Jordan leading the way: Advancing NCD care in a humanitarian setting

Non-communicable diseases (NCDs) become particularly difficult to manage in crisis settings. For the more than 117 million people displaced worldwide today (1), chronic diseases do not pause for a crisis. Displacement disrupts access to healthcare and essential medicines, leads to interruptions in treatment, and restricts opportunities for screening and healthy living.

This reality has become one of the most pressing public health challenges across the Middle East, a region shaped by successive waves of forced migration. In Jordan alone, more than 600,000 Syrian refugees are officially registered, with unofficial estimates reaching 1.2 million. This is on top of Jordan’s long-standing role as host to a large Palestinian refugee population, further underscoring the strain on national systems. Most displaced people live dispersed across host communities rather than in camps, placing additional strain on already stretched health systems. The prevalence of NCDs among displaced populations is well-documented and growing, and in Jordan, host and refugee communities face a shared and intensifying burden. The burden does not fall on displaced people alone; it ripples outward, affecting entire communities and the systems designed to serve them.

What makes these contexts so demanding is not simply their scale, but their permanence. These are not emergencies that will resolve in months. They require long-term responses that are sustainable and embedded in national health systems and built to serve everyone they affect. This is the challenge WDF has spent years to address in humanitarian settings. Through sustained collaboration with trusted local and national actors, we have fined tuned an approach centred on system strengthening, and on responses embedded within national systems, supporting impact that continues beyond individual projects.

When WDF first entered the area of NCDs in humanitarian settings, just a handful of international and local organisations were already working to build the agenda - at local, regional, and global levels. "When we first entered this area, the idea of addressing chronic diseases for refugees seemed almost avantgarde," recalls Jakob Sloth Madsen, Regional Team Lead for MENA and LATAM at WDF.

"Most organisations focused on acute needs like vaccinations and hygiene. It wasn't considered necessary to think beyond that."

WDF therefore focused its early efforts on learning from local partners, providing funding and technical support to work that was already meaningful, yet but chronically under-resourced, across the Palestinian territories, Syria, Yemen, Afghanistan, Jordan, Lebanon, Myanmar, Haiti, Mali, Sudan, and the Caribbean.

Yet it was not until 2017 that the issue began to receive the global recognition it had long deserved. The International Conference on Refugees and Diabetes, co-hosted by WDF, the Jordanian Ministry of Health, and UNRWA, brought together governments, multilateral agencies, and civil society behind a shared commitment to placing NCD care at the centre of humanitarian health planning. It was the first global conference dedicated specifically to diabetes in humanitarian settings and resulted in the launch of the Dead Sea Declaration. This significantly consolidated the thematic field and helped place NCD care for displaced populations firmly on the global NCD policy agenda.

A year later, at the 2018 UN High-Level Meeting on NCDs, that commitment was formally acknowledged on the global stage, carried there by years of shared effort, accumulated evidence, and the persistent advocacy of a growing coalition of partners. What had once seemed avant-garde had become, at last, a global priority.

A crisis that could not wait

That shift in global attention brought renewed focus to Jordan and to what a genuinely integrated, long term response might look like at scale. At the time, the Ministry of Health (MoH) was confronting a dual burden in Jordan: NCDs already accounted for nearly 78% of all deaths, with diabetes prevalence almost doubling over two decades, while the protracted Syrian displacement crisis placed additional strain on an already stretched health system.

For many refugees, including those living in urban communities and in camps like Al-Zaatari, the barriers to chronic disease care were significant: the cost of medicines, limited service availability, and a system not originally designed to manage long-term NCD needs within a humanitarian setting. The challenge for the MoH was not simply one of capacity. It was one of coherence, how to deliver consistent, prevention-oriented NCD care to a rapidly expanding and highly vulnerable population, while ensuring that host communities relying on the same system were not left behind.

However, for the Government of Jordan the question was never whether to support those arriving across the border - only how. "Syria is our adjacent country," reflects Dr Anas Almohtaseb, the former Director of the NCD Directorate at the MoH's Primary Health Care Administration.

"These are similar families and tribes between borders. When they came to the northern areas of Jordan and they were suffering, this was a matter of humanitarian responsibility and loyalty. They are our neighbours. We share the same values, the same culture. And so, the Government of Jordan provided services for Syrian refugees, and they were treated initially free of charge, and later they were treated similarly to uninsured Jordanians at MoH facilities."

