WHO develops facility-based monitoring system to tackle rising burden of NCDs

Non-communicable diseases (NCDs) such as cardiovascular illnesses, diabetes, respiratory disorders, and cancers have emerged as the greatest threat to human health, causing more than 40 million deaths annually. Low- and middle-income countries shoulder the heaviest burden, with millions dying prematurely between the ages of 30 and 69. In response, the World Health Organization (WHO), working with the Non-Communicable Diseases Research Center at Tehran University of Medical Sciences, the University of Washington, the International Agency for Research on Cancer in Lyon, Kaiser Permanente in Los Angeles, Istanbul University, Chiang Mai University, the University of Calgary, and multiple WHO regional offices across Africa, Asia, the Americas, and Europe, has unveiled a major new framework to track and combat NCDs. The guidance directly supports Sustainable Development Goal (SDG) 3.4, which urges countries to reduce premature mortality from NCDs by one-third by 2030.

The New Language of Indicators

For decades, WHO has promoted technical packages such as PEN for essential interventions in primary healthcare and HEARTS for cardiovascular disease. While valuable, these lacked a unified mechanism for monitoring progress at the facility level. The new framework fills this gap with 81 standardized indicators developed through a rigorous Delphi process involving more than 100 experts and backed by a systematic review of over 1,100 studies. Of these, 22 are classified as core indicators, essential for all settings, while 59 are optional, to be adopted where resources allow.

The indicators cover seven high-burden NCD domains: hypertension and cardiovascular diseases, diabetes mellitus, chronic respiratory diseases including asthma and COPD, breast cancer, cervical cancer, childhood cancers, and general cancers. They are organized around the Donabedian model of healthcare quality: structure (availability of medicines and diagnostic tools), process (screening, treatment, referrals), and outcomes (disease control and survival rates). Examples include ensuring access to blood pressure monitors, assessing glycemic control among diabetic patients, timely referrals for women with suspected breast cancer, and the availability of human papillomavirus tests for cervical cancer screening. Each measure is accompanied by metadata specifying its definition, calculation, frequency, and disaggregation by facility type and patient profile, allowing for comparability across regions and over time.

What the Evidence Shows

The systematic review revealed gaps in the existing literature. While indicators for diabetes and cardiovascular diseases are widely studied, cancer-related measures remain less developed, with only a handful, such as the timeliness of breast cancer treatment and cervical cancer screening positivity, appearing frequently. Cross-cutting indicators, such as reporting timeliness or supervisory visits, rarely feature in published research, underscoring how this WHO guidance is breaking new ground.

By embedding these overlooked dimensions into routine monitoring, the initiative seeks to transform NCD data collection from a fragmented, disease-specific exercise into a cohesive, system-wide practice. In doing so, it provides countries with actionable evidence to identify weaknesses, design interventions, and evaluate outcomes in real time rather than waiting for periodic national surveys.

Why Facility-Based Monitoring Matters

Unlike population surveys, which offer snapshots every few years, facility-based monitoring provides a dynamic, ongoing view of healthcare delivery. It captures the patient journey inside health systems, from initial screening to treatment outcomes. For health ministries, this means the ability to detect bottlenecks, reallocate resources efficiently, and benchmark progress toward global targets. The system is designed to integrate seamlessly with existing WHO technical tools and national health information platforms, including digital health systems such as DHIS-2, making it both scalable and adaptable.

Its modular design ensures flexibility. Countries with limited capacity can begin with the 22 core indicators, focusing on basics such as medicine availability and disease control, while more advanced systems can expand into optional indicators covering complications, secondary prevention, and systemic functions. Over time, the system can also incorporate new domains; dental health is already under consideration. In this way, the framework balances ambition with pragmatism.

Barriers and the Road Ahead

The vision, however, faces steep challenges. Financial constraints in low- and middle-income nations threaten investments in monitoring infrastructure and digital platforms. Data privacy and security concerns loom large, particularly as countries move toward electronic health records. Human resource shortages, with health workers already stretched thin, complicate the collection and analysis of complex datasets. Importantly, two vital areas, patient-reported outcomes and financial data, are not yet included, limiting insights into patient experience and economic sustainability. WHO acknowledges these gaps and has committed to introducing new modules every three to five years to keep the framework updated.

Despite these hurdles, the potential is transformative. By standardizing definitions and methods, the system enables meaningful comparisons across facilities, districts, and nations, paving the way for accountability and shared learning. It also invites stronger public–private partnerships, helping harmonize multiple digital platforms and avoid duplication. If widely adopted, the framework could bring consistency to NCD monitoring worldwide, allowing countries to benchmark progress, identify best practices, and accelerate progress toward SDG 3.4.

Ultimately, the initiative is about reorienting health systems to deliver equitable, patient-centered, evidence-based care. It is designed so that a nurse in Dhaka can reliably track hypertension control, a physician in Kampala can ensure continuity of diabetes treatment, or a woman in Lima can be referred promptly for breast cancer diagnosis. By rooting NCD surveillance in everyday facility operations, WHO hopes to empower countries to transform their fight against the world’s leading killers. It is a call not merely for better data but for stronger, more resilient health systems that put patients first and leave no one behind.