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¡°Trouble comes in pairs.¡± This saying rings true with many low- and middle-income countries in East Asia and the Pacific currently facing the twin challenges of dwindling donor funding of health programs and a rapid increase in non-communicable diseases (NCDs).

Thailand has gone through this global trend that most low- and middle-income countries are facing and it¡¯s fitting that Bangkok was the venue for the regional workshop on ¡°When Two Transitions Converge: Integrating Externally-Financed Health Programs While Gearing-Up for Non-Communicable Diseases¡±.

Some 120 participants from 12 countries and 35 agencies at the January 29-30 workshop explored how countries can integrate donor funded health programs into their publicly funded health systems while preparing to confront rapidly advancing NCD challenges.

It¡¯s a daunting task. The disease burden of the four main NCD conditions ¨C cancer, heart and lung diseases, stroke, and diabetes ¨C are forecasted to cause a global loss in economic output of nearly US$ 47 trillion for the period 2011-2030.

¡°This is a huge global loss in economic output,¡± World Bank senior economist Xiaohui Hou said.

Furthermore, NCDs constituted more than half of the entire global burden of disease, but received less than 2% of all international health aid, which means that countries have to provide domestic funds to carry the bulk of the NCD burden.

The two-day event, held as a side meeting of the

(PMAC), was co-hosted by Australia¡¯s Department of Foreign Affairs and Trade (DFAT), Global Fund, Gavi, UHC2030, World Health Organization, and the World Bank.

On top of the challenges of transitioning from external funds to mobilizing domestic resources to prepare their health systems to handle rapidly rising NCDs, low- and middle-income countries also has to work toward an ¡°integrated care¡± system that fuses disease management seamlessly into their frontline service delivery.

This will involve information management, governance, financing and purchasing, outreach and community health. It is a lot of work but an integrated care system is essential for preventing fragmentation in patient services and focuses on frontline health care in contrast to hospital-centric care.

Clearly countries will require substantial organizational reforms to face the epidemiological transition and a ¡°whole system¡± perspective is key when they think about this. Experts advise that when designing any public health program or reform, they have to consider what it will take to adjust their systems and organizations to deliver desired results.

Mickey Chopra, Global Solutions Lead from the World Bank Group, cautioned: ¡°Believing that the existing delivery system is robust enough to absorb incremental tasks is usually the cause of program failure.¡±

And despite the overall reduction in the share of communicable diseases, significant pockets of unimmunized children and populations suffering from malaria, tuberculosis, and HIV/AIDS remain. Thus, in their preparation to face the NCD tsunami, countries transiting out of external financing support will have to use domestic financing to sustain and improve their infectious disease management.

Michael Borowitz, Global Fund¡¯s chief economist, said that these diseases will have to be integrated into countries¡¯ health system platforms along with the NCDs.  Integration is not just about integrating different levels of care, but also integrating vertical diseases.

Making a great impact on NCD outcomes would require a well-coordinated response throughout the health system, but above all ¡°people¡± will have to be the centerpiece of everything.

¡°People will have to be the center of any integrated care system,¡± Malitta Jakab, senior health economist at the World Health Organization Regional Office for Europe, said. ¡°A people-centered multi-profile primary care is a great leapfrogging opportunity in health systems.¡±

While they confront dwindling donor funds and rising NCDs, countries also must not forget their commitment to Universal Health Coverage which allows all individuals and communities to receive the health services they need without suffering financial hardship.

Joseph Kutzin from the World Health Organization health financing team summarized well that countries should think about health financing in terms of UHC goals ¨C ensuring equity in service use, improving quality sufficiently to make a difference, and improving financial protection for all. This may seem a tall order to some but Kutzin argued that no country can fully achieve these objectives and it may be more useful to ¡°think of UHC as a direction, not a destination¡±.