Toolkit

for developing a
multisectoral action plan
for noncommunicable
diseases

Module 1.
Conducting a
comprehensive assessment
Toolkit
for developing a
multisectoral action plan
for noncommunicable
diseases

Module 1.
Conducting a
comprehensive assessment
Toolkit for developing a multisectoral action plan for noncommunicable diseases.
Module 1. Conducting a comprehensive assessment
ISBN 978-92-4-004349-7 (electronic version)
ISBN 978-92-4-004350-3 (print version)
© World Health Organization 2022
Some rights reserved. This work is available under the Creative Commons Attribution-
NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO;
https://creativecommons.org/licenses/by-nc-sa/3.0/igo).
Under the terms of this licence, you may copy, redistribute and adapt the work for non-
commercial purposes, provided the work is appropriately cited, as indicated below. In
any use of this work, there should be no suggestion that WHO endorses any specific
organization, products or services. The use of the WHO logo is not permitted. If you adapt
the work, then you must license your work under the same or equivalent Creative Commons
licence. If you create a translation of this work, you should add the following disclaimer
along with the suggested citation: “This translation was not created by the World Health
Organization (WHO). WHO is not responsible for the content or accuracy of this translation.
The original English edition shall be the binding and authentic edition”.
Any mediation relating to disputes arising under the licence shall be conducted in
accordance with the mediation rules of the World Intellectual Property Organization
(http://www.wipo.int/amc/en/mediation/rules/).
Suggested citation. Toolkit for developing a multisectoral action plan for noncommunicable
diseases. Module 1. Conducting a comprehensive assessment. Geneva: World Health
Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris.
Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/
bookorders. To submit requests for commercial use and queries on rights and licensing, see
https://www.who.int/copyright.
Third-party materials. If you wish to reuse material from this work that is attributed to a
third party, such as tables, figures or images, it is your responsibility to determine whether
permission is needed for that reuse and to obtain permission from the copyright holder. The
risk of claims resulting from infringement of any third-party-owned component in the work
rests solely with the user.
General disclaimers. The designations employed and the presentation of the material in
this publication do not imply the expression of any opinion whatsoever on the part of WHO
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps
represent approximate border lines for which there may not yet be full agreement.
The mention of specific companies or of certain manufacturers’ products does not imply that
they are endorsed or recommended by WHO in preference to others of a similar nature that
are not mentioned. Errors and omissions excepted, the names of proprietary products are
distinguished by initial capital letters.
All reasonable precautions have been taken by WHO to verify the information contained in
this publication. However, the published material is being distributed without warranty of
any kind, either expressed or implied. The responsibility for the interpretation and use of the
material lies with the reader. In no event shall WHO be liable for damages arising from its use.
Contents

