Title: Multi-sectoral partnerships for equitable NCD Care in LMICs: Mobilising capabilities for stronger health systems
Abstract:
Background: Non-communicable diseases (NCDs) disproportionately burden low- and middle-income countries (LMICs), accounting for 77% of global NCD deaths, 86% of premature mortality, and US$7 trillion in economic losses. Reducing NCD care disparities requires public health leaders to mobilise state and non-state actors. Yet evidence explaining how these actors are convened and which leadership approaches are required is limited. This doctoral study examined pharmaceutical-sector initiatives in convening NCD partnerships, identified programme patterns, and developed an equity-focused framework to support public health leaders in advancing collective, measurable, and system-level practices.
Method: The study adapted the Bergen Model of Collaborative Functioning with implementation science constructs. Qualitative mixed methods included document analysis of 95 partnership reports (2023–2025) and 10 semi-structured interviews with global health leaders. Data were coded, triangulated, and thematically analysed in MAXQDA, with >80% second-coder agreement on 10% of data.
Results: Initiatives adopted whole-system engagement, mobilising patient groups, academia, think tanks, governments, and multilateral actors around a common agenda to address rising NCD burden, chronic underinvestment, and fragmented care. Activities spanned workforce capacity, patient empowerment, policy advancement, and digital health, alongside disease-specific pathways from diagnosis to ongoing care. Measurement relied mainly on numeric outputs, including people trained, patients reached, and care models upgraded. The study identified public health leadership as critical to partnership effectiveness and durability. Enablers of effective external partner engagement included: 1) aligning agendas with national health priorities and community needs; 2) co-developing strategies and programme pathways with partners; 3) translating awareness into collective action through consensus-building, policy engagement, and capacity strengthening; and 4) remaining agile in adapting to socioeconomic change. Within organisations, leaders also needed to secure executive sponsorship and focused investment, establish cross-functional coordination, and balance long-term value with frequent planning cycles. Short-termism, excessive policy lobbying, and limited value-based measurement constrained durability. Thematic analysis revealed a gap between stated partnership intent and operational transparency: 59% of coded content focused on conceptual framing (vision, mission, strategy), while only 20% described activities or outcomes. The most frequent theme (16%) was identifying health-system challenges to contextualise partnership value; only 1% referenced committed resources.
Conclusions: Findings surfaced an emerging private sector–convened, pluralistic ecosystem guided by an implicit logic: health equity as the vision, health system strengthening as the objective, and multisectoral collaboration as the mechanism. This fostered common ground among diverse health-system actors, including the private sector, and supported shared agenda-setting, though challenges remained in translating narratives into implementation. The study recommends a mutual value-loop creation model linking health equity, system resilience, and sustainability through three pillars: an equity-anchored vision, dual internal–external endorsement, and impact-focused evaluation. Leadership connects these pillars by institutionalising public health competencies of embedding equity in business strategy, building trust and alignment, securing resources, and translating strategy into measurable local action. This shifts partnerships from fragmented initiatives toward replicable, system-level practices that build stronger health systems and strengthen collective capacity. Capturing industry engagement during peak health equity discourse, this study also provides a reference for assessing whether leadership commitments can withstand growing global health volatility.
