National Health Programmes of

Government of Nepal

By
R. Adhikari
9851281415
[email protected]
 Programmes
Child Health
• Immunization
• Community Based Integrated Management of Childhood Illness and Newborn
Care
Nutritional Program
• Current nutrition situation and program in Nepal
• Current nutrition policy and strategy
Family Health
• Family Planning
• Safe Motherhood and Newborn Health
• Female Community Health Volunteer (FCHV)
• Primary Health Care Outreach (PHC/ORC)
• Adolescent Sexual and Reproductive Health
 Contd…..
Disease Control
• Malaria
• Kala-azar
• Lymphatic Filarisis
• Dengue
• Zoonosis
• Epidemiology and outbreak management
• Leprosy
• Tuberculosis
• HIV/AIDS
• Eye care
Non-communicable Disease (NCD)
CHILD HEALTH
 EPI: Background
•The National Immunization Programme (NIP) is a priority 1 (P1)
programme of the Government of Nepal.
• Launched as the Expanded Programme on Immunization in
2034 BS (1977/78), the National Immunization Programme has
met several milestones, including Millennium Development Goal
4 (MDG 4) on reducing under-5 mortality.
• Eleven antigens are provided through the national programme
to eligible infants, children and mothers through more than
16,000 outreach sessions, including in geographically and
economically hard-to-reach and marginalized communities.
•Immunization services are delivered through static
immunization clinics in health facilities, outreach sessions and
mobile clinics in communities (VDCs and municipalities)
throughout the country.
 Goal & objectives
The National Immunization Programme has two main
guiding documents:
• The Nepal Health Sector Programme-2 Implementation Plan
(NHSP IP 2) focused on increasing access and utilisation of
essential health care services, especially to reduce disparities
in access to health care. It gave high priority to the
immunization programme.
• The Comprehensive Multi-year Plan of Action (2012–2016) is
the main guiding document for the national immunization
programme. It was aligned with policy documents of the
national immunization programme, World Health Assembly
(WHAs) resolutions and the Global Vaccine Action Plan.
• The overall goal of the cMYPoA (2012-2016) was “To reduce
child mortality, morbidity and disability associated with
vaccine preventable diseases.”
 Objectives

1. Achieve and maintain at least 90% vaccination coverage for all

antigens at national and district level by 2016:
2. Ensure access to vaccines of assured quality and with
appropriate waste management:
3. Achieve and maintain polio free status:
4. Maintain maternal and neonatal tetanus elimination status:
5. Initiate measles elimination:
6. Accelerate control of vaccine-preventable diseases by
introducing new and underused vaccines:
7. Strengthen and expand VPD surveillance:
8. Continue to expand immunization beyond infancy:
 Targets and schedule

The target population of the National Immunization

Programme are:
 under 1 year old children for BCG, DPT-HepB-Hib,
OPV, IPV, PCV and measles-rubella1 (MR1) vaccine.
 12 month old children for Japanese encephalitis
 15 month old children for measles-rubella second
dose (MRSD)
 pregnant women for tetanus toxoid and low dose
diphtheria toxoid (Td) containing vaccine.
COMMUNITY BASED INTEGRATED MANAGEMENT OF CHILDHOOD
ILLNESS
(CB-IMCI):Introduction
 In 1997 the IMCI program was initiated in Mahottari districts as a
pilot.
 Fiscal year 2066/67 (2009/2010) CB-IMCI covers all 75 districts.
 CB-IMCI program is an integrated package of child survival
interventions and addresses major childhood killer diseases
(Pneumonia, Diarrhoea, Malaria, Measles, and Malnutrition ).
 CB-IMCI is for 2 months to 5years children in a holistic way
 CB – IMCI also includes management of infection, Jaundice,
Hypothermia and counseling on breastfeeding for young infants
less than 2 months of age
 FCHVs are the main vehicle of services delivery and also play key
role to increase community participation
 Goal
Improve newborn and child survival and healthy growth and
development.
Targets of Nepal Health Sector Strategy (2015-2020)
•Reduction of Under-five mortality rate (per 1,000 live births) to 28
by 2020
• Reduction of Neonatal mortality rate (per 1,000 live births) to 17.5
by 2020
Objectives
•To reduce neonatal morbidity and mortality by promoting essential
newborn care services.