Acknowledgements v

1. Introduction 1

2. Conducting a comprehensive assessment 3

2.1 Sociodemographic and economic information 3

2.2 Magnitude and trends of NCDs and risk factors 4

2.3 Existing strategies, policies, plans and programmes 6

2.4 Compiling a situation analysis 9

References 11

Resources 11

Annex. MSAP DEVELOPMENT ACTION 12

ACTION 1: Prepare a situation analysis and summary 12
Acknowledgements

Acknowledgements are due to the many individuals who contributed to the

development of this toolkit.
The toolkit was prepared under the overall coordination and technical
guidance of Ruitai Shao, Cherian Varghese and Bente Mikkelsen,
Department of Noncommunicable Diseases, World Health Organization
(WHO).
Special thanks are due to the experts who participated in three
consultative meetings: Jawad Al-Lawati, Department of Noncommunicable
Diseases, Ministry of Health, Oman; Levan Baramidze, Head of Public
Health Department, Ministry of Labour, Health and Social Affairs, Tbilisi,
Georgia; Pascal Bovet, Unit for Prevention and Control of Cardiovascular
Disease, Ministry of Health, Victoria, Seychelles; Deborah Carvalho Malta,
Departamento de Análise de Situação de Saúde, Secretaria de Vigilância
em Saúde, Ministério da Saúde, Brazil; Regina Cheuk Tuen Ching, Assistant
Director of Health (Health Promotion), Centre for Health Protection,
Department of Health, Hong Kong Special Administrative Region (SAR),
China; Jacqueline Choi, Surveillance and Epidemiology Branch, Centre
for Health Protection, Department of Health, Hong Kong SAR, China;
Patrick Shing Kan Chong, Central Health Education Unit, Centre for
Health Protection, Department of Health, Hong Kong SAR, China; Frances
Prescilla L Cuevas, National Centre for Disease Prevention and Control,
Department of Health, Manila, Philippines; Albertino Damasceno, Ministry
of Health, Maputo, Mozambique; Gopalakrishna Gururaj, Professor and
Head of Department of Epidemiology, National Institute of Mental Health
and Neurosciences, Bangalore, India; Vlasta Hrabak-Zerjavic, Head,
Epidemiology of Chronic Diseases Service, Croatian National Institute of
Public Health, Zagreb, Croatia; Lingzhi Kong, Bureau of Disease Control,
Ministry of Health, Beijing, China; Ping Yan Lam, Department of Health,
Hong Kong SAR, China; Ting Hung Leung, Consultant (Noncommunicable
Diseases), Centre for Health Protection, Department of Health, Hong Kong
SAR, China; Barbara Legowski, International Programs, WHO Collaborating
Centre on Chronic Disease Policy, Public Health Agency of Canada, Canada;
David R MacLean, BC Cancer Foundation, Vancouver, Canada; Zhenglong
Lei, Division of NCD Prevention and Control, Bureau of Disease Control,
Ministry of Health, China; Sania Nishtar, Heartfile, Islamabad, Pakistan;
Alfred K Njamnshi, Scientific Networks, Division of Health Operations
Research, Ministry of Public Health, Yaoundé, Cameroon; Nancy Porteous,
Chronic Disease Prevention, Centre for Chronic Disease Prevention and
Control, Public Health Agency of Canada, Ottawa, Canada; Sheela Reddy,
Department of Health, Health Improvement and Prevention, London,
United Kingdom of Great Britain and Northern Ireland; Christina Santos
Samuel, Ministry of Health, Maputo, Mozambique; Nizal Sarrafzadegan,
Director of Isfahan Cardiovascular Research, Isfahan University of
Medical Sciences, Isfahan, Islamic Republic of Iran; Bettina Schwethelm,
Partnerships in Health, Switzerland; Erkki Vartiainen, Department of

v
 Epidemiology and Health Promotion, National Public Health Institute,
Helsinki, Finland; Gonghuan Yang, Chinese Centre for Disease Control and
Prevention, Beijing, China; Dr Yusharmen, Noncommunicable Diseases
Control, Directorate-General of Disease Control & Environmental Health,
Ministry of Health, Indonesia; Joizica Maucec Zakotnik, Countrywide
Integrated Noncommunicable Diseases Intervention Programme,
Community Health Centre, Slovenia; and Juan Zhang, Division of
NCD Prevention and Control, Chinese Center for Disease Control and
Prevention, China.
Thanks are also due to the following experts, who reviewed the toolkit and
provided technical assistance at different stages: Jawad Al-Lawati, Aulikki
Nissinen, Nancy Porteous, Pekka Puska and Sylvie Stachenko.
The following WHO staff (past and present) also contributed to the toolkit:
Robert Beaglehole, Francesco Branca, Patrick Chong, Jean-Marie Dangou,
Mathilde Elizabeth de Bruin, Allisa Deloge, Ibtihal Fadhil, Dongbo Fu,
Gauden Galea, Paolo Hartmann, Barbara Hjalsted, James Hospedales,
Branka Legetic, Sidi Allal Louzani, Chizuru Nishida, Armando Peruga,
Vladimir Poznyak, Gojka Roglic, Natalie Rosseau, Boureima Hama Sambo,
Cherian Varghese, Temo Waqanivalu, Di Wu, Ran Zhang and Yuxi Zhang.
WHO gratefully acknowledges the financial support of the Governments of
Finland, Netherlands and the Republic of Korea towards the development
and publication of this toolkit, as well as that of the Department of Health,
Hong Kong SAR, China and the Public Health Agency of Canada.

