implication for global policy is the need for greater emphasis in donor funding on strengthening health systems so they are better equipped to provide NCD care. Development assistance for health remains substantially skewed toward infectious diseases, which can be more readily prevented and treated through disease-specific programs. Treating NCDs requires patients to have consistent access to a well-coordinated care team and a reliable supply of medications; health systems in most low- and middle-income countries are currently ill-equipped to provide this type of care. Additional donor investments in health system strengthening are one avenue that can help support countries with low levels of domestic spending on health to improve their ability to meet the needs of the growing number of NCD patients.
Conclusion HealthRise was an innovative initiative in many respects – the decision to focus on NCDs, which are still relatively underfunded worldwide; the cross-country design, targeting underserved communities in both the richest country in the world and three low- and middle-income countries; and the utilization of public-private partnerships in each country. Furthermore, grantees were provided substantial flexibility in designing each program, allowing each organization to implement sets of interventions that were highly tailored to the unique challenges of NCD prevention and treatment in nine different contexts. Above all, a significant feature of HealthRise was its emphasis on learning. A broad range of data were collected before, during, and after implementation, to support robust research on what worked well and to understand key challenges encountered. This endline evaluation attempts to synthesize the many lessons learned, highlight the most effective practices, point to key areas for future research, and identify policy priorities to guide future programs and interventions to prevent and treat NCDs worldwide. Among many more detailed findings of this evaluation, HealthRise confirms the major contribution of NCDs to the global disease burden, finding a high prevalence of both these diseases and their leading risk factors in diverse communities in Brazil, India, South Africa, and the United States. Furthermore, weaknesses in the cascade of care are highlighted, with health systems not currently detecting or effectively treating most cases of diabetes or hypertension. The need for strong, well-functioning, and integrated health systems to support complex and ongoing NCD care is confirmed, and the particular benefits of incorporating home visits and having well-coordinated care are demonstrated. Several novel technological and programmatic innovations are tested, pointing to new avenues for research and development on ways to provide more efficient care and make the most of resources available in each health system. Finally, the role of communities underlies the HealthRise model, which emphasized the use of frontline health workers who have a unique connection to communities and specialize in treating disease from a more holistic perspective. The development of NCDs is deeply affected by social and environmental conditions, and combatting NCDs effectively requires health professionals partnering with communities to address social determinants of health, educate patients, instill healthy habits, improve norms around diet and exercise, and provide social support for patients and families coping with complex illnesses.
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