programme implementation: an over-looked priority

“…For example, a 2017 investment case developed by the Jamaican government with support from the United Nations Development Program (UNDP) examined the return on investment from scaling up NCD clinical interventions and implementing or intensifying prevention policies. 4 The results showed a potential saving of US$640 million and 6600 lives in Jamaica between 2017 and 2032 from implementing the intervention package. This analysis spurred an immediate response from the government's top echelons to implement the NCD programme to accelerate their ambitious economic growth targets.…”

“…An investment case uses economic and political analysis to provide countries with an evidence-based agenda for implementing NCD policies that provide best value-for-money and is feasible in that country. The process of conducting an investment case has been described elsewhere 4 and involves careful review of existing NCD programmes and policies, discussions with national stakeholders to determine how to augment existing programmes in scale and scope, costing these and calculating return on investment—for population health and the national economy. Each step entails detailed discussions with the Ministry of Health and, importantly, the other ministries that have a stake in the results in relation to the economy, agriculture, industry and education.…”

Invitations and incentives: a qualitative study of behavioral nudges for primary care screenings in Armenia

“…Screening through medical examinations and tests increases opportunities to diagnose hypertension and diabetes, even when individuals are asymptomatic or have mild symptoms. Furthermore, screening of high-risk populations can be cost-effectively delivered in primary care facilities or by community health workers even in LMICs [ 8 , 9 ].…”

Introducing the PLOS special collection of economic cases for NCD prevention and control: A global perspective

“…A simpler modeling approach to measuring the economic impacts of NCDs and the return on investment (ROI) for NCD control is used in Hutchinson et al's case study for Jamaica [5]. The authors combined a quantitative analysis of the benefits and costs of NCD control in Jamaica with a qualitative political economy analysis of government and stakeholder readiness for change.…”