vi
 1. Introduction

Noncommunicable diseases (NCDs) are the leading cause of death globally,

killing more people each year than all other causes combined. Contrary to
common perceptions, available data show that nearly 80% of NCD-related
deaths occur in low- and middle-income countries. Moreover, recent
decades have witnessed a steady increase in such deaths, with vulnerable
population groups often worst affected, and yet many of the dire human
and social consequences could be prevented by implementing cost-
effective and feasible interventions.
The Political declaration of the high-level meeting of the General Assembly
on the prevention and control of non-communicable diseases (2011) (1)
recognizes the scale of the NCD crisis and the urgent need for action. The
Global action plan for the prevention and control of NCDs 2013–2020 (2),
recently extended to 2030, provides a vision and a road map to scale up
action for the prevention and control of NCDs.
The global epidemic of NCDs is widely acknowledged as a major challenge
to development in the 21st century and is a significant threat to achieving
the United Nations Sustainable Development Goals. In addition, globally,
the main NCDs represent the greatest cause of death in people aged
under 70 years, imposing years of disability on those affected and their
families. The Global status report on noncommunicable diseases 2014 (3)
highlights the need to intensify national multisectoral action to meet the
global targets that governments have agreed upon and to protect people
from cardiovascular diseases, cancers, diabetes and chronic respiratory
diseases.
Countries, including some that are low income, are showing that it is
feasible to make progress and reduce premature deaths from NCDs.
But that progress, particularly in low- and middle-income countries,
is insufficient and uneven. The global status report of 2014 reveals a
distressing gap in our ability to achieve Sustainable Development Goal
target 3.4 of reducing, by one third, premature deaths from NCDs by 2030,
and outlines the disparities in progress on preventing NCDs worldwide.
This toolkit is a “how to” guide for developing, implementing and evaluating
a multisectoral action plan for prevention and control of NCDs. It is
targeted at policy-makers, planners and programme managers, and is
intended to help countries, provinces and cities meet the requirements
for achieving global and national NCD targets and the Sustainable
Development Goals.
The toolkit takes the user through a series of actions related to the
development of a multisectoral action plan (“MSAP development actions”),
and provides forms and a template framework for users to complete as
they undertake these actions.
Developing a multisectoral action plan involves establishing health needs
and engaging relevant stakeholders before determining the actions to
take, identifying and prioritizing interventions, deciding on ways to address

Toolkit for developing a multisectoral action plan for NCDs. Module 1 1

 NCDs while establishing support and resources for prevention and control,
and evaluating progress in implementing the plan.
Using the toolkit is an inclusive and participatory process that involves
engaging relevant stakeholders before determining the actions to take.
The toolkit focuses on the main NCDs and wider determinants of health
and aims to reduce the premature mortality from NCDs and the negative
impacts of these determinants on health and health inequalities.
This work entails an array of competencies, such as situation analysis,
advocacy, planning, mobilizing, implementing interventions and evaluating
them, and disseminating the results of the evaluation. Users can refer to
programme theory and logic modelling to guide the development of their
action plan. The structure of the toolkit is set out in Fig. 1.1.

