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Table 1 Challenges of GHD for NCDs at the international level

From: Opportunities and challenges of global health diplomacy for prevention and control of noncommunicable diseases: a systematic review

Themes Subthemes Challenges Solutions
Global Health Governance Evidence Support ▪ Insufficient scientific research
▪ Many countries lack the necessary technical expertise, resources, research capacity, and data required to overcome NCD challenges
▪ GHD negotiations depend upon clinical or epidemiological evidence, and the quality or type of the evidence can limit or expand policy options
▪ Potential differences between national and global priorities
▪ Lack of informations and input from LMICs in stakeholder negotiations
▪ Creating an evidence base through focused primary research that involves all stakeholders and affects the infrastructural challenges to global NCD policy and governance
▪ Combining existing resources and skills in order to negotiate access to the expertise necessary to support effective planning
▪ The need for technical support, training, strengthening scientific research, and capacity building initiatives
▪ Holding workshops
▪ Using from marketing and business media, magazines, and NGO reviews for complementary desk research and more information for stakeholder negotiations preparedness in LMICs
Coordination ▪ GHD is more difficult for issues in which there is less interdependence among countries than issues in which countries are directly affected by the actions or inaction of their neighbors
▪ Complex and synergistic policies and political relations at both national and international levels
▪ Policy implications not considering country-specific social and cultural factors
▪ Language barriers to interaction
▪ Lack of coordinated strategies and diplomatic initiatives to address the multinational dimension of the issue
▪ Using Media for advocacy and influence on the policy positions of countries
▪ Advocacy to highlight the importance of developing coordinated strategies
Advocacy ▪ Dealing with the effects of the globalization of marketing strategies of the food and tobacco industry requires stronger engagement especially with developing countries (For example, the export of unhealthy and processed foods high in added sugars and salts from a developed country to a developing country may increase the prevalence of obesity, without impact on people in the developed country) ▪ Using Media for advocacy and influence on the policy positions of countries
▪ Design an effective consumer campaign that includes the participation of all relevant stakeholders and is suitable for different settings
Financial Support ▪ Limited and unstable funding for building alliances at the global, regional, and local levels
▪ Low national investments and failure to mobilize sufficient funds at the international level; (a large number of policies are developed without the necessary structure and resources for implementation)
▪ Scarcity of resources and competing infectious disease priorities in LMICs
▪ The costs and consequences of inaction are unclear or not fully understood
▪ Increased public-private partnerships
▪ A strategy for increasing the quality and visibility of information about the global economic impacts of chronic disease, which could create incentives for cross-border collaboration
▪ advocacy efforts to seize opportunities for development agencies and international partners that play different roles in supporting LMICs
▪ Translate existing policies into appropriate action plans to ensure LMICs facing multiple health burdens within their specifi c local conditions and contexts
▪ using low-cost ways to prevent and control NCDs and learning from high-income countries and other LMICs cost-effectiveness models and policies and devising their models ​in LMICs
Legal Mandates ▪ Inability to develop a coherent plan on financial, policy, and institutional issues ▪ Ensuring implementation through legislation, norms and standards, or investment; application of health-in-all-policies, whole-of-government, whole-of-society, and cross-sectoral approaches in actions against NCDs
Implementation, Monitoring and Evaluation ▪ Lack of awareness by various sectors about their potential contribution, weak political will, coordination complexity, and inadequate resources
▪ Lack of time from different partners who often have additional responsibilities
▪ Different goals and priorities between partner organizations and competition between organizations for resources
▪ Ad-hoc groups instead of sustainable mechanisms
▪ Gathering the right people around the table
▪ The importance of engaging of high-level stakeholders
▪ Creating synergies between international partners
▪ Cooperation in identifying and participating in strong regional partners