All the evidence suggests that NCDs are low on the list of health priorities before, during and after humanitarian crises. This is compounded by weak coordination between health actors, little clarity as to where responsibility for health lies (from local up to national level), and a failure in emergencies to focus on anything other than short-term, acute issues. 

Every country should be prepared for disaster – and a preparedness plan will help mitigate the negative impacts, should the worst happen. NCDs must be fully integrated into preparedness, both nationally and internationally. This should also be a core part of planning for and delivering Universal Health Coverage.

Prevention is even less of a priority than treatment of NCDs – but good preparedness should also include consideration of how to prevent those at risk of developing NCDs (and related complications) in an emergency.

Discussion

The definition of ‘preparedness’ is a particular challenge: preparedness for what, for whom, and by whom? It covers community capacity, health system capacity and awareness raising (among local communities and political leaders) and must be contextualised to a range of settings, at the level of the individual, local community, national health system or even globally. The private sector can also be encouraged to integrate NCD prevention measures into its partnerships on NCDs.

International leadership is needed – but there must be national ownership of the plans. A small number of at-risk countries spearheading this approach would demonstrate the difference that effectively executed plans could make in practice.

The plan should be adequately resourced and specify the roles and responsibilities of government, civil society, local communities and other stakeholders. There are lessons to be learnt from the HIV experience. For example, healthsystem resilience increased when there was a switch from requiring patients to access health facilities daily to a system under which larger stocks of medicines could be supplied. This is both more convenient for patients, but also increases the effectiveness of the system when supply chains are temporarily disrupted.

Other strong ideas from the Bootcamp included: 

• a call for partnerships between NGOs, research institutions and donors to trial interventions and identify best practice on improving NCD prevention in at-risk populations, prior to and during humanitarian crises; and 
   
• a call for all humanitarian responses to include NCD prevention and treatment – such as providing healthy food in malnutrition programmes and including sports activities in social programmes.