Fig. 1.1 Structure of the toolkit for developing a multisectoral action

plan for noncommunicable diseases

Overview

Module 1 Conducting a comprehensive assessment

Establishing stakeholder engagement and

Module 2
governance mechanisms

Module 3 Establishing a framework for action

Module 4 Developing an implementation plan

Evaluating the implementation of a multisectoral

Module 5
action plan

2 Toolkit for developing a multisectoral action plan for NCDs. Module 1

 2. Conducting a comprehensive
assessment

One of the first steps in developing a multisectoral action plan (MSAP) is

to use a situation analysis to provide a comprehensive assessment of the
health needs, prevailing risks and the context of the area to which the plan
will apply. This will help countries, regions, provinces or cities intending to
create a multisectoral action plan to align with the global commitments on
targeting the four major NCDs: cardiovascular disease, diabetes, cancer
and chronic respiratory diseases.
A situation analysis is essentially an information-gathering process to
understand the specifics of the NCD burden in a particular area, as well as
the nature and extent of any activities that may be in place to deal with the
problem. It is therefore a critical component of the development of any
policy, plans and programmes designed to address NCD prevention and
control.
A situation analysis guides the identification of priorities for an action
plan and informs the subsequent steps in the planning process. It should
therefore be conducted before developing an NCD strategy or plan. It
seeks to establish a clear, detailed and realistic picture of the opportunities,
resources, challenges and barriers regarding NCDs and their determinants.
A systematic situation analysis is an essential component of building
the case; it is only through such an analysis that the needs, gaps and
country capacity for, and response to, NCD prevention and control can
be documented and understood. In addition, the results of the analysis
provide the essential baseline data necessary for planning, monitoring and
evaluating any policy or programme interventions.
The quality of the situation analysis will affect the success of the entire
national effort for NCD prevention and control.

2.1 Sociodemographic and economic information

The epidemic of NCDs is being driven by powerful forces, including
demographic ageing, rapid unplanned urbanization, and the globalization
of unhealthy lifestyles. NCDs and their risk factors are unevenly distributed
within populations, and these inequalities need to be considered to ensure
an effective mix of policy solutions is selected.

Population and health indicators

Health indicators are quantifiable characteristics of a population. These
include, but are not limited to, population growth, crude birth rates, age-
adjusted death rates, maternal mortality ratios, female/male populations
and infant mortality rates. Such basic information should be included when
assessing the health status of a population.

Toolkit for developing a multisectoral action plan for NCDs. Module 1 3

 Economic and health indicators
Economic and health expenditure indicators include, but are not limited to,
gross national income (GNI), inflation rate and health expenditure.

Social determinants of health

The social determinants of health are the circumstances in which people
are born, grow, live, work and age, and the systems put in place to deal
with illness. These circumstances are, in turn, shaped by a wide set
of forces that includes economics, social policies and politics. Better
health contributes to increased well-being, education, social cohesion,
environmental protection, increased productivity and economic
development. A “virtuous circle” is thus possible whereby improvements
in health and its determinants feed back into each other, providing mutual
benefits.
NCDs cannot be addressed effectively without action on social
determinants of health. For example, local transport and housing
policies are needed, as are national fiscal, environmental, education and
social policies, along with global financial, trade and agriculture policies.
Understanding and modifying the social determinants of NCDs is crucial to
addressing inequalities in NCDs and in health outcomes between different
social groups.
Social determinants need to be routinely monitored and factored into
policy-making in order to evaluate the impact of policies and change course
when necessary.

2.2 Magnitude and trends of NCDs and risk factors

NCDs have been established as a clear threat, not only to human health,
but also to development and economic growth. NCDs are the leading cause
of death globally, responsible for more than 70% of all deaths. Almost
three quarters of NCD deaths occur in low- and middle-income countries
and, of these deaths, 85% are “premature”: of people aged between 30 and
69 years (4). The disability caused by chronic illness, and the lives lost, are
endangering industrial competitiveness across borders.
The global response to NCDs has included the UN High-level meetings of
2011 and 2018 and the declarations resulting from them (1, 5). In addition,
Sustainable Development Goal target 3.4 commits to reducing, by one
third, premature deaths from NCDs by 2030.
To determine the magnitude of the NCD problem in each country, region,
province or city, the following information is required:
—— mortality rates attributable to each of the four leading NCDs:
cardiovascular disease, diabetes, cancer, and chronic respiratory
diseases;
—— age-standardized rates and gender-specific data concerning mortality
and morbidity;
—— overall premature NCD mortality rates;

4 Toolkit for developing a multisectoral action plan for NCDs. Module 1

 —— prevalence of multiple risk factors in the population, such as unhealthy
diets, harmful use of tobacco and lack of physical activity;
—— further breakdown by ethnicity, income, education, geographical
location (regional or local) to identify highly affected and vulnerable
groups (if available);
—— trends (if available); and
—— overall impact of NCDs on development and social burdens.

