Addressing non-communicable diseases and injuries through an equity lens: insights from the Cameroon non-communicable disease and injury (NCDI) Poverty Commission

Background: Non-communicable diseases and injuries (NCDIs) constitute a leading cause of premature mortality globally, disproportionately affecting low- and middle-income countries (LMICs). To curb the rising burden of NCDIs in Cameroon, the Ministry of Public Health established the National NCDI Poverty Commission to assess the burden of NCDIs, evaluate investments and expenditures related to NCDI services, and generate evidence to guide national policy formulation and resource prioritisation. Methods: We synthesised data from the Global Burden of Disease (GBD) 2019 database and conducted a comprehensive literature review of peer-reviewed and grey literature (2005-2022) to characterise the burden and risk factors of NCDIs in Cameroon. Investments and expenditures related to NCDIs were extracted from the World Health Organization Global Health Expenditure Database and national planning documents. A two-phase priority-setting process was applied to rank NCDI conditions and identify cost-effective, context-appropriate interventions through quantitative scoring and expert consensus. Results: NCDIs accounted for 43% of all deaths in 2019, with nearly 29% occurring among individuals aged <40 years. Disability-adjusted life years (DALYs) from NCDIs have risen steadily since 1990, with almost two-thirds (61%) attributable to conditions beyond the 'big four' disease categories of diabetes, neoplasms, chronic respiratory diseases, and cardiovascular diseases. Over half (51%) of NCDI-related DALYs in Cameroon were not attributable to quantified behavioural or metabolic risk factors in the GBD framework. Despite this high burden, only 6% of disease prevention funding was directed to NCDIs between 2016 and 2020. The Commission identified 49 priority NCDI conditions and 123 interventions for phased implementation across community, primary, and hospital platforms. Conclusions: NCDIs are a major public health burden in Cameroon, heavily impacting the 'economically productive' age group. Rebalancing financing and integrating a prioritised package of NCDI services into Universal Health Coverage (UHC) would be essential to reduce premature mortality and financial hardship.