EClinicalMedicine (Jul 2025)
World health Organization’s guidance for tracking non-communicable diseases towards sustainable development goals 3.4: an initiative for facility-based monitoringResearch in context
- Arlene Quiambao,
- Mohammad-Reza Malekpour,
- Ali Golestani,
- Mahsa Heidari-Foroozan,
- Seyyed-Hadi Ghamari,
- Mohsen Abbasi-Kangevari,
- Benjamin O. Anderson,
- Prebo Barango,
- Elena Fidarova,
- Bianca Hemmingsen,
- Andre Ilbawi,
- Taskeen Khan,
- Roberta Ortiz Sequeria,
- Gojka Roglic,
- Sarah Rylance,
- Felipe Roitberg,
- Leanne Riley,
- Slim Slama,
- Lubna Bhatti,
- Melanie Cowan,
- Patricia Rarau,
- Stefan Savin,
- Farshad Farzadfar,
- Kouamivi Mawuenyegan Agboyibor,
- Ashutosh N. Aggarwal,
- Oyetayo Akala,
- Chaisiri Angkurawaranon,
- Hong Anh Chu,
- Ranjit Mohan Anjana,
- Carmen Antini,
- Zeba Aziz,
- Shannon Barkley,
- Abdul Basit,
- Partha Basu,
- Sara Benitez Majano,
- Kazi Bennoor,
- Jeffrey W. Brettler,
- Neslihan Cabioglu,
- Roberta Caixeta,
- Norman Campbell,
- Carolina Chavez,
- Sohel Reza Choudhury,
- Marilys Anne Corbex,
- Alvaro Cruz,
- Nemdia Daceney,
- Shona Dalal,
- Goodarz Danaei,
- Jean-Marie Dangou,
- Wouter De Groote,
- Cheick Bady Diallo,
- Issimouha Dille,
- Rolando Enrique Domingo,
- Gampo Dorji,
- Brucel B. Duncan,
- Uzochukwu Egere,
- Hicham El Berri,
- Asma El Sony,
- Mai Eltigani,
- Jill Farrington,
- Heba Fouad,
- Paola Friedrich,
- Soad Fuentes-Alabi,
- Angelo Gamarra,
- Edward Gregg,
- Reena Gupta,
- Sumit Gupta,
- Weiping Jia,
- Evelyn Jiagge,
- Pekka Jousilahti,
- Ratnasabathipillai Kesavan,
- Somesh Kumar,
- Tiina Laatikainen,
- Bagher Larijani,
- Maria Lasierra Losada,
- Tuyet Lan Le Thi,
- Naomi Levitt,
- Sylvana Luciani,
- Mauricio Maza,
- Bente Mikkelsen,
- Yousser Mohammad,
- Andrew Moran,
- Ali Motlagh,
- Stephen Mulupi,
- Raul H. Murillo,
- Miriam Mutebi,
- Rebecca Nantanda,
- Moffat Nyirenda,
- Patrick O’Connor,
- Dike Ojji,
- Gertrude Edna Omoro,
- Dolores Ondarsuhu,
- Pedro Ordunez,
- Mohamed Ould Sidi Mohamed,
- Mayowa Owolabi,
- Kazem Rahimi,
- Ivo Rakovac,
- Joao Filipe Raposo,
- Andres Rosende,
- Jane Rowley,
- Rengaswamy Sankaranarayanan,
- Vitaly Smelov,
- Josaia Tiko,
- Marcello Tonelli,
- Elena Tsoyi,
- Todd Tuttle,
- Cherian Varghese,
- Liliana Vásquez,
- Kavitha Viswanathan,
- Hongyi Xu,
- Cheng-Har Yip
Affiliations
- Arlene Quiambao
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Ali Golestani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Mahsa Heidari-Foroozan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Seyyed-Hadi Ghamari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Benjamin O. Anderson
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland; University of Washington, Seattle, WA, USA
- Prebo Barango
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Elena Fidarova
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Bianca Hemmingsen
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Andre Ilbawi
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Taskeen Khan
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Roberta Ortiz Sequeria
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Gojka Roglic
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Sarah Rylance
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Felipe Roitberg
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Leanne Riley
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Slim Slama
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Lubna Bhatti
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Melanie Cowan
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Patricia Rarau
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Stefan Savin
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Farshad Farzadfar
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland; Corresponding author. Surveillance, Monitoring and Reporting Unit, Department of Noncommunicable Diseases, World Health Organization, Switzerland.