Mortality
Mortality data indicate the number of deaths by place, time and cause.
The methodology used to measure mortality depends on the capacity
of the country. Strengthening vital registration is essential to achieving
quality mortality data. However, where vital registration is unavailable,
or inadequate, from the perspective of coverage and/or quality, it is
acceptable to use alternative methods, such as verbal autopsy.

Morbidity
Morbidity data provide important information for the management of
health care systems, in particular the planning and evaluation of service
delivery. They are useful for the estimation of disease burden, gaps in
health system capacity, and the identification of missed opportunities in
prevention. They also provide critical information for the evaluation of
quality of care, and the production of cost estimates of NCDs to the health
system and individuals.
The principal methods for collecting morbidity data include population-
based disease registries, hospital-based registries, cross-sectional surveys,
cohort studies and technology that links records routinely collected by
health and administrative data systems.
Cancer registries are important because cancer type and staging are
critical in the planning of health care services, and to the quality of
care assessment and prevention programmes. For this reason, cancer
registration has been included in the global NCD monitoring framework.
The inclusion of indicators of acute myocardial infarction, stroke, chronic
obstructive pulmonary disease, asthma, diabetes, and kidney and liver
disease will depend on a country’s technical and economic capacity, as well
as the priority assigned to these conditions. Surveys and/or hospital-based
data are recommended for these morbidity indicators.

Data sources
Disease incidence can be assessed through population-based disease
registries and/or hospital-based registries, where feasible. Record linkage
can be used to calculate incidence from routinely collected health and
administrative data systems. Prevalence rates of the main NCD risk factors
can be assessed through WHO STEPS surveys, tobacco surveys or similar
health surveys representative of the national or sub-national levels. Case
fatality and survival rates are derived from statistical analysis of disease
registry and hospital-based data. (See Resources section.)

Toolkit for developing a multisectoral action plan for NCDs. Module 1 5

 Risk and protective factors
NCDs are complex and multifactorial. The main risk factors linked to the
four most prevalent NCDs are:
—— tobacco use
—— unhealthy diet
—— physical inactivity
—— the harmful use of alcohol.
These risk factors have their roots in unhealthy patterns of living, and the
environments where people live, play and work. It is recommended that
the plan takes into account the prevalence of these risk factors.

2.3 Existing strategies, policies, plans and programmes

A critical component of a situation analysis is to gather as much relevant
information as possible to establish a level of understanding of current
activities being undertaken with respect to NCD prevention and control.
Assessing the nature and extent of activities (or the lack thereof) across
sectors is important for a national or regional situation analysis. The
sections below describe the key elements to consider.

2.3.1 Interventions, experience and best practices

A desk review could be conducted to examine the best practices and
experience in prevention and control of NCDs, consistent with the technical
and financial capacity available. This review should seek to:
—— assess the existing evidence-based interventions and experience
in the prevention and control of NCDs, including community-based
programmes;
—— identify procedures and practices used to deliver health services;
—— review the influence of NCDs on economic and social development;
—— identify major issues and key gaps in knowledge, resources and
management that need to be addressed to move forward the national
NCD prevention and control agenda;
—— provide information and guidance on developing, implementing and
evaluating sustainable and effective national NCD prevention and
control policies and programmes; and
—— integrate NCDs and risk factors into master health plans and
synchronize them with well-established programmes such as those
addressing HIV/AIDS and tuberculosis (TB).

2.3.2 National NCD strategies, policies, programmes and plans

An important component of a situation analysis is an examination of
the status of existing NCD-relevant policies, strategies, action plans,
programmes and guidelines. This could include:
—— legislation, regulations and ministerial decrees;
—— overarching national health and development strategies;

6 Toolkit for developing a multisectoral action plan for NCDs. Module 1

 —— use of pre-existing and well-established plans on communicable
diseases, such as HIV/AIDS and TB;
—— polices, strategies, plans, programmes and guidelines formulated and
implemented by the ministry of health in response to NCD prevention
and control;
—— use of a multisectoral action plan for NCDs in existing master or
developmental plans, along with sustained national commitments;
—— policies, strategies, plans and programmes originating in other
government ministries, such as those involved in transportation,
agriculture, education and finance that have significant impact (both
negative and positive) on population health and NCDs; and
—— technical guidelines.

