South Asia, home to nearly a quarter of the world’s population, is grappling with the escalating burden of non-communicable diseases. A recent study published in The Lancet Global Health reveals a sobering reality — NCDs such as cardiovascular diseases, diabetes, and cancer have become the region’s leading cause of mortality, overwhelming health systems that were historically focused on combating infectious diseases.
The challenge facing governments across India, Pakistan, Bangladesh, Nepal, and Sri Lanka is not merely one of scale, but of preparedness. While political commitments abound, the capacity of primary health care systems to deliver effective prevention, screening, and management of chronic diseases remains alarmingly inadequate. As the global spotlight shifts toward public health resilience in the post-pandemic era, South Asia must confront the urgent imperative of reorienting its health infrastructure to tackle this growing epidemic.
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NCDs: A public health time bomb
The study highlights a critical issue — South Asian nations have made commendable political commitments to address NCDs, but there is a glaring gap in translating these commitments into effective action. Primary health care systems, the first point of contact for most patients, are insufficiently prepared to manage the prevention, screening, and long-term management of NCDs.
NCDs account for 82% of all deaths in Sri Lanka, 55% in Pakistan, and around 70% in Bangladesh, Nepal, and India. Cardiovascular diseases, the leading cause of NCD mortality, are responsible for over 38% of deaths in Bangladesh. The economic and social costs of NCDs are staggering, particularly for low- and middle-income countries like those in South Asia, where health inequities exacerbate the burden on disadvantaged populations.
The rising incidence of NCDs in South Asia can be attributed to common modifiable risk factors — tobacco use, harmful alcohol consumption, unhealthy diets, and physical inactivity — compounded by rapid urbanisation and industrialisation. For instance, Bangladesh has the highest tobacco consumption rate at 35%, while India reports the lowest physical activity rates, particularly among women, with only 34% engaging in adequate physical activity.
Despite high political commitment to combating NCDs, multisectoral engagement and preparedness remain weak. The region’s health systems face a shortage of skilled human resources, inadequate infrastructure, inconsistent availability of essential medicines, and limited financial resources, all of which severely hamper the implementation of NCD prevention and control programs at the PHC level.
Role of primary health care
Primary health care is a critical entry point for managing NCDs, offering an opportunity for prevention, early detection, and long-term management. The PHC model, rooted in providing continuous, person-centred care, is particularly well-suited for managing the multi-morbidities associated with NCDs. However, PHC systems in South Asia are largely geared toward addressing acute and infectious diseases, leaving a significant gap in NCD care.
Across South Asia, there are efforts to integrate NCD services into PHC, but these initiatives are often small-scale, fragmented, and plagued by systemic challenges. Bangladesh, for example, has emphasised skill-building for health workers, but lacks the infrastructure and resources to ensure the consistent availability of NCD medications. In India, pilot programs have shown promise, such as training Junior Public Health Nurses to manage diabetes in primary health settings. Yet, scaling these programs remains a challenge due to resource constraints and inconsistent policy implementation.
Sri Lanka stands out as an outlier, having implemented more advanced PHC systems that incorporate NCD management. Its early epidemiological transition has allowed it to develop a more robust system for managing chronic diseases, resulting in high NCD mortality but lower premature mortality compared to its neighbours. Nonetheless, even Sri Lanka faces significant challenges in maintaining an uninterrupted supply of medicines and ensuring adequate workforce capacity at the PHC level.
Scaling innovative solutions
The study highlights several promising innovations that could serve as blueprints for scaling up NCD care across South Asia. Community-centric approaches, task-shifting, and the use of information and communication technology (ICT) to extend NCD services to rural and hard-to-reach areas offer feasible solutions. For example, India’s experiments with task-shifting—training community health workers to provide home-based care for cancer patients and conduct NCD screenings—demonstrate the potential for scaling up such models.
Similarly, Bangladesh has prioritised skill-building for front-line health workers and ensuring adherence to treatment protocols. Pakistan’s focus on improving staff supervision and Nepal’s community-based awareness campaigns on NCD risks represent other scalable interventions. However, the biggest barrier to scaling these innovations is the lack of sustained leadership, financing, and coordination across different levels of government and sectors.
To mitigate the growing NCD burden in South Asia, policymakers must take urgent action to reform and strengthen their PHC systems. The study offers five key recommendations:
Governments must back their political will with increased financial investment in NCD care. This includes not only allocating more resources to PHC systems but also ensuring that funds are directed toward building the necessary infrastructure, workforce, and supply chains.
Given that NCDs are influenced by factors beyond the health sector, such as education, agriculture, and urban planning, there is a need for integrated multisectoral action. Governments should adopt a “Health in All Policies” approach to address the social determinants of health that contribute to NCD risk factors.
PHC systems must be redesigned to deliver comprehensive NCD services, from prevention to long-term management. This includes upskilling health workers, task-shifting to community health workers, and ensuring an uninterrupted supply of essential NCD medicines and technologies.
The use of ICT in delivering NCD care to rural and hard-to-reach areas has shown promise. Governments should expedite the adoption of digital health solutions to extend the reach of PHC services and ensure continuity of care for NCD patients.
Reducing vulnerability to NCDs requires action on social determinants such as poverty, education, and access to clean water and nutritious food. Policies aimed at reducing inequality and improving living conditions must be integrated into NCD prevention strategies.
The NCD crisis in South Asia presents an urgent challenge, but also an opportunity for reform. Strengthening PHC systems to integrate NCD care will not only alleviate the burden on tertiary care facilities but also improve health outcomes for the region’s most vulnerable populations. As the study in The Lancet Global Health concludes, the time for action is now—accelerated reform, increased financing, and a commitment to equity are essential to ensuring that South Asia can effectively tackle the NCD epidemic.
The costs of inaction are far too great. Governments, civil society, and international organisations must collaborate to ensure that no one is left behind in the fight against NCDs. A robust, integrated PHC system is the foundation upon which healthier, more resilient South Asian societies can be built.