Improving outcomes for noncommunicable diseases in low- and middle-income countries

By Kenneth A LaBresh

Noncommunicable diseases (NCDs) are the main cause of death worldwide. In addition, the incidence, prevalence, and death rates from NCDs are expected to increase in the future. No single discipline can address the issues of prevention, early detection, access to care, and appropriate treatment that are needed to improve outcomes for NCDs; this growing need will require transdisciplinary collaborations. Improving outcomes in NCDs is clearly a difficult endeavor that will require significant efforts. However, previous research and program implementation indicate that improving outcomes for NCDs is an achievable goal. Given the tremendous impact of NCDs on morbidity, mortality, and costs worldwide, there is little doubt that efforts to improve NDC outcomes are much needed. Recognizing the importance of new strategies and interventions addressing NCDS globally, RTI funded the projects described here to assess how the institute’s range of expertise could be focused on the reduction of NCDs. The projects described in this book focus on the risk factors or treatment (or both) of one or more of the four NCDs that are responsible for the greatest impact on morbidity and mortality: cardiovascular disease, cancer, diabetes, and chronic respiratory diseases. The pilot projects were carried out in low- and middle-income countries, which are disproportionately affected by NCDs. The lessons learned from these initial pilot projects have great potential to be increased in their scale and reduce the devastating impact of noncommunicable diseases.

March 2017: This version contains the following updates to Chapter 4 since the original publication: a copyright notice for the Morisky Medication Adherence Scale has been added to page 67 and to Tables 4.1 and 4.3, and two references have been added, 28 and 29, which caused some renumbering of nearby references. In addition, the words “Mean at” have been removed from the Baseline and 3 Months columns in Table 4.3.


LaBresh, K. A. (Ed.) (2016). Improving outcomes for noncommunicable diseases in low- and middle-income countries. (RTI Press Publication No. BK-0017-1608). Research Triangle Park, NC: RTI Press.

© 2019 RTI International. This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.


This book succinctly summarizes the results of a Grand Challenge project from RTI International. If you are looking for a work long on hand-wringing about the challenges of noncommunicable diseases (NCDs) in low- and middle-income countries (LMICs), this is not for you.

But if you are searching for a series of creative, inspiring, and yet practical approaches that target significant problems for humanity, transcend traditional segmented disciplines, are challenging to implement, but are clearly achievable . . . this book is just what the doctor ordered!

—Gray Ellrodt, MD, Chief of Medicine and Director of the Internal Medicine Training Program, Berkshire Medical Center

The alarm has been sounded. Developing countries are facing major public health challenges with the rapid rise of noncommunicable diseases. Although hidden behind the news headlines and a clearly important focus on the suffering caused by the Ebola and Zika viruses, the alarming and rapid increase in the incidence of chronic diseases in low- and middle-income countries (LMICs) must be addressed by the global health community. This clarion call was highlighted by the United Nations, particularly in its statement that members must ensure healthy lives and promote well-being and, specifically, “by 2030 reduce by one third premature mortality from non-communicable diseases through prevention and treatment.”

RTI International has responded to this evolving crisis by applying its considerable expertise across a range of interventions in several LMICs. The featured pilot projects, launched under a “Grand Challenge” framework, are grounded in the real world of primary health care. They were implemented in collaboration with frontline health care professionals who are grappling with this surge in largely preventable diseases. Effective partnerships will be crucial for meeting the global challenge, and RTI has offered a bold but pragmatic roadmap for future engagement with local practitioners, aimed at addressing this new global health threat and saving lives.

—Aaron Williams, Director of the US Peace Corps (2009–2012), Executive Vice President, RTI International


Kenneth A LaBreshKenneth A. LaBresh, MD, FAHA, is a Senior Fellow at RTI International. He is a clinical cardiologist and health service researcher with a primary interest in evidence-based medicine and health care quality improvement. Dr. LaBresh led the early development of the American Heart Association’s Get With The Guidelines quality improvement program for stroke, heart attack, heart failure, and resuscitation, which is now active in more than half of all US hospitals and is used as a model for similar projects in China, Taiwan, India, and Brazil.

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