2.3.3 Capacity of the health system for NCD prevention and control
Health service
An assessment of health sector capacity is key to determining its ability
to tackle NCD prevention and control. It is important to consider the
capacities of both the public and the private health sector in relation to
NCD prevention and management. For both, the following components
require assessment:
—— physical and organizational infrastructure
—— appropriate equipment, medicines and technology
—— numbers and extent of training of appropriate personnel
—— availability of practice guidelines for specific NCD conditions and risk
factor management
—— distribution of services and personnel
—— access to services with regard to chronic conditions.
Assessment of primary care services is also required, in terms of:
—— health promotion and primary prevention
—— surveillance
—— management of risk factors
—— treatment of the main NCDs
—— palliative care and home-based care
—— patient education, self-care
—— counselling.

Health information systems

A situation analysis is necessary to assess the extent to which health
information systems can deliver quality data, applicable to the jurisdiction
involved. An assessment of the capacity to use and analyse existing data is
also an important element.
National health information comes principally from the following
resources: a national health reporting system, a disease registry system,

Toolkit for developing a multisectoral action plan for NCDs. Module 1 7

 regular or irregular surveys, and surveillance on mortality or morbidity of
specific diseases or prevalence of risk factors.

Financial resources
A situation analysis should consider the potential sources of financial
resources to support NCD policies and programmes and the potential for
financial and in-kind support from other sectors and stakeholders that
have an interest in health, such as:
—— government departments and agencies
—— international and national NGOs
—— national and international philanthropic organizations
—— research funding agencies
—— health charities
—— private sector, e.g. insurance companies.

Research capacity
A national NCD policy and a plan need to be informed by evidence.
Addressing gaps in this evidence can be greatly assisted by applied, policy-
driven research. A situation analysis should therefore include, as far as
possible, an assessment of research capacity that could potentially be
harnessed to support NCD prevention and control.
A situation analysis can include an assessment of basic clinical,
epidemiological and implementation research, and can target particular
population groups and settings. The analysis should also provide
information on possible gaps in research training, methodology
development and how research results are used and disseminated. In
particular, research capacity includes research on methods and theories
of implementation that can be applied to identify gaps in implementation
of the existing evidence-based interventions, technical guidelines and
barriers, and facilitators. Research can also help to develop implementation
strategies to address these issues in order to improve the implementation.

Community capacity
Assessment of community capacity includes the following areas:
—— public awareness and health literacy with regard to NCD prevention and
control;
—— the existence of supportive networks, for example patient associations;
—— the existence of supportive local environments, for example school
programmes and municipal or local initiatives and facilities, including
recreational facilities;
—— a supply of supportive services, including water supply and sanitation;
—— adequate safety measures in the local environment; and
—— the existence of community leaders and champions to help motivate
behavioural change.

8 Toolkit for developing a multisectoral action plan for NCDs. Module 1

 2.3.4 Responses of non-health sectors
NCD prevention and control requires a range of actors for an effective
response. At the national level, multi-stakeholder collaborations and
partnerships are vital because in most national and local budgets
resources for the prevention and control of NCDs are limited. An
assessment of contributions by non-health sectors to NCD prevention and
control include the following areas:
—— the existence of partnerships or collaborations for implementing key
NCD activities at the national level, such as advocacy and awareness-
raising, financing and resource mobilization, capacity-building, and
product development and innovation;
—— existing mechanisms for cooperation and coordination among relevant
sectors;
—— descriptions of NGOs, private sectors, charitable organizations,
foundations, etc., in terms of their networks, involvement, activities,
contributions, interests and impacts.

