From declarations to delivery: Accountability matters for NCDs and mental health in South-East Asia

Following the South-East Asia Regional Conference on NCDs and Mental Health held in January 2026, this blog reflects on the key messages and emerging priorities for strengthening accountability across the region.

For noncommunicable diseases (NCDs) and mental health, global commitments are not new. Political declarations, targets, and high-level meetings have shaped the agenda for over a decade. Yet across South-East Asia (SEA), preventable conditions continue to rise, families face catastrophic out-of-pocket expenditure, and mental health remains under-resourced and stigmatised.

The challenge before us is no longer what we commit to, but how we deliver.

As countries continue translating global commitments into national policies and implementation plans in 2026, strengthening accountability mechanisms will be critical to ensuring these commitments lead to measurable progress.

This topic was central to the South-East Asia Regional Conference on NCDs and Mental Health: Strengthening Accountability Post-UNHLM 2025, held on 12 January 2026 in Lalitpur, Nepal. Organised by the South-East Asia Regional NCD Alliance (SEAR NCDA) and hosted by the Nepal NCD Alliance, the conference took place at a critical moment following the UNHLM. Its purpose was clear: to move the region from political commitments to accountable, people-centred action.

A regional conversation with political weight

The conference convened senior government officials, civil society organisations (CSOs), people living with NCDs and mental health conditions, academia, development partners, and regional and national NCD alliances from Nepal, India, Bangladesh, Sri Lanka, Thailand, Maldives, and Malaysia, alongside the Global NCD Alliance in Geneva. For the global NCD Alliance, participating in the meeting provided an opportunity to hear directly from regional partners about the realities of translating global NCD and mental health commitments into national action. The discussions highlighted both the shared challenges facing countries across South-East Asia and the importance of regional and global collaboration in strengthening accountability and implementation.

High-level participation from the Honourable Minister of Health and Population of Nepal and the Deputy Mayor of Kathmandu Metropolitan City sent a strong signal: NCDs and mental health are not merely health sector concerns; they are political, economic, and social priorities. Their presence reinforced recognition of the devastating impact of out-of-pocket expenditure for NCD treatment, which continues to push households into financial hardship, and underscored the urgent need to shift toward prevention-focused approaches. Reducing exposure to risk factors, strengthening regulatory and fiscal measures, creating supportive community and urban environments, and scaling up comprehensive primary health care must go hand in hand with re-centering mental health within national health agendas.

Accountability as a living process

A key message throughout the conference was that accountability is not a reporting exercise—it is a continuous process. In her keynote address, Ms. Linda Markova from the global NCD Alliance reminded participants that the world remains off-track on NCD and mental health targets, with prevention and financing consistently under-prioritised. Without sustained accountability, even strong political commitments risk remaining aspirational rather than transformative. She emphasised that accountability requires defining clear commitments, monitoring progress, reviewing results transparently, and acting decisively when gaps emerge.

Regional perspectives: Shared challenges, common priorities

Country experiences revealed striking similarities across the region. Speakers from SEAR countries highlighted persistent challenges: mental health stigma, insufficient national policies, limited access to essential psychotropic medicines, shortage of trained specialists at the primary health care level, and weak implementation. These shared challenges accentuate the need to move beyond policy statements toward consistent implementation at the primary health care and community levels.

Panelists stressed that the burden of NCDs and mental health cannot fall on the health sector alone. Effective responses require multisectoral collaboration, particularly with ministries of finance, education, urban development, and environment. There was strong agreement that approaches focused solely on individual behavior are insufficient; changing community attitudes, social norms, and structural determinants of health is essential.

A recurring theme was the need for ministries of finance to recognize NCDs and mental health as long-term investments, not short-term costs. Joint data review, evidence-based planning, and coordinated prevention and health promotion—especially at the local level—were identified as critical to reducing avoidable conditions and premature mortality.

Lived experience at the centre of accountability

Discussions on the role of CSOs and people living with NCDs brought lived realities to the forefront. Experiences shared by advocates highlighted delayed care due to financial hardship, lack of transportation and shelter, stigma, weak follow-up systems, and limited mental health support.

These perspectives reinforced a vital truth: NCD care extends beyond clinical treatment. It encompasses emotional, social, and financial dimensions and requires community-based care models, early detection, social acceptance, and strong referral and monitoring systems. Accountability was framed as a democratic and human rights responsibility, with CSOs playing a critical role in evidence generation, social accountability, media engagement, and linking community realities to policy processes.

Bridging promises and practice: Multistakeholder Accountability Framework

A key outcome of the conference was the introduction of the Multistakeholder Accountability Framework for NCDs and Mental Health (2026–2030). The framework links policies, financing, and data systems to measurable outcomes and reductions in premature mortality, with a strong focus on WHO “Best Buy” interventions. By connecting commitments to financing, delivery, and measurable outcomes, the framework addresses one of the region’s most persistent implementation gaps.

Progress is tracked through a regional NCD Accountability Scorecard using clear indicators and traffic-light ratings, complemented by independent annual reviews led by academia and civil society to strengthen credibility. Accountability is operationalised through a seven-stage cycle: commit, finance, implement, monitor, review, respond, and report, ensuring that targets are funded, actions delivered, progress independently assessed, and gaps addressed through time-bound corrective measures. By embedding transparency, participation, and follow-up, the framework shifts accountability from passive monitoring to active governance, helping translate political commitments into tangible health gains across SEA.

Regional scorecards and independent reviews provide SEAR countries with a structured mechanism to benchmark progress, pinpoint persistent implementation gaps, and draw lessons from stronger regional performance. By directly linking monitoring findings to budget allocations, regulatory enforcement, and time-bound corrective actions, the framework transforms accountability into a practical lever for policy action and improved health outcomes across SEA.

From promises to progress: Next steps

The conference concluded with a unified call to action. Accountability must be institutionalised as a core governance function across SEA. SEAR NCDA and national NCD alliances should first introduce and share the Multistakeholder Accountability Framework (2026–2030) with governments, civil society, and key stakeholders to build common understanding and ownership. Countries can begin by identifying simple baseline information and selecting a few priority indicators to start tracking progress on NCDs and mental health. Countries can pilot the accountability cycle to learn what works before expanding across the region. Civil society, academia, and people living with NCDs should be involved from the start to support community perspectives and transparent review. As countries across South-East Asia begin translating the conference discussions into national and regional initiatives during 2026, the importance of practical accountability mechanisms is becoming increasingly clear.

Commitment alone is not enough. Without accountability linked to financing, prevention, primary health care, monitoring, and community oversight, progress will remain uneven. The conference made clear that accountability must function as an ongoing governance practice, not a one-off reporting exercise. The time for half-measures has passed. By placing people, equity, and accountability at the centre of action, South-East Asia can move decisively from promises to progress.