• To reduce neonatal morbidity and mortality by managing major
causes of illness
• To reduce morbidity and mortality by managing major causes of
illness among under 5 years children
 Major interventions
Newborn Specific Interventions
• Promotion of birth preparedness plan
• Promotion of essential newborn care practices and postnatal care to mothers
and newborns
• Identification and management of non-breathing babies at birth
• Identification and management of preterm and low birth weight babies
• Management of sepsis among young infants (0‐59 days) including diarrhoea
Child Specific Interventions
• Case management of children aged between 2‐59 months for 5 major childhood
killer diseases (Pneumonia, Diarrhoea, Malnutrition, Measles and Malaria)
Cross Cutting Interventions
• Behaviour change communications for healthy pregnancy, safe delivery and
promote personal hygiene and sanitation
• Improved knowledge related to Immunization and Nutrition and care of sick
children
• Improved interpersonal communication skills of HWs and FCHVs
 Newborn care: Background
• From birth to 4 weeks (28 days) of age, the baby is called newborn.
• Delivery by a skilled birth attendant at home and facility births with
immediate newborn care (warmth, cleanliness, immediate breast feeding,
cord care, eye care and immunization) for all newborns and the
resuscitation of newborns with asphyxia, Nyano Jhola Programme to
protect newborns from hypothermia and infections and to increase the
use of peripheral health facilities (birthing centers).
• Health education and behavior change communication for mothers on
early newborn care at home.
• The identification of neonatal danger signs and timely referral to an
appropriate health facility, and
• Community based integrated management of newborn care (CBNCP).
 CURRENT SITUATION
• A separate report on post-natal care to new born is not reported in HMIS
and it can be assumed that the percentage of new born who received PNC
as per protocol is similar to as of mothers.
• Among 343,577 live births reported 91 percent received application of
Chlorhexidine (Nabi care) at umbilical cord at delivery.
• Total low birth weight (LBW) was 11.5 percent among institutional
deliveries -2.5 percent were very low birth weight (less than 2000 gm) and
another 9 percent were LBW (2000-2499 gm). Reported still birth rate
among deliveries at health institutions increased from 14 in 2072/73 to 17
per 1000 total births in 2073/74.
• CBIMNCI(Community Based Integrated Management of Newborn and
Childhood Illness) includes immediate referral by FCHV, comprehensive
newborn care training, free newborn care services.
 CURRENT ISSUES AND CHALLANGES
• Lack of equipment to deliver newborn at service delivery
points.
• Unable to implement free newborn care guideline since last
FY as expected.
• Plateauing of 4ANC use and timely first ANC visits, and very
low PNC coverage.
• The inadequate use of some birthing centre and increasing
the number of birthing centre.
• No CEONC services in some remote districts:Rasuwa,Manang
and Mustang.
• Frequent stock outs of essential commodities in districts and
communities.
 NUTRITION
• Nutrition is a globally recognized development agenda.
Since the year 2000, several global movements have
advocated nutrition for development.
• The Scaling-Up-Nutrition (SUN) initiative calls for multi-
sectoral action for improved nutrition during the first
1,000 days of life.
• The Government of Nepal as an early member of SUN
adopted the Multi-sector Nutrition Plan (MSNP) in 2012 to
reduce chronic nutrition. Recently, the UN General
Assembly declared the 2016–2025 period as the Decade of
Action on Nutrition.
 Goal & Objectives

• The goal of the National Nutrition Programme

is to achieve nutritional well-being of all people to
maintain a healthy life (to contribute to the
socioeconomic development of the country), through
improved nutrition programme implementation in
collaboration with other sectors.
• The overall objective is to enhance nutritional
well-being, reduce child and maternal mortality and
contribute to equitable human development.
 Specific objectives
• To reduce protein-energy malnutrition in children under 5 years of age and women of
reproductive age
• To improve maternal nutrition
• To reduce the prevalence of anaemia among adolescent girls, women and children
• To eliminate iodine deficiency disorders and vitamin A deficiency and sustain elimination
• To reduce the infestation of intestinal worms among children and pregnant women
• To reduce the prevalence of low birth weight
• To improve household food security to ensure that all people can have adequate access,
availability and use of food needed for a healthy life
• To promote the practice of good dietary habits to improve the nutritional status of all
people
• To prevent and control infectious diseases to improve nutritional status and reduce child
mortality
• To control lifestyle related diseases including coronary disease, hypertension, tobacco
related diseases, cancer and diabetes
• To improve the health and nutritional status of schoolchildren
• To reduce the critical risk of malnutrition and life during very difficult circumstances
• To strengthen the system for analysing, monitoring and evaluating the nutrition situation
 Programme strategies
• The main overall strategies for improving
nutrition are
i) the promotion of a food based-approach,
ii) food fortification,
iii) the supplementation of foods and
iv) the promotion of public health measures.