By then, the conditions were in place for a more ambitious response: a clear and growing need, stronger global recognition of NCDs in humanitarian settings, and an existing base of experience in Jordan to build on. It was in this context that the Novo Nordisk Foundation (NNF) began increasing its strategic focus on humanitarian settings, recognising an urgent and underserved need. Rather than waiting for proposals, NNF reached out to WDF directly. For WDF, the conversation in Jordan was not starting from scratch.

For years, WDF had supported community rooted work on NCDs across Jordan through a sustained partnership with the Royal Health Awareness Society (RHAS), focused on reaching vulnerable and underserved communities with diabetes prevention and care. Over time, this work demonstrated what a well designed programme could achieve when given the space and resources to develop properly. Building on these foundations, earlier WDF support for the Healthy Community Clinic model provided a practical testing ground, generating experience, evidence, and learning that would later inform the development of a far more ambitious, integrated national response.

The alignment between NNF's evolving priorities and the work already underway on the ground created the conditions for something far more ambitious: a large-scale, integrated NCD programme designed to serve both Jordanian host communities and Syrian refugees through the same national systems and one designed, from the outset, to last.

Built to last

What would become Jordan's landmark Integrated NCD–Humanitarian Response did not begin with a blueprint. It began with a question: what would it actually take to address NCDs properly, not partially, not in isolation, but as a sustained and systemic response to a crisis that showed no signs of ending?

Central to answering that question was the choice of implementing partner. Founded under the umbrella of the Queen Rania Foundation, RHAS had spent years building a reputation as both a clinical organisation anda force for health promotion, community mobilisation, and upstream prevention, arguing consistently that NCD care had to begin long before people reached a health facility. Alongside the MoH, it had developed a partnership defined by genuine complementarity and growing shared ownership. One of the most tangible expressions of that collaboration was the Healthy Community Clinic model: embedded within primary health centres, offering structured lifestyle counselling alongside clinical consultations.

The planning phase was intensive and deliberate. Teams from RHAS, WDF, and NNF consulted extensively with Ministry departments to ensure the programme aligned with national priorities. "We were very aware that alone we could not do everything, not as RHAS, not as the Ministry of Health," reflects Amal Ireifij, Director General of RHAS. "We had to have all the relevant sectors and partners along on the planning phase and on the review and decision-making table."

To that end, RHAS and the MoH convened a multi-stakeholder platform that included World Health Organisation, the UN Refugee Agency, Caritas, the Ministry of Education, the Institute of Family Health, Save the Children, and a range of academic institutions. Formal steering and technical committees were established as the primary mechanisms for shared decision-making, strategic alignment, and accountability.

The goal from the beginning was long-term institutionalisation: not a five-year project, but a foundation for a permanent shift in how NCDs were managed within Jordan's public health system.

"We wanted to address NCDs properly," Amal says simply. "We took our sweet time, so that the end result was a really good one."

From vision to action

Launched in 2020 with funding from the NNF and WDF, and led by RHAS in close collaboration with the MoH, the Integrated NCD–Humanitarian Response Programme set out with a clear and deliberate ambition: to refuse the parallel-track logic that had long characterised humanitarian health responses, and instead serve both Jordanian citizens and Syrian refugees through tan integrated national response. "From day one, we wanted to work with the system, not in a parallel system," says Amal. "We wanted to also serve Syrian refugees within the clinics of the Ministry of Health."

The scale of that ambition was reflected in the programme's targets from the outset: 190 primary health centres strengthened, 600 MoH staff trained across different cadres, and 150,000 patients reached with improved care - including 50,000 refugees. These were not modest numbers, but signals of a programme designed to operate at genuine national scale, with a clear focus onreducing the burden of diabetes, hypertension, and related conditions among some of Jordan's most vulnerable populations. To achieve this, the programme set out to embed NCD prevention and care simultaneously across primary health centres, public schools, and communities in the areas of highest refugee density.This was an undertaking of significant scope, one that would take years to build out fully.

From the beginning, each component was conceived with an eye towards long term sustainability. The central question was not only whether an intervention worked, but whether it could be adopted and sustained by the government beyond the lifespan of external support.

In primary health centres, the aim was to support healthcare providers to gradually weave NCD screening and behaviour change counselling into their daily patient encounters. Two complementary models were developed to meet different needs. The first brought patients together in groups, creating space for shared learning around the risks of unhealthy diets, physical inactivity, and tobacco use. The second offered a more intimate, one-to-one counselling session - built around listening, understanding, and helping someone make changes that were realistic within the contours of their actual life.

