WHO STEPwise approach to surveillance


Members of the national STEPS team in Tajikistan take physical measurements of a respondent.

The WHO STEPwise approach to surveillance (STEPS) is an internationally comparable, standardized and integrated surveillance tool through which countries can collect, analyse and disseminate core information on noncommunicable diseases (NCDs).

A standard STEPS survey involves:

  • questionnaires for households on sociodemographic information, aspects of individuals’ medical history related to the main NCDs, and risk behaviours including tobacco use, alcohol consumption, unhealthy diet and physical inactivity;
  • physical measurements to assess overweight and obesity and increased blood pressure; and
  • blood and urine sampling to measure raised blood glucose, cholesterol, high-density lipids, and sodium and creatinine levels.

Optional STEPS modules include other topics such as injury and violence, sexual and reproductive health, mental health and suicide, oral health, and tobacco use.


The standardized questions and protocols of the survey enable all countries to monitor national trends and develop integrated information on NCD risk factors. The survey results also enable comparisons across countries that help to identify good practices and inform the development of targeted policies and programmes.

The broad scope of the STEPS tool will help to improve NCD risk-factor prevention, health-care management, and monitoring and surveillance. It provides data for 12 of the 25 outcome indicators of the WHO Global Monitoring Framework on NCDs.


WHO/Europe provides technical, financial and material resources to support the implementation of STEPS surveys in the Region through its surveillance hub, based at and coordinated from the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) in Moscow, Russian Federation.

Within the WHO European Region, 11 eastern European and central Asian countries conducted the survey in 2011–2017. Armenia, Azerbaijan, Belarus, Georgia, Kyrgyzstan, the Republic of Moldova, Tajikistan, Turkey, Turkmenistan and Uzbekistan conducted nationally representative STEPS surveys during this period, and Kazakhstan implemented the survey in 2 regions of the country.

Ukraine is currently planning to undertake the STEPS survey for the first time. Kyrgyzstan, the Republic of Moldova, Turkmenistan and Uzbekistan will conduct a second round of the survey in 2017–2018.

Overall, by the end of 2018, regional NCD surveillance coverage with the STEPS survey will have reached nearly 200 million people, or around 25% of the Region’s entire population.