2.4 Compiling a situation analysis

This situation analysis is paramount to the success of developing a plan as
it underpins the stakeholders’ assessment of the opportunities, resources,
challenges and barriers regarding NCDs, and the relevance and importance
of the available interventions. Furthermore, the situation analysis serves as
a baseline when monitoring and evaluating the interventions implemented
as a result of the plan.
Before embarking on the process of developinga multisectoral action
plan, the responsible officer therefore needs to gather the necessary
information and provide a summary of the situation – including the NCD
burden, capacity, major socioeconomic policies and the addressing of
health issues in a range of policies. This profile of the country/province/
city should also identify weaknesses, strengths and challenges faced when
reinforcing NCD prevention and control.
A more detailed analysis may be required for a specific programme,
including epidemiological data and national capacity in the area of the
specific programme, and social acceptability for the planned intervention.
For example, in a national tobacco control programme, it is important
to know the prevalence of current smokers in different population
groups. This includes types of tobacco used; advertising and promotion
restrictions; prices of various types of tobacco; existing legislations to
control tobacco, including exposure to second-hand smoke and cessation
practices; the burden of diseases related to tobacco; and national progress
towards the implementation of the WHO Framework Convention on
Tobacco Control (FCTC).

MSAP DEVELOPMENT ACTION 1: Prepare a situation analysis

and summary

Toolkit for developing a multisectoral action plan for NCDs. Module 1 9

 Key messages

—— Teams developing a multisectoral action plan for NCDs should include

the four main NCDs in their plan: CVD, diabetes, cancer, and chronic
respiratory disease.
—— A situation analysis of the NCD burden and activities that may be in
place to deal with the problem is a critical component of developing a
country action plan.
—— Age- and sex-specific data concerning mortality and morbidity are the
mainstay of information systems to determine the size of the NCD
burden. Wherever possible, data should be analysed by socioeconomic
status, ethnicity and other relevant variables to assess inequalities in
NCDs.
—— The population prevalence of NCD risk factors, including unhealthy
diets, use of tobacco, harmful use of alcohol and lack of physical activity,
must be considered.
—— A critical component of a situation analysis is to gather information
on current activities, master health plans, development plans, and
individual health plans being undertaken, and to integrate NCDs and
their risk factors into those ongoing responses.
—— In order to harness the collective capacity of all stakeholders who have
an influence on a community’s determinants of health, it is important to
identify them.
—— A situation analysis provides essential baseline data necessary for the
planning, monitoring and evaluation of any policy and programme
intervention.
—— A situation analysis needs a summary of all information gathered.

10 Toolkit for developing a multisectoral action plan for NCDs. Module 1

 References
1. Political declaration of the high-level meeting of the General Assembly on the
prevention and control of non-communicable diseases. New York: United Nations; 2011
(A/RES/66/2; https://digitallibrary.un.org/record/720106, accessed 1 November 2021).
2. Global action plan for the prevention and control of NCDs 2013–2020. Geneva: World
Health Organization; 2013 (https://apps.who.int/iris/handle/10665/94384, accessed 1
November 2021).
3. Global status report on noncommunicable diseases 2014. Geneva: World Health
Organization; 2014 (http://apps.who.int/iris/handle/10665/148114/, accessed 1
November 2021).
4. Noncommunicable diseases: key facts [website]. World Health Organization
(https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases,
accessed 1 November 2021).
5. Political declaration of the third high-level meeting of the General Assembly on the
prevention and control of non-communicable diseases. New York: United Nations;
2018 (A/RES/73/2; https://digitallibrary.un.org/record/1648984, accessed 1 November
2021).

