Abstract
Background. Non-communicable diseases (NCDs) account for over 60% of annual global deaths, disproportionately affecting low- and middle-income countries. This trend undermines progress toward Sustainable Development Goal (SDG) 3.4, which seeks to reduce premature mortality from NCDs by one-third by 2030. Despite the availability of effective and relatively affordable interventions, addressing NCDs requires sustained, coordinated efforts and robust monitoring systems. Facility-based monitoring offers a dynamic alternative to static surveys, enabling continuous assessment of healthcare quality and utilization.
Methods. This study followed a systematic approach to develop standardized global and national NCD monitoring indicators, using the Donabedian model as a conceptual framework. It focused on four major NCD categories: hypertension and cardiovascular diseases (CVDs), diabetes, chronic respiratory diseases, and cancers. The methodology included systematic scoping reviews from inception up to November 2021 and a multi-round Delphi process involving global experts to assess the validity and feasibility of proposed indicators. This study was funded internally by WHO. There were no payments to participants.
Findings. The final output consisted of 81 validated indicators-22 core and 59 optional. These indicators demonstrated high feasibility and relevance for facility-based monitoring of NCD service delivery. They provide actionable metrics for assessing and improving the quality of care across diverse health system settings.
Interpretation. This study highlights the urgent need for comprehensive, context-sensitive NCD monitoring frameworks. The proposed set of indicators offers a validated foundation for improving NCD care delivery and aligns with efforts to achieve SDG target 3.4. Ongoing updates and local adaptations will be essential to ensure continued relevance and effectiveness.
Funding. This study was funded internally by WHO.
Keywords Medicine · Tracking (education) · Medical emergency · Environmental health
Cite this paper
Arlene Quiambao, Mohammad‐Reza Malekpour, Ali Golestani, Mahsa Heidari‐Foroozan, Seyyed‐Hadi Ghamari, Mohsen Abbasi‐Kangevari, Benjamin O. Anderson, Prebo Barango, Elena F. Fidarova, Bianca Hemmingsen, André Ilbawi, Taskeen Khan, Roberta Ortiz Sequeria, Gojka Roglić, Sarah J. Rylance, Felipe Roitberg, Leanne Margaret Riley, Slim Slama, Lubna Ishaq Bhatti, Melanie J. Cowan, Patricia Rarau, Stefan Savin, Farshad Farzadfar, Mawuényégan Kouamivi Agboyibor, Ashutosh N. Aggarwal, Oyetayo Akala, Chaisiri Angkurawaranon, Hong Anh Chu, Ranjit Mohan Anjana, Carmen Antini, Zeba Aziz, Shannon Barkley, Abdul Basit, Partha Sarathi Basu, Sara Benítez Majano, Kazi Saifuddin Bennoor, Jeffrey W. Brettler, Neslihan Cabıoğlu, Roberta de Betânia Caixeta, Norman R.C. Campbell, Carolina Chávez, Sohel Reza Choudhury, Marilys Anne Corbex, Ãlvaro A. Cruz, Nemdia Daceney, Shona Dalal, Goodarz Danaei, Jean-Marie Dangou, Wouter DeGroote, Cheick Bady Diallo, Issimouha Dille, Rolando Enrique Domingo, Gampo Dorji, Bruce Bartholow Duncan, Uzochukwu Egere, Hicham El Berri, Asma El Sony, Mai Eltigani, Jill Farrington, Heba M. Fouad, Paola M. Friedrich, Soad Fuentes-Alabí, Ángelo Gamarra, Edward W. Gregg, Reena Gupta, Sumit Gupta, Weiping Jia, Evelyn Mawunyo Jiagge, Pekka Jousilahti, R Kesavan, Somesh Kumar, Tiina Laatikainen, Bagher A. Larijani, Maria Lasierra Losada, Thắng Nguyễn Thị, Naomi Sharlene Levitt, S Luciani, Maurício Maza, Bente Mikkelsen, Yousser Mohammad, Andrew Edward Moran, Ali Ghanbari Motlagh, Stephen Mulupi, Raúl Murillo, Miriam Claire Mutebi, Rebecca Nantanda, Moffat J. Nyirenda, Patrick J. O’Connor, Dike Bevis Ojji, Gertrude Omoro, Dolores Ondarsuhu, Pedro Ordúñez, Mohamed Ould Sidi Mohamed, Mayowa Ojo Owolabi, Kazem Rahimi, Ivo Rakovac, João Filipe Raposo, Andrés Rosende, Jane T. Rowley, & Rengaswamy Sankaranarayanan. (2025). World health Organization’s guidance for tracking non-communicable diseases towards sustainable development goals 3.4: an initiative for facility-based monitoring. EClinicalMedicine, 85, 103304. https://doi.org/10.1016/j.eclinm.2025.103304