"We thought that the group sessions would be the best thing," reflects Amal. "But people preferred to have both - some group sessions and some individual counselling, where they were free to discuss more intimate issues. So we listened and we adapted."

Beyond the clinics, the programme worked towards mobilising a network of over 560 teachers across public schools, equipping them with evidence-based tools to bring NCD awareness into the classroom. Alongside them, hundreds of young peer health educators were trained to carry health messages into their schools and communities, reaching the places and the people that formal services alone could not. And in the areas of highest need, community health workers were deployed to conduct household visits, bridge the gap between formal services and hard-to-reach households, and partner with local organisations already trusted by the communities they served. These ambitions did not unfold overnight. They were built steadily over years of implementation, shaped by experience, adaptation, and continuous learning along the way. From the outset, the partners placed strong emphasis on evidence based approach, ensuring that implementation research and continuous evaluation were embedded in programme design and used actively to guide adaptation and decision making throughout implementation. Delivery was supported by a comprehensive implementation research component led by the Eastern Mediterranean Public Health Network (EMPHNET), which provided real time evidence, informed programme adjustments, and strengthened the foundation for scale up and long term institutionalisation.

The continuous learning loop

With a clear vision in place, partners shifted their focus from design to delivery within a complex and constantly evolving humanitarian context. Implementing a programme of this scale in the midst of a protracted crisis was rarely straightforward. Challenges emerged at every level, make the journey as much about pragmatic adaptation as ambition.

Perhaps no challenge was more disruptive than the COVID-19 pandemic, which struck just as implementation was finding its footing. "After a year or maximum two years of the programme start, we were hit by COVID and we had to stop for a while," recalls Amal. "We had to be so agile. Changing our mandate to cater for the status quo. We were not able to reach our beneficiaries, so we had to partner with another platform to digitally reach out to them and continue providing the counselling sessions they needed." The disruption was significant enough that two supplementary grants from NNF and WDF were secured to support the programme's adaptation to the pandemic; sustaining outreach, training, and counselling through digital channels when physical access was impossible. It was an early test of the programme's capacity for adaptation, and one that it passed.

Subsequent challenges were less dramatic yet equally persistent. In high-volume clinics, some providers initially found it difficult to take on counselling sessions alongside their existing workloads. In rural facilities and overcrowded schools, the absence of private consultation rooms made structured sessions genuinely hard to deliver. Staff turnover disrupted continuity of care. Cultural and gender dynamics in some communities initially made group participation difficult. For many people the programme sought to reach, especially refugees, barriers to behaviour change extended beyond what health interventions could address: the cost of nutritious food, stress, and a gap between advice and what households could afford.

Rather than treating these constraints as insurmountable, the programme worked deliberately within them. Counselling and prevention efforts were designed to be practical, realistic, and sensitive to everyday circumstances, prioritising small, achievable changes over idealised recommendations. At the same time, the programme focused on improving the quality of care, strengthening the consistency of advice and follow-up so that people received the same standard of support regardless of where they entered the system. Health workers were trained to tailor guidance to households’ financial means, emphasising incremental changes in diet, activity, and routines suited to economic insecurity. These efforts aimed to engage people as they were and build provider and community capacity over time.

Delivery models were also adapted to bring support closer to where people lived. By embedding counselling within primary health centres, schools, and community outreach activities, as well as mobilising community health workers and trusted local actors, the programme sought to reinforce messages across multiple settings, recognising that sustained behaviour change rarely results from isolated clinical encounters alone.

Simplified job aids and refresher trainings helped providers maintain quality despite rotation and workload pressures. Gender-segregated sessions were introduced to circumvent privacy concerns that were limiting participation. Respected community figures were brought in to build the trust that made engagement possible. And throughout, a continuous flow of data was fed back regularly to those delivering the work, so that when something was not functioning as intended, there was evidence to act on quickly.

That learning loop showed results. Among patients receiving individual counselling in MoH clinics, systolic blood pressure fell by an average of 10.5 mmHg, diastolic blood pressure by 5.0 mmHg, and fasting blood glucose by 39.6 mg/dL. In Save the Children clinics in Zaatari Camp, physical inactivity dropped from 58.8% to 7.7% after three counselling sessions, while vegetable intake doubled. Knowledge of diabetes, hypertension, and their risk factors also improved substantially across participating patients. In schools, students were making healthier food choices and carrying health messages home to their families. Similar trends in clinical and behavioural outcomes were seen across public and humanitarian clinics (2).

"When we could very evidently see that glucose levels were dropping, that weight was dropping, that blood pressure was dropping," reflects Amal, "it became easier for everyone to accept this project and continue with it."

