Demand for services for non-communicable diseases (NCDs) and mental health has increased with population growth and ageing, yet financing has not kept pace. Political commitments exist but coverage of essential services remains limited, with progress in reducing out-of-pocket payments stalling as overall government health spending slowed in the 2010s and pandemic-related surges faded. In many settings the macroeconomic outlook has tightened, including higher debt servicing, which constrains sustained investment. Aligning financing with prevention, early detection, treatment and protection from financial hardship is therefore central to improving access. A practical agenda links targeted measures on health taxes and medicines with broader reforms to governance, data and purchasing so budgets translate into equitable and efficient delivery.
Financing Landscape and Priority Levers
Tracking of disease-specific spending is limited, but available estimates indicate essential NCD and mental health services receive only a fraction of required resources, at about 5–10% in low-income countries and 10–30% in lower-middle-income countries. Indicators of service coverage are often worse than for other conditions. Pandemic disruptions added pressure, including adverse effects on population mental health, while health has been deprioritised within government budgets in many countries. Development assistance has grown since 2011 but remains modest relative to overall health aid. Roughly half derives from official development assistance and the rest from philanthropies and other sources, with most funding channelled directly to countries and about 10–20% supporting global functions. Reductions in official aid since 2024 suggest unofficial sources could become relatively more prominent, underscoring the need to strengthen domestic financing anchored in pooled funds, as most resources are for personal health services, rehabilitation and palliative care.
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Seven actions can expand access and protection. National coalitions can raise the profile of NCDs and mental health, sustain advocacy across political cycles and support implementation through partnerships with academic and civil society. Well-designed excise taxes on tobacco, alcohol and sugar-sweetened beverages reduce risk exposure and raise revenue without promoting illicit trade or reducing growth or employment.
Updating tax levels as incomes rise preserves effectiveness, while phasing out subsidies for health-harming products, including fossil fuels, complements taxation but requires careful design to protect lower income households. Reducing the costs of essential medicines is an immediate lever. Prices vary widely due to negotiation practices, procurement approaches, markups and tariffs, increasing burdens on public budgets and patients. Stronger price negotiation using reference tools, pooled procurement in key therapeutic classes and rationalised patient payments, including eliminating or capping copayments for essential medicines where feasible and replacing percentage copayments with low fixed amounts, can lower household uncertainty.
Dedicated funds for high-cost treatments can improve affordability but risk crowding out cost-effective primary care if not carefully structured. Engaging retail pharmacies and ensuring coverage of essential NCD and mental health medicines through pooled schemes require robust regulation, while avoiding unintended consequences such as market exit or quality erosion under aggressive price controls.
Programme funds can finance foundational activities that improve effective coverage, including mass-media campaigns to increase uptake of health promotion and screening, clinical guidelines to support consistent quality and appropriate generic use and training of primary care teams in integrated approaches to NCDs and mental health. Commissioning applied research and supporting policy entrepreneurs can help diagnose implementation barriers and sustain attention to priority reforms.
System Reforms to Convert Budgets into Outcomes
Increasing the overall allocation of general government expenditure to health is a prerequisite for expanding NCD and mental health services. Engagement with finance and planning authorities and legislatures gains credibility when linked to highly cost-effective interventions and to improved access in underserved rural and informal urban areas where marginal benefits are high. Investments in governance and data systems are essential to translate budgets into outcomes. Weak public financial management can leave funds unspent and disrupt service delivery. Modernising health information from fragmented paper records to unified digital platforms enables accountability, longitudinal care for chronic conditions and the analytics required for contemporary provider payment systems. External support can facilitate transitions while local capacity must be developed to design, operate and maintain systems at scale.
Financing reforms that align incentives with prevention, continuity and quality can improve chronic care performance. Contributory insurance schemes often prioritise curative services, rebalancing benefits toward prevention and early treatment can increase uptake of cost-effective interventions. Eliminating copayments that deter necessary care, establishing explicit guarantees for essential services and medicines financed by general budgets and protecting people who lose contributory coverage can strengthen financial protection. Provider payment reforms that move beyond line-item budgets toward mechanisms such as capitation with empanelment, complemented where appropriate by performance payments, can support coordinated, person-centred management across providers and levels of care. These reforms are most effective when implemented alongside digital records, reliable medicine supply and strengthened primary care models.
Development assistance can complement domestic action without displacing national responsibility. Catalytic support can help overcome implementation barriers by supporting advocacy in health legislation, strengthening supply chains and digital transitions for medicines, training health workers in humanitarian settings, piloting integrated chronic care models and building local capacity in health economics and priority setting. Investment in global and regional public goods can develop tools and products that benefit many countries simultaneously, including market-shaping for affordable commodities, standardised instruments to measure service need and coverage and mechanisms to address cross-border threats such as tobacco smuggling and unhealthy product marketing. Leadership, accountability and peer learning can further enhance stewardship and accelerate diffusion of effective approaches.
A combined strategy can align financing with the scale of NCD and mental health need. Coalitions, health taxes, medicine price policies and programme budgets offer near-term gains in access and protection. Increased public spending, stronger governance and modern data systems, and payment models that reward prevention and continuity can consolidate progress. Carefully designed development assistance can catalyse national action and strengthen public goods without substituting for domestic leadership, providing a practical route to expand essential services and protect households.
Source: The Lancet Global Health