Authors and affiliations
Arlene Quiambao
World Health Organization
Mohammad‐Reza Malekpour
Tehran University of Medical Sciences
ORCID 0000-0002-8648-5402Ali Golestani
Tehran University of Medical Sciences
ORCID 0000-0002-5192-0435Mahsa Heidari‐Foroozan
Tehran University of Medical Sciences
ORCID 0000-0003-3969-8015Seyyed‐Hadi Ghamari
Tehran University of Medical Sciences
ORCID 0000-0001-6028-3303Mohsen Abbasi‐Kangevari
Tehran University of Medical Sciences
ORCID 0000-0001-8405-7482Benjamin O. Anderson
University of Washington
ORCID 0000-0001-7217-7428Prebo Barango
World Health Organization
ORCID 0000-0001-9498-8053Elena F. Fidarova
World Health Organization
ORCID 0000-0003-3521-4589Bianca Hemmingsen
World Health Organization
ORCID 0009-0005-4248-5004André Ilbawi
World Health Organization
ORCID 0000-0002-4751-6595Taskeen Khan
World Health Organization
ORCID 0000-0002-1676-4895Roberta Ortiz Sequeria
World Health Organization
Gojka Roglić
World Health Organization
ORCID 0000-0003-0872-0689Sarah J. Rylance
World Health Organization
ORCID 0000-0001-6459-9073Felipe Roitberg
World Health Organization
ORCID 0000-0003-2546-543XLeanne Margaret Riley
World Health Organization
ORCID 0000-0003-0615-9752Slim Slama
World Health Organization
ORCID 0000-0002-1241-5962Lubna Ishaq Bhatti
World Health Organization
Melanie J. Cowan
World Health Organization
Patricia Rarau
World Health Organization
ORCID 0000-0003-0795-4686Stefan Savin
World Health Organization
Farshad Farzadfar
World Health Organization
ORCID 0000-0001-8288-4046Mawuényégan Kouamivi Agboyibor
World Health Organization Regional Office for Africa
ORCID 0000-0002-7459-6914Ashutosh N. Aggarwal
Post Graduate Institute of Medical Education and Research
ORCID 0000-0001-8556-3600Oyetayo Akala
World Health Organization
Chaisiri Angkurawaranon
Chiang Mai University
ORCID 0000-0003-4206-9164Hong Anh Chu
World Health Organization
ORCID 0000-0002-4991-2997Ranjit Mohan Anjana
Dr. Mohan's Diabetes Specialities Centre
Carmen Antini
World Health Organization Regional Office for the Americas
ORCID 0000-0002-3051-4243Zeba Aziz
Rashid Latif Medical College
ORCID 0000-0001-5032-4503Shannon Barkley
World Health Organization
ORCID 0000-0002-8216-9453Abdul Basit
Baqai Institute of Diabetology and Endocrinology
ORCID 0000-0003-3116-895XPartha Sarathi Basu
Centre international de recherche sur le cancer
ORCID 0000-0003-0124-4050Sara Benítez Majano
World Health Organization Regional Office for the Americas
ORCID 0000-0001-8032-9794Kazi Saifuddin Bennoor
National Institute of Cardiovascular Diseases
ORCID 0000-0002-9973-6784Jeffrey W. Brettler
Kaiser Permanente
ORCID 0000-0002-2069-9643Neslihan Cabıoğlu
Istanbul University
ORCID 0000-0002-0989-7411Roberta de Betânia Caixeta
World Health Organization Regional Office for the Americas
ORCID 0000-0003-3943-8176Norman R.C. Campbell
University of Calgary
ORCID 0000-0002-1093-4742Carolina Chávez
World Health Organization Regional Office for the Americas
ORCID 0009-0001-6512-8123National Heart Foundation Hospital & Research Institute
ORCID 0000-0002-7498-4634Marilys Anne Corbex
World Health Organization Regional Office for Europe
ORCID 0000-0001-5755-7326Ãlvaro A. Cruz
Universidade Federal da Bahia
Nemdia Daceney
Expertise France
Shona Dalal
Joint United Nations Programme on HIV/AIDS
ORCID 0000-0003-1684-7452Goodarz Danaei
Harvard University
ORCID 0000-0003-2456-5463Jean-Marie Dangou
World Health Organization Regional Office for Africa
ORCID 0000-0003-2117-0714Wouter DeGroote
World Health Organization
