Translating global commitments on NCDs into national action: the role of civil society.

The inclusion of non-communicable diseases (NCDs) in the UN Agenda 2030 for Sustainable Development, adopted in September, 2015, firmly establishes NCDs as an urgent global health and development priority. With the global prioritisation of NCDs and associated commitments, such as the WHO Global NCD Action Plan 2013–20, in place, the responsibility for action has shifted to the national and regional level. However, progress at the national level has been insufficient and highly uneven, to use the words of the UN SecretaryGeneral Ban Ki-moon. According to the recent WHO NCD Progress Monitor, only 33% of countries have a national NCD action plan or strategy, and only 31% have national NCD targets and indicators. The situation is even bleaker when it comes to resources for NCDs. With only 10 years to achieve the global 25 by 25 NCD mortality reduction goal, what is missing to ensure significant progress over the coming years? Translating global commitments into national action will require political leadership and a whole-of-society approach that engages all sectors in the response. It is our belief that a vibrant and strong NCD civil society movement capable of delivering its three primary roles—advocacy, accountability, and the direct provision of services—is essential to accelerate sustained progress at national and regional levels. Victories in several global health and development issues, particularly HIV/AIDS, have repeatedly reinforced the importance of strong civil society organisations and community-based efforts in accelerating action. Through close connection with communities, civil society organisations provide people affected by NCDs with an essential voice in decision-making processes. Civil society organisations have the ability to raise public demand, and engage with and apply concerted pressure on governments, to ensure that resources and services reach and benefit the affected communities. And, crucially, these organisations hold governments and other sectors to account to make sure they fulfil their duties and deliver their promises. Indeed, investing in civil society should be recognised as part of the global public goods agenda. The NCD civil society movement is relatively young, particularly in low-income and middle-income countries (LMICs). Although many professional societies and disease-specific or risk-factor-specific associations have been active for many years, the decision to unite with other like-minded organisations across the NCD spectrum is relatively new. It was only 6 years ago, after all, that the NCD Alliance was formed at the global level. Working in alliances on complex issues such as NCDs poses many challenges, in part due to the sheer breadth of the agenda and competing interests of constituent members. No one can say it is easy. But as an African proverb reads, “If you want to go fast, go alone; if you want to go far, go together”. By working together and pooling leadership, technical expertise, resources, and networks around a common agenda, the effect of one’s work is multiplied many times over. Testament to both the demand for, and effectiveness of, this unified approach to NCD advocacy is the emergence of a network of national and regional NCD alliances around the world. Over the past 5 years this network has grown dramatically. According to findings of a report published by the NCD Alliance, more than two-thirds of such alliances emerged in the past 5 years; before 2005, there were only three known national NCD alliances, all of which were in high-income countries (figure 1). A major trigger for the formation of these civil society alliances has been global political NCD events, with the 2011 UN High-Level Summit on NCDs referred to by a third of such formations as their impetus for convening, with the Sustainable Development Goal (SDG) process also highlighted as an important factor. There also seems to be a domino effect at the