Resources
Blas E, Sivasankara Kurup A, editors (2010). Equity, social determinants and public health
programmes. Geneva: World Health Organization
(https://apps.who.int/iris/handle/10665/44289).
Commission on Social Determinants of Health (2008). Closing the gap in a generation:
health equity through action on the social determinants of health. Final report: executive
summary. Geneva: World Health Organization (WHO/IER/CSDH/08.1;
https://apps.who.int/iris/handle/10665/69832).
UN (2011). Political declaration of the high-level meeting of the General Assembly on the
prevention and control of non-communicable diseases. New York: United Nations (A/
RES/66/2; https://digitallibrary.un.org/record/710899/?ln=en).
UN (2018). Political declaration of the Third High-level Meeting of the General Assembly
on the Prevention and Control of Non-communicable Diseases. New York: United
Nations (A/RES/73/2; https://digitallibrary.un.org/record/1648984?ln=en).
WHO. Global Health Observatory (GHO) [online database]. Geneva: World Health
Organization (https://www.who.int/data/gho/data/themes/noncommunicable-diseases).
WHO. Health accounts [online resource]. Geneva: World Health Organization
(https://www.who.int/health-topics/health-accounts#tab=tab_1).
WHO. Social determinants of health [website]. Geneva: World Health Organization
(https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1, accessed 1
November 2021).
WHO. STEPwise approach to NCD risk factor surveillance (STEPS) [online tool] (https://
www.who.int/teams/noncommunicable-diseases/surveillance/systems-tools/steps).
WHO (2008). 2008–2013 Action plan for the global strategy for the prevention and
control of noncommunicable diseases. Geneva: World Health Organization
(https://www.who.int/nmh/publications/ncd_action_plan_en.pdf).
WHO (2013). Global action plan for the prevention and control of noncommunicable
diseases 2013–20. Geneva: World Health Organization (https://apps.who.int/iris/
handle/10665/94384).
WHO (2018). Time to deliver: report of the WHO Independent High-level Commission on
Noncommunicable Diseases. Geneva: World Health Organization (https://apps.who.int/
iris/handle/10665/272710).
WHO (2019). Global health estimates [online database]. Geneva: World Health
Organization (https://www.who.int/data/global-health-estimates).

Toolkit for developing a multisectoral action plan for NCDs. Module 1 11

 Annex. MSAP DEVELOPMENT ACTION

✤✤ Download the MSAP template and forms here.

ACTION 1: Prepare a situation analysis and summary

✤✤ Step 1: Gather the information you need for a situation analysis
—— Form 1.1 provides a structure for recording the information.

✤✤ Step 2: Describe the status of NCDs within your remit and

outline a suitable response
—— Identify challenges and opportunities to tackle the NCD epidemic.
—— Write up your report. A suggested structure is outlined below.

Suggested structure for a situation analysis and summary

Profile of area
—— Describe the status of the population and provide the main health
indicators.
—— Describe the status of economic and health expenditure.

Status and trends of NCDs and their determinants

—— Provide information on the status and trends of NCDs, including
mortality and morbidity, and the prevalence of their risk factors.
—— List the main NCDs and common risk factors.
—— Provide the premature death rate (30 to 70 years old) from NCDs.
—— List the social determinants for NCDs.

Current responses and commitments

—— Put your MSAP in context by including reference to:
ooglobal NCD strategies, targets, action plans, and monitoring
frameworks;
ooregional NCD action plan/framework;
oonational efforts to tackle NCDs including NCD strategies, action plans,
and programmes;
oohealth system readiness: the availability of health infrastructures
related to NCDs, including public health institutes, health service
delivery for NCDs, health information, financial resources and human
health resources; and
oothe response of the non-health-sector, private sector and NGOs to the
NCD epidemic.

12 Toolkit for developing a multisectoral action plan for NCDs. Module 1

 Summary of findings and proposals for action
—— Identify the most important risk factors.
—— Describe barriers and challenges to tackling NCDs and their
determinants.
—— Identify key gaps in existing policies, actions and research for NCD
prevention and control.
—— Propose ways in which the MSAP could reduce premature mortality and
result in a healthier population.

CHECKLIST
✤✤ Use the Checklist available here to make sure you have
completed all the necessary steps before moving on to the next
module.

Toolkit for developing a multisectoral action plan for NCDs. Module 1 13

Department of Noncommunicable Diseases
World Health Organization
20 Avenue Appia
1211 Geneva 27
Switzerland
https://www.who.int/teams/noncommunicable-diseases