- Kouamivi Mawuenyegan Agboyibor
- Communicable and Noncommunicable Diseases Cluster, WHO Regional Office for Africa, Brazzaville, Congo
- Ashutosh N. Aggarwal
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
- Oyetayo Akala
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Chaisiri Angkurawaranon
- Chiang Mai University, Chiang Mai, Thailand
- Hong Anh Chu
- Department of Data and Analytics, WHO, Geneva, Switzerland
- Ranjit Mohan Anjana
- Dr Mohan’s Diabetes Specialities Centre, Chennai, India
- Carmen Antini
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Zeba Aziz
- Hameed Latif Hospital, Lahore, Pakistan
- Shannon Barkley
- Special Programme on Primary Health Care, WHO, Geneva, Switzerland
- Abdul Basit
- Diabetic Association of Pakistan, Karachi, Pakistan
- Partha Basu
- Early Detection, Prevention, and Infections Branch, International Agency for Research on Cancer, Lyon, France
- Sara Benitez Majano
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Kazi Bennoor
- National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
- Jeffrey W. Brettler
- Kaiser Permanente, Los Angeles, United States of America
- Neslihan Cabioglu
- Istanbul University, Istanbul, Türkiye
- Roberta Caixeta
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Norman Campbell
- University of Calgary, Calgary, Canada
- Carolina Chavez
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Sohel Reza Choudhury
- National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh
- Marilys Anne Corbex
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
- Alvaro Cruz
- Universidade Federal de Bahia, Salvador, Brazil
- Nemdia Daceney
- Expertise France, Paris, France
- Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, WHO, Geneva, Switzerland
- Goodarz Danaei
- Harvard T.H. Chan School of Public Health, Boston, United States of America
- Jean-Marie Dangou
- Communicable and Noncommunicable Diseases Cluster, WHO Regional Office for Africa, Brazzaville, Congo
- Wouter De Groote
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Cheick Bady Diallo
- Communicable and Noncommunicable Diseases Cluster, WHO Regional Office for Africa, Brazzaville, Congo
- Issimouha Dille
- Communicable and Noncommunicable Diseases Cluster, WHO Regional Office for Africa, Brazzaville, Congo
- Rolando Enrique Domingo
- Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific, Manila, Philippines
- Gampo Dorji
- Division of Healthier Populations and Noncommunicable Diseases, WHO Regional Office for South-East Asia, New Delhi, India
- Brucel B. Duncan
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Uzochukwu Egere
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Hicham El Berri
- Division of Noncommunicable Diseases, WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
- Asma El Sony
- Epidemiological Laboratory for Public Health Research and Development, Khartoum, Sudan
- Mai Eltigani
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Jill Farrington
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
- Heba Fouad
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Paola Friedrich
- St Jude Children’s Research Hospital, Memphis, United States of America
- Soad Fuentes-Alabi
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Angelo Gamarra
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Edward Gregg
- Imperial College London, London, United Kingdom
- Reena Gupta
- University of California San Francisco, San Francisco, United States of America
- Sumit Gupta
- Hospital for Sick Children, Toronto, Canada
- Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- Evelyn Jiagge
- Henry Ford Cancer Institute, Detroit, United States of America
- Pekka Jousilahti
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
- Ratnasabathipillai Kesavan
- Division of Healthier Populations and Noncommunicable Diseases, WHO Regional Office for South-East Asia, New Delhi, India
- Somesh Kumar
- Jhpiego, Baltimore, United States of America
- Tiina Laatikainen
- Institute of Public Health and Clinical Nutrition, Faculty of Medicine, University of Eastern Finland, Helsinki, Finland
- Bagher Larijani
- Tehran University of Medical Sciences, Tehran, Iran
- Maria Lasierra Losada
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
- Tuyet Lan Le Thi
- Viet Nam Respiratory Society, Hanoi, Viet Nam
- Naomi Levitt
- University of Cape Town, Cape Town, South Africa
- Sylvana Luciani
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Mauricio Maza
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Bente Mikkelsen
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Yousser Mohammad
- Latakia University, Latakia, Syria
