middle-income countries are already overburdened in many cases, yet much can be done even with very limited resources. One view is that the primary purpose of developing a toolkit would be to dispel the myth that the problem is overwhelming and to support countries in navigating the choices.

There are many questions that countries may want to answer as they plan for chronic disease control, a discussant said, and the participants at the workshop offered a number of examples: What are the health aims, or the diseases, or the risk factors that need to be targeted? Which programs should be implemented? Which programs will be effective, feasible, and affordable? What should be the timeframe for developing priorities and planning?

One discussant commented that it is “useful to take a step back and ask ourselves, what is the key factor that is impeding the implementation of NCD programs at the country level that the toolkit should address?” The discussant suggested several possible impediments: the difficulty of getting a line item for specific chronic disease activities in the budget, the need for assistance with how to estimate costs for interventions, or the need for cost-effectiveness evidence for chronic disease interventions that can be used in national dialogue.

Amanda Glassman was particularly interested in the idea of a toolkit that could lead to a costed national plan for chronic disease prevention and control that also includes estimates of impact. Having estimates of the number of lives that could be saved and what it would cost would provide a very powerful policy tool, she said. She noted that it is also important to be able to approach ministers of finance in particular not just with costs but with estimates of economic impacts and potential savings.

Several participants suggested that a focus on a specific disease—or even a focus on a category of diseases, such as communicable diseases or noncommunicable diseases—is too narrow. Many of the actions needed to address one disease or category of diseases are also important for other diseases, one observer noted: strengthening health services, improving health insurance and primary care, and providing more well-trained and motivated health care workers. Another offered a similar comment: “If what goes into the [chronic disease] toolkit is different from what goes into a communicable disease toolkit, we are potentially misallocating resources.” In fact, one goal of a toolkit may be to help countries plan how to coordinate the programs and care they can offer—across population-based programs and individual health services as well as with efforts such as policy changes that need to be implemented outside the health system. However, this is a challenge in part because programs and funding are often organized in “silos.” Sectors that could be working together are often in competition, which undermines the goal of coordination or integration.

One discussant noted that an important goal for the toolkit might be to



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