FAMILY HEALTH
 Family Planning
• The Government of Nepal is committed to providing equitable access
to voluntary family planning services based on informed choices by
individuals and couples and particularly poor, vulnerable and
marginalized people.
• Family planning is a priority programme of the Government of Nepal.
• It is a component of the reproductive health package and essential
health care services under the Nepal Health Sector Programme-2
(2010-2015), the National Family Planning Costed Implementation
Plan (2015–2021), the Nepal Health Sector Strategy (2015-2020) and
the government’s commitments to Family Planning 2020.
• The main aim of the National Family Planning Programme is to
ensure that individuals and couples can fulfill their reproductive
needs by using appropriate family planning methods based on
informed choices.
 Objectives
• The overall objective of Nepal’s family planning programme is to improve
the health status of all people through informed choice on accessing and using
voluntary family planning.
The specific objectives are as follows:
• To increase access to and the use of quality family planning services that
are safe, effective and acceptable to individuals and couples. A special
focus is on increasing access in rural and remote places and to poor, Dalit
and other marginalized people with high unmet needs and to postpartum
and post-abortion women, the wives of labour migrants and adolescents.
• To increase and sustain contraceptive use, and reduce unmet need for
family planning, unintended pregnancies and contraception
discontinuation.
• To create an enabling environment for increasing access to quality family
planning services to men and women including adolescents.
• To increase the demand for family planning services by implementing
strategic behaviour change communication activities.
 Safe Motherhood and Newborn Health
• The goal of the National Safe Motherhood Programme is to reduce maternal
and neonatal morbidity and mortality and improve maternal and neonatal
health through preventive and promotive activities and by addressing
avoidable factors that cause death during pregnancy, childbirth and the
postpartum period.
• Evidence suggests that three delays are important factors for maternal and
newborn morbidity and mortality in Nepal (delays in seeking care, reaching
care and receiving care).
The following strategies have been adopted to reduce risks during pregnancy
and childbirth and address factors associated with mortality and morbidity:
• Promoting birth preparedness and complication readiness including
awareness raising and improving availability of funds, transport and blood
supplies.
• The Safe Motherhood Programme (Aama Suraksha Programme) promotes
antenatal checkups and institutional delivery.
• The expansion of 24-hour emergency obstetric care services (basic and
comprehensive) at selected public health facilities in all districts.
 Strategies
1. Promoting inter-sectoral coordination and collaboration at central, regional, districts
and community levels to ensure commitment and action for promoting safe
motherhood with a focus on poor and excluded groups.
2. Strengthening and expanding delivery by skilled birth attendants and providing basic
and comprehensive obstetric care services at all levels. Interventions include:
• developing the infrastructure for delivery and emergency obstetric care
• standardizing basic maternity care and emergency obstetric care at appropriate levels
of the health care system;
• strengthening human resource management — diploma in gynaecology (DGO),
advanced skilled birth attendant (ASBA), SBA, anaesthesia assistant training and
deployment;
• establishing a functional referral system with airlifting for emergency referrals from
remote areas, the provision of stretchers in VDC wards and emergency referral funds in
remote districts; and
• strengthening community-based awareness on birth preparedness and complication
readiness through FCHVs and increasing access to maternal health information and
services.
3. Supporting activities that raise the status of women in society.
4. Promoting research on safe motherhood to contribute to improved planning, higher
quality services and more cost-effective interventions.
 FCHV Programme
• The government initiated the Female Community Health Volunteer (FCHV)
Programme in 2045/46 (1988/1989) in 27 districts and expanded it to all
districts thereafter.
• FCHVs are selected by healthy mothers’ groups.
• FCHVs are provided with 18 days basic training following which they receive
medicine kit boxes, manuals, flipcharts, ward registers, IEC materials, and an
FCHV bag, signboard and identity card.
• Family planning devices (pills and condoms only) iron tablets, vitamin A
capsules, and ORS are supplied to them through health facilities.
• The major role of FCHVs is to advocate healthy behaviour by mothers and
community people to promote safe motherhood, child health, and family
planning and other community based health issues and service delivery.
• FCHVs distribute condoms and pills, ORS packets and vitamin A capsules,
treat pneumonia cases, refer serious cases to health institution and motivate
and educate local people on healthy behaviour. They also distribute iron
tablets to pregnant women.
