As low- and middle-income countries (LMIC) begin to make gains in combating infectious disease and malnutrition and garner the bene"ts of economic development, they have become increasingly vulnerable to the impact of noncommunicable diseases (NCDs). NCDs such as cardiovascular disease (CVD), cancer, respiratory disease and diabetes are already the leading causes of death in all LMIC except those in sub- Saharan Africa. Projected data indicate that there will be a rapid increase in NCDs over the next seven years, including in sub-Saharan Africa. The economic impact of this increase will be substantial because working-age adults account for a high proportion of the NCD burden. Effective approaches to reduce the NCD burden in LMIC include a mixture of population-wide and individual interventions. Such cost-effective interventions are already available and include methods for early detection of NCDs and their diagnoses using inexpensive technologies, non pharmacological and pharmacological approaches for modi"cation of NCD risk factors and affordable medications for prevention and treatment of heart attacks and strokes, diabetes, cancer and asthma. These low technology interventions, if effectively delivered, can reap future savings in terms of reduced medical costs, improved quality of life and productivity. However, due to weak health systems, there are substantive gaps in their implementation particularly in LMIC. Ef"cient use of limited health care resources, sustainable health "nancing mechanisms, access to basic diagnostics and essential medicines and organized medical information and referral systems are imperative for provision of equitable care for people with and at risk of NCDs. They require long-term care that is proactive, patient centered, community based and sustainable. Such care can be delivered equitably only through health systems based on primary health care (PHC).