Equally important was embedding the programme within national systems, including the national health information system: Hakeem, marking a shift in the country’s approach to NCD care.. The MoH integrated the Healthy Community Clinic into the professional development structure for nurses, making training completion a formal requirement for career advancement. NCD focal points were assigned across all 14 health directorates. A core team of MoH trainers was established to sustain the work independently. The final steering committee meeting was chaired and hosted by the Ministry itself - a signal, perhaps more than any other, of where ownership now resided.

Together, these efforts added up to something significant. Over five years of implementation, through a pandemic, persistent resource constraints, and the enduring complexity of a humanitarian context the programme reached a scale that few integrated NCD initiatives in this setting have matched. More than 190 primary health centres and partner clinics were strengthened, alongside 319 schools and a wide network of community platforms. Over 2,000 healthcare providers, 560 teachers, 775 youth volunteers and 119 community health workers were trained and engaged, reaching more than 192,000 patients with improved care and over 160,000 students and families through school based initiatives.

A foundation for what comes next

What Jordan's Integrated NCD–Humanitarian Response demonstrates, above all, is that it is possible to build something durable, even in the most challenging of circumstances. Over five years, amid a protracted humanitarian crisis compounded by a global pandemic, a large-scale, multi-sectoral NCD programme was built from the ground up. It was embedded into national systems and delivered meaningful improvements in the health of both refugees and host communities. Crucially, it challenges the long-standing divide between humanitarian and development programming. With the right partnerships, the right commitment, and the willingness to learn and adapt, the two can reinforce each other.

Building on this foundation, the MoH is now working to build on the programme's foundations, with plans to invest further in early detection and screening for hypertension, diabetes, cancer, and obesity, and to establish dedicated NCD prevention pathways linked directly to the Healthy Community Clinic model.

The lessons extend beyond Jordan. "We have learned in Jordan that we have, about every ten years, a crisis," reflects Dr. Anas Almohtaseb.

"We learned that the best thing we can provide in crisis management and preparation is to have a very good healthcare system."

This insight, that investing in health system strength is itself a form of crisis preparedness, has broad relevance. The model developed in Jordan: context sensitive, multi sectoral, built on trust and informed by evidence, offers a replicable pathway for other countries facing the combined pressures of rising chronic disease and prolonged humanitarian need. In 2024, that same story has also reached a still wider audience: a BBC StoryWorks film documenting Jordan's experience was produced to inspire other countries and partners to learn from what has been built here, and to consider what might be possible in their own contexts.

At the institutional level, the journey has been equally as transformative. For RHAS, this collaboration marked a change in both scale and capability. "From 30 clinics to 190 clinics," Amal reflects, "and from an organisation that could handle a project of 250,000 dollars to one that can handle a multi-year, multi-million project - that was also a big achievement." The ambition now is to share that experience more widely.

"We want others to learn from what we have built here, rather than reinventing the wheel."

From a small-scale local organisation focused on community outreach, RHAS has grown alongside the programme and is now recognised as a thought-leader on the regional and global stage.

The programme has brought momentum in reshaping the field. It is increasingly seen as a point of reference for the region and beyond, for how NCD care in humanitarian settings is understood, funded, and delivered. Jordan’s leadership on the issue has been demonstrated through a growing role as a regional convenor, including the co‑hosting of a comprehensive regional NCD conference with Lebanon in Amman in May 2025, which brought together governments, UN agencies, and civil society to advance shared approaches to NCDs in humanitarian contexts. Jordan's co-hosting of the 2024 Global high-level technical meeting on NCDs in humanitarian settings further affirmed national leadership.

What has been built in Jordan is more than just a programme. It is proof of what becomes possible, in the words of Director of Global and Public Health Department, Mette Ide Davidsen from the NNF, "when partners commit to building with a system rather than around it." For those who funded and supported the work, the results have reinforced a fundamental conviction:

"that integrated, people-centred NCD care is not an aspiration reserved for well-resourced settings - it is achievable in the most demanding circumstances, and it can last. That is exactly the kind of evidence-based, sustainable impact that we believe the world needs more of."

Resources:

1. Grandi, F. and Doris. Global trends, UNHCR. Available at: https://www.unhcr.org/global-trends (Accessed: 28 May 2026).
2. Saad, R.K. et al. (2025) ‘Outcomes and lessons from the integrated NCD–humanitarian response in Jordan (2020–2025)’, Archives of Public Health, 84(1). doi:10.1186/s13690-025-01814-x.