ORCID 0000-0002-0969-1077Cheick Bady Diallo
World Health Organization Regional Office for Africa
Issimouha Dille
World Health Organization Regional Office for Africa
ORCID 0000-0002-1977-9769Rolando Enrique Domingo
World Health Organization Regional Office for the Western Pacific
ORCID 0009-0009-8971-5603Gampo Dorji
World Health Organization Regional Office for South-East Asia
Bruce Bartholow Duncan
Universidade Federal do Rio Grande do Sul
ORCID 0000-0002-7491-2630Uzochukwu Egere
Liverpool School of Tropical Medicine
ORCID 0000-0002-0282-6004Hicham El Berri
World Health Organization Regional Office for the Eastern Mediterranean
ORCID 0000-0002-8951-6999Asma El Sony
National Public Health Laboratory
ORCID 0000-0002-6989-8862Mai Eltigani
World Health Organization
Jill Farrington
World Health Organization Regional Office for Europe
Heba M. Fouad
Liverpool School of Tropical Medicine
ORCID 0000-0001-7910-3501Paola M. Friedrich
St. Jude Children's Research Hospital
ORCID 0000-0002-5265-3113Soad Fuentes-Alabí
World Health Organization Regional Office for the Americas
ORCID 0000-0003-4245-3537Ángelo Gamarra
World Health Organization Regional Office for the Americas
ORCID 0000-0003-4760-2087Edward W. Gregg
Imperial College London
ORCID 0000-0003-2381-6822Reena Gupta
University of California, San Francisco
ORCID 0000-0003-0048-2575Sumit Gupta
Hospital for Sick Children
ORCID 0000-0003-1334-3670Weiping Jia
Shanghai Jiao Tong University
ORCID 0000-0002-6244-2168Evelyn Mawunyo Jiagge
Henry Ford Health
ORCID 0000-0002-5708-0326Pekka Jousilahti
Finnish Institute for Health and Welfare
ORCID 0000-0001-7190-0979R Kesavan
World Health Organization Regional Office for South-East Asia
Somesh Kumar
Jhpiego
ORCID 0000-0003-2453-4333Tiina Laatikainen
Finland University
Bagher A. Larijani
Tehran University of Medical Sciences
ORCID 0000-0001-5386-7597Maria Lasierra Losada
World Health Organization Regional Office for Europe
Thắng Nguyễn Thị
Hội Gastroenterology Việt Nam
Naomi Sharlene Levitt
University of Cape Town
ORCID 0000-0001-6480-8066S Luciani
World Health Organization Regional Office for the Americas
Maurício Maza
World Health Organization Regional Office for the Americas
ORCID 0000-0003-2027-4431Bente Mikkelsen
World Health Organization
ORCID 0000-0002-2949-8784Yousser Mohammad
Latakia University
Andrew Edward Moran
Resolve to Save Lives
ORCID 0000-0003-3554-0085Ali Ghanbari Motlagh
Shahid Beheshti University of Medical Sciences
ORCID 0000-0002-7596-6016Stephen Mulupi
Liverpool School of Tropical Medicine
ORCID 0000-0001-8533-578XRaúl Murillo
Pontificia Universidad Javeriana
ORCID 0000-0001-7187-9946Miriam Claire Mutebi
Aga Khan University
ORCID 0000-0002-0809-5812Rebecca Nantanda
Makerere University
ORCID 0000-0002-5039-8489Moffat J. Nyirenda
London School of Hygiene & Tropical Medicine
ORCID 0000-0003-2120-4806Patrick J. O’Connor
HealthPartners
ORCID 0000-0002-2324-6228Dike Bevis Ojji
University of Abuja
ORCID 0000-0002-2084-1988Gertrude Omoro
World Health Organization
Dolores Ondarsuhu
World Health Organization Regional Office for the Americas
ORCID 0000-0003-0506-3046Pedro Ordúñez
World Health Organization Regional Office for the Americas
ORCID 0000-0002-9871-6845Mohamed Ould Sidi Mohamed
World Health Organization Regional Office for Africa
Mayowa Ojo Owolabi
University of Ibadan
ORCID 0000-0003-1146-3070Kazem Rahimi
University of Oxford
Ivo Rakovac
World Health Organization Regional Office for Europe
ORCID 0000-0002-6815-5274João Filipe Raposo
Associacao Protectora dos Diabeticos de Portugal
ORCID 0000-0003-2589-7208Andrés Rosende
World Health Organization Regional Office for the Americas
ORCID 0000-0001-8173-0686Jane T. Rowley
Joint United Nations Programme on HIV/AIDS
ORCID 0000-0001-7027-2130Rengaswamy Sankaranarayanan
Karma Healthcare
ORCID 0000-0003-2595-6642