- Andrew Moran
- Resolve to Save Lives, New York, United States of America
- Ali Motlagh
- Shahid Beheshti Medical University, Tehran, Iran
- Stephen Mulupi
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Raul H. Murillo
- Pontificia Universidad Javeriana, Bogotá, Colombia
- Miriam Mutebi
- Aga Khan University, Karachi, Pakistan
- Rebecca Nantanda
- Makerere University Lung Institute, Kampala, Uganda
- Moffat Nyirenda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Patrick O’Connor
- HealthPartners Institute, Bloomington, United States of America
- Dike Ojji
- University of Abuja, Abuja, Nigeria
- Gertrude Edna Omoro
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Dolores Ondarsuhu
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Pedro Ordunez
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Mohamed Ould Sidi Mohamed
- Communicable and Noncommunicable Diseases Cluster, WHO Regional Office for Africa, Brazzaville, Congo
- Mayowa Owolabi
- University of Ibadan, Ibadan, Nigeria
- Kazem Rahimi
- University of Oxford, Oxford, United Kingdom
- Ivo Rakovac
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
- Joao Filipe Raposo
- APDP-Diabetes Portugal, Lisbon, Portugal
- Andres Rosende
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Jane Rowley
- Global HIV, Hepatitis and STIs Programmes, WHO, Geneva, Switzerland
- Rengaswamy Sankaranarayanan
- Karkinos Healthcare, Bengaluru, India
- Vitaly Smelov
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
- Josaia Tiko
- Division of Programmes for Disease Control, WHO Regional Office for the Western Pacific, Manila, Philippines
- Marcello Tonelli
- University of Calgary, Calgary, Canada
- Elena Tsoyi
- Special Initiative on Noncommunicable Diseases and Innovation, WHO Regional Office for Europe, Copenhagen, Denmark
- Todd Tuttle
- University of Minnesota Health Clinics and Surgery Center, Minneapolis, United States of America
- Cherian Varghese
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
- Liliana Vásquez
- Department of Noncommunicable Diseases and Mental Health, WHO Regional Office for the Americas, Washington, DC, United States of America
- Kavitha Viswanathan
- Consultant to the World Health Organization, Geneva, Switzerland
- Hongyi Xu
- Department of Noncommunicable Diseases, Rehabilitation and Disability, WHO, Geneva, Switzerland
- Cheng-Har Yip
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
- DOI
- https://doi.org/10.1016/j.eclinm.2025.103304
- Journal volume & issue
-
Vol. 85
p. 103304
Abstract
Summary: Background: Non-communicable diseases (NCDs) account for over 60% of annual global deaths, disproportionately affecting low- and middle-income countries. This trend undermines progress toward Sustainable Development Goal (SDG) 3.4, which seeks to reduce premature mortality from NCDs by one-third by 2030. Despite the availability of effective and relatively affordable interventions, addressing NCDs requires sustained, coordinated efforts and robust monitoring systems. Facility-based monitoring offers a dynamic alternative to static surveys, enabling continuous assessment of healthcare quality and utilization. Methods: This study followed a systematic approach to develop standardized global and national NCD monitoring indicators, using the Donabedian model as a conceptual framework. It focused on four major NCD categories: hypertension and cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases, and cancers. The methodology included systematic scoping reviews from inception up to November 2021 and a multi-round Delphi process involving global experts to assess the validity and feasibility of proposed indicators. This study was funded internally by WHO. There were no payments to participants. Findings: The final output consisted of 81 validated indicators—22 core and 59 optional. These indicators demonstrated high feasibility and relevance for facility-based monitoring of NCD service delivery. They provide actionable metrics for assessing and improving the quality of care across diverse health system settings. Interpretation: This study highlights the urgent need for comprehensive, context-sensitive NCD monitoring frameworks. The proposed set of indicators offers a validated foundation for improving NCD care delivery and aligns with efforts to achieve SDG target 3.4. Ongoing updates and local adaptations will be essential to ensure continued relevance and effectiveness. Funding: This study was funded internally by WHO.
Keywords
- Noncommunicable diseases
- Health information systems
- Quality indicators
- Primary health care
- Delphi technique
- World Health Organization