 Goal and objectives of the FCHV
Programme
Goal — Improve the health of local communities by promoting public
health.
• This includes imparting knowledge and skills for empowering
women, increasing awareness on health related issues and involving
local institutions in promoting health care.
Objectives —
i) Mobilize a pool of motivated volunteers to connect health
programmes with communities and to provide community-based
health services,
ii) activate women to tackle common health problems by imparting
relevant knowledge and skills;
iii) increase community participation in improving health,
iv) develop FCHVs as health motivators and
v) increase the use of health care services.
 Primary Health Care Outreach
• Health facilities were extended to the village level under the National Health
Policy (1991).
• However, the use of services provided by these facilities, especially
preventive and promotive services, was limited due to accessibility factors.
• Primary health care outreach clinics (PHC-ORC) were therefore initiated in
1994 (2051 BS) to bring health services closer to communities.
• The aim of these clinics is to improve access to basic health services
including family planning, child health and safe motherhood. These clinics
are service extension sites of PHCCs and health posts.
• The primary responsibility for conducting them lies with maternal and child
health workers (MCHWs) and village health workers (VHWs) at sub-health
posts and ANMs, AHWs and VHWs at PHCCs and health posts.
• With the upgrading of MCHWs and VHWs and the upgrading of all sub-health
posts the responsibility is being shared with all ANMs and AHWs.
• FCHVs and local NGOs and community based organizations (CBOs) support
health workers to conduct clinics including recording and reporting.
 Services to be provided by PHC-ORCs
according to PHC-ORC strategy
Safe motherhood and newborn care: Child health:
• Antenatal, postnatal, and newborn • Growth monitoring of under 3 years
care children
• Iron supplement distribution • Referral • Treatment of pneumonia and
if danger signs identified diarrhoea.
Family planning: Health education and counselling:
• DMPA (Depo-Provera) pills and • Family planning
condoms • Maternal and newborn care
• Monitoring of continuous use • Child health
• Education and counselling on family • STI, HIV/AIDS
planning methods and emergency • Adolescent sexual and reproductive
contraception health.
• Counselling and referral for IUCDs, First aid:
implants and VSC services • Minor treatment and referral of
• Tracing defaulters. complicated cases.
 Demography and Reproductive Health
Research
• The planning, monitoring and evaluation of reproductive health activities
are key functions of the Programme, Budget and Demography Section.
• This section conducts studies and coordinates reproductive health related
research and studies carried out by other organisations in Nepal.
• The major responsibilities of this section are as follows:
 Estimate annual national targets for family planning, safe motherhood and
adolescent reproductive health services including family planning acceptors and
reproductive health commodities.
 Regularly monitor reproductive health and essential obstetric care (EOC) activities.
 Provide supportive supervision to DHOs, DPHOs and all levels of health facilities on
reproductive health services.
 Conduct periodic and ad-hoc research and studies on family planning, maternal
and neonatal health, safe abortion services, adolescent sexual and reproductive
health and FCHV services.
 Conduct and support the piloting of maternal and newborn health initiatives.
 Adolescent Sexual and Reproductive Health
• Nepal endorsed and published the National Adolescent Health
and Development (NAHD) Strategy in 2000.
• An implementation guideline on Adolescent Sexual and
Reproductive Health (ASRH) was developed in 2007 to support
district health managers to operationalize the strategy.
• In 2008, a draft national ASRH programme was developed with
the support from GIZ. This programme was piloted in 2009 in 26
public health facilities. Based on the findings from the pilot
intervention, a National ASRH Programme was designed in 2011.
• The programme has orientation manuals for district health
managers, district stakeholders, health service providers and
health facility operation and management committees
(HFOMCs)/local stakeholders.
 Goal & Objectives
• Goal —To promote the sexual and reproductive health of adolescents.
• Objectives:
 To increase the availability of and access to quality information on adolescent health and
development, and provide opportunities to build the knowledge and skills of adolescents,
service providers and educators.
 To increase the accessibility and use of adolescent health and counselling services.
 To create safe and supportive environments for adolescents to improve their legal, social and
economic status.
 To create awareness on adolescence issues through BCC campaigns and at national, districts
and community levels through FCHVs and mothers groups.
• Target
 To make 1,000 health facilities adolescent-friendly by 2015 in line with NHSP-2 (2010-2015).
