Innovative Financing for NCDs: A New Path to Health Equity in Asia and the Pacific

The Asian Development Bank (ADB), in partnership with PATH South Asia, has presented a compelling working paper titled “Innovative Financing for Noncommunicable Diseases in Asia and the Pacific”. Authored by experts Swati Mahajan, Priyanka Bajaj, Divya Wahi Malik, Rachana Parikh, Jae Kyoun Kim, Eduardo P. Banzon, and Vasoontara S. Yiengprugsawan, this report offers a rigorous examination of how financial innovation can close persistent funding gaps in addressing the region’s growing noncommunicable disease (NCD) burden. Drawing on policy analysis, global case studies, and strategic financial frameworks, the paper is a vital resource for governments, donors, investors, and multilateral agencies focused on strengthening health systems in lower-middle-income countries (LMICs).

NCDs: A Growing Crisis Undermined by Poor Funding

The report opens with a powerful reminder of the scale of the NCD crisis. Globally, NCDs account for about 75% of all deaths, with the Asia-Pacific region shouldering a disproportionate burden. In countries like Kiribati, Papua New Guinea, and Afghanistan, premature mortality rates from NCDs remain alarmingly high. Even in fast-growing economies, urbanization, aging, processed food consumption, and sedentary lifestyles are intensifying the NCD threat. Despite this, NCDs receive minimal financial attention. Only 1% of global development assistance for health was allocated to NCDs in 2020. Meanwhile, national budgets remain focused on infectious diseases, maternal and child health, or emergency responses. The consequences are high out-of-pocket costs, delayed diagnoses, and treatment inaccessibility for many in LMICs. The report argues that traditional public funding and external aid will never be sufficient to meet the scale of this challenge. Instead, a bold shift to innovative financial strategies is urgently needed.

Breaking Down the Innovation: Three Financing Models

ADB’s report introduces a taxonomy of innovative financing based on how funds are generated and used. These models are categorized into three types. Type 1 innovations focus on sourcing additional revenue through unconventional means, such as taxes on tobacco, alcohol, and sugary drinks. Examples include Fiji’s Sugar-Sweetened Beverage Tax and Indonesia’s Tobacco Excise Tax. Crowdfunding and donations from commercial sales also fall under this category. While novel, such models can lack long-term predictability and are often not earmarked for health spending.

Type 2 innovations involve the strategic repurposing of existing funds. This includes performance-based financing or redirecting health budgets toward early detection, prevention, and community outreach. Programs like India’s Ayushman Bharat initiative, which has facilitated over 870 million NCD screenings, and the Philippines’ conditional cash transfer schemes serve as examples of how existing resources can be restructured for impact. However, the report emphasizes that the most transformative approach lies in Type 3 innovations, integrated models that combine new revenue streams with strategic pooling and deployment. These include development impact bonds, microinsurance, blended finance, and public–private partnerships that align financial incentives with public health outcomes.

Blended Finance and Impact Investing on the Rise

Blended finance emerges as a powerful instrument to unlock private capital for public health outcomes. By using concessional funds, such as grants or zero-interest loans, to de-risk investments, these models attract private-sector players who might otherwise avoid entering uncertain markets. In India, the Health for All Bond has leveraged public, donor, and private capital to expand rural NCD care. Thailand’s Health Promotion Fund, sustained by a 2% surcharge on alcohol and tobacco taxes, is another standout model that effectively earmarks funds for preventive care. The report illustrates how blended finance mechanisms are mapped across the life cycle of health projects, from exploratory stages to scale-up, using tools like guarantees, performance contracts, and pooled procurement.

Impact investing also plays a critical role in this new financial architecture. Unlike traditional investments that focus solely on monetary returns, impact investments seek measurable social outcomes. The SDG500 platform, for instance, channels investments into health tech innovations across emerging markets. Microinsurance initiatives, such as those by BRAC in Bangladesh and Telenor’s Tonic in South Asia, are using digital platforms to extend affordable health coverage to underserved populations. These innovations not only improve financial protection but also expand access to early diagnosis and treatment.

Real-World Applications from Across the Globe

The paper profiles 81 financing initiatives, 50 of which have direct implications for NCDs. These range from national programs to subnational pilots and include interventions in cancer care, cardiovascular health, diabetes management, and integrated health systems. Thailand’s 30-baht universal health scheme is credited with reducing rural–urban disparities in healthcare access. India’s e-Sanjeevani teleconsultation platform has supported over 93 million consultations, expanding specialist access in remote areas. In Africa, AstraZeneca’s Healthy Heart Africa and the African Access Initiative showcase how cross-sectoral partnerships can improve hypertension screening and access to cancer medicines.

Pharmaceutical-led market access programs and patient support schemes, like Pfizer’s cost-sharing initiatives or Novartis’s CML Path to Care, further highlight how industry can align with public goals. Meanwhile, philanthropic and government-backed social impact bonds in India, the UK, and Latin America demonstrate how outcomes-based funding can deliver results in maternal health, cancer screening, and chronic disease management.

A Roadmap for Reform: Policy Recommendations

The report concludes with a detailed roadmap that includes short, medium, and long-term policy recommendations. In the short term, countries should scale up WHO’s “Best Buys” such as taxing harmful products and promoting health education. Revenues from such taxes should be earmarked specifically for NCD programs to ensure sustainability and accountability. Over the medium term, the report urges countries to adopt strategic purchasing models, encourage intersectoral collaboration, and invest in digital health infrastructure. Long-term reforms should focus on building integrated financing ecosystems that bring together governments, private investors, donors, and civil society under a shared agenda. Strong governance, transparency, and capacity-building are essential to ensure that these innovations are sustainable, scalable, and equitable.

The report makes a compelling case for financial innovation as a means to confront the under-resourced crisis of NCDs in Asia and the Pacific. Through well-documented global examples and thoughtful frameworks, it shows that mobilizing additional funds is only part of the solution. How those funds are pooled, governed, and deployed strategically will determine whether health systems can truly deliver on the promise of universal coverage and equitable care in the face of this 21st-century health challenge.