Health workforce implications of integrating NCD prevention, screening and treatment into hospital-based MNCH services: perspectives from Kyrgyzstan, Tajikistan and Viet Nam

Introduction Non-communicable diseases (NCDs), such as cardiovascular disease, cancers, chronic respiratory conditions and diabetes, are responsible for the deaths of 43 million people annually, with 18 million of these occurring prematurely before the age of 70.1 The burden of NCDs is concentrated in low-income and middle-income countries (LMICs), where 82% of premature NCD mortality takes place.1 The challenges that NCDs and their shared risk factors pose to global health and development (economic, social and environmental), along with mental health conditions, were articulated in three United Nations General Assembly high-level meetings on the prevention and control of NCDs.2 These meetings have highlighted the necessity of a coordinated global response to achieve a one-third reduction in premature mortality from NCDs by 2030, through prevention, treatment and promotion of mental health, a key target of the Sustainable Development Goals (SDGs).3 Despite increased global attention over the past two decades, countries’ efforts to prevent and control NCDs and mental health conditions remain insufficient.2 In response, the WHO has scaled up action and intensified its efforts at the global, regional and national levels, promoting a whole-of-government and whole-of-society approach to tackle NCDs and their shared risk factors through a strengthened multisectoral and multistakeholder response and integrated service delivery models, with consideration of specific country contexts. An example of WHO’s work is the project Improving the Quality of Hospital Care to Reduce Maternal, Newborn and Child Deaths and Accelerate the Achievement of the SDG Health Targets (the WHO quality improvement project) in Kyrgyzstan,4 Tajikistan5 and Viet Nam.6 In the lead-up to the fourth high-level meeting on the prevention and control of NCDs in September 2025, there is a growing acknowledgement of the pivotal role played by the health workforce (The term includes emergency, public health, polio, immunisation and other subgroups in the health workforce) in advancing the delivery of quality care and achieving global health targets. A strong health workforce is critical for delivering quality integrated care encompassing promotion, prevention, treatment and rehabilitative services for effective NCD prevention and control.7 Effective integration is crucial to ensure that everyone has access to a comprehensive and coordinated continuum of care that meets their needs across their life course. This integration should include a holistic approach to managing NCDs, focusing on both the prevention of risk factors and the treatment of NCDs. Additionally, NCDs should be integrated with mental health and maternal, newborn and child health (MNCH) services to provide more cohesive and effective care. The argument that a strong, well-trained health workforce is essential to improving the quality of care is not new. Standard 7 of the WHO Standards for Improving the Quality of Maternal and Newborn Care in Health Facilities7 points out the important role of health workers in providing routine care and managing complications. Particularly, the availability, competencies, skills mix, team design and motivation of health workers are deemed critical components. Standard 8 recognises the importance of an enabling environment for health workers to operationalise care integration. The WHO Package of Essential Noncommunicable Disease Interventions for Primary Health Care (WHO PEN)8 recognises the role of a trained workforce and the importance of the availability of and adherence to guidelines and protocols of care to address the prevention and control of NCDs. These frameworks collectively provide valuable insights into the crucial role that the health workforce plays in the health system. This paper aims to analyse health workforce challenges, as well as the factors that support quality integrated care for the prevention and control of NCDs and mental health. The analysis draws on implementation experiences, documented through WHO-supported country assessments conducted in Kyrgyzstan, Tajikistan and Viet Nam. The data presented in those assessments were derived from a mixed-methods approach, including document review of national policies, health information systems and service statistics, as well as semistructured interviews and focus group discussions with policymakers, health managers and frontline health workers. For this manuscript, these country-specific findings were synthesised and supplemented with practitioner insights from global health workforce implementation, enabling the identification of cross-cutting themes and lessons relevant to integrating NCD services into MNCH platforms in LMICs. We identify the common challenges encountered within these three countries, alongside country-specific insights, and propose a series of prerequisites essential for effective integration from the health workforce perspective. We use Donabedian’s quality improvement model to discuss health workforce challenges, considering three major dimensions of care8 9: (a) outcome—reduction of mortality, recovery and survival, and improved patient experience; (b) process—the way systems and processes work to deliver the desired outcome, such as services, diagnostics or treatments and (c) structure—characteristics of the health facility in which care takes place, including the modern protocols of care and treatment guidelines. We chose this framework due to its simplicity and ability to assess the health workforce holistically in shaping both process and structural quality to deliver the desired outcome. Throughout the paper, we stress the importance of adopting a systemic approach and solutions that are context-specific and tailored to the part of the system responsible for addressing health workforce challenges in these countries. We conclude by outlining the direction of future efforts in the NCD health workforce agenda and identifying research priorities to inform the development of comprehensive programmes aimed at integrating NCDs within other areas of health services.