 The National Health Policy (2014) and NHSS (2016–2021) envision all health facilities
providing adolescent friendly health services.
 The programme aims to reduce the adolescent fertility rate (AFR) by improving access to
family planning information and devices.
DISESASE CONTROL
 Malaria: Introduction
• Nepal’s malaria control programme began in 1954, mainly in the
Tarai belt of central Nepal with support from the United States.
• In 1958, the National Malaria Eradication Programme was initiated
and in 1978 the concept reverted to a control programme.
• In 1998, the Roll Back Malaria (RBM) initiative was launched for
control in hard-core forests, foothills, the inner Tarai and hill river
valleys, which accounted for more than 70 percent of malaria
cases in Nepal.
• Malaria is a greater risk in areas with an abundance of vector
mosquitoes, amongst mobile and vulnerable populations, in
relatively inaccessible areas, and during times of certain
temperatures.
 Visio, Mission & Goals
• Vision — A malaria-free Nepal by 2025.
• Mission — Empower health staff and communities at risk to
contribute towards the vision of a malaria-free Nepal by 2025.
• Goals:
 Sustain zero deaths due to malaria from 2012 onwards.
 Reduce the incidence of indigenous malaria cases by 90% by
2018 (relative to 2012).
 Reduce the number of VDCs with indigenous malaria cases by
70% by 2018 (relative to 2012).
 Receive WHO certification of malaria free status by 2025.
 National Malaria Strategic Plan(2014-2025)
• The strategic plan was divided into two phases;achive malaria Pre-
Elimination by 2018 and attain malaria Elimination by 2026.
• STRATEGY
I. To strengthen strategic information for decision making towards malaria
elimination
II. To further reduce malaria transmission and eliminate the Foci wherever
feasible
III. To improve quality of and access to early diagnosis and effective
treatment of malaria
IV. To develop and sustain support through advocacy and communication,
from the political leadership and the communities towards malaria
elimination
V. To strengthen programmatic technical and managerial capacities
towards malaria elimination.
 Kala-Azar- Introduction
• Kala-azar is a vector-borne disease caused by the parasite Leishmania
donovani, which is transmitted by the sand fly Phlebotomus argentipes.
• The disease is characterized by fever for more than two weeks with
spleenomegaly, anaemia, and progressive weight loss and sometimes
darkening of the skin.
• In endemic areas, children and young adults are the principal victims.
• The disease is fatal if not treated on time. Kala-azar and HIV/TB co-
infections have emerged in recent years.
• The government committed to the regional strategy to eliminate kala-
azar and signed the memorandum of understanding that was
formalized at the World Health Assembly in 2005, with the target of
achieving elimination by 2015.
• In 2005, the EDCD formulated a National Plan for Eliminating kala-azar
across preparatory (2005-2008), attack (2008–2015) and consolidation
(2015 onwards) phases.
 Goal, objectives and strategies
• Goal — To improving the health status of vulnerable groups and at risk populations living in
kala-azar endemic areas of Nepal by eliminating kala-azar so that it is no longer a public
health problem.
• Target — Reduce the incidence of kala-azar to less than 1 case per 10,000 populations at
district level.
• Objectives:
 Reduce the incidence of kala-azar in endemic communities including poor, vulnerable and
unreached populations.
 Reduce case fatality rates from kala-azar.
 Treat post-kala-azar dermal leishmaniasis (PKDL) to reduce the parasite reservoir.
 Prevent and treat kala-azar and HIV–TB co-infections.
• Strategies — Based on the regional strategy proposed by the South East Asia kala-azar
technical advisory group and the adjustments proposed by the Nepal expert group
discussions, MoH has adopted the following strategies for the elimination of kala-azar.
 Improve programme management
 Early diagnosis and complete treatment
 Integrated vector management
 Effective disease and vector surveillance
 Social mobilization and partnerships
 Clinical, implementation and operational research.
 Zoonoses
• The Epidemiology and Disease Control Division (EDCD) is responsible for responding to poisonous snake
bites, and the control and prevention of rabies and other zoonoses in coordination and collaboration with
the general public and non-governmental and private partners
Goals:
• No Nepalese dies of rabies or poisonous snake bites due to the unavailability of anti-rabies vaccine (ARV) or
anti-snake venom serum or timely health care services.
• To prevent, control and manage outbreaks and epidemics of zoonoses.
Objectives:
• To strengthen the response and capacity of health care service providers for preventing and
controlling zoonoses.
• To improve coordination among and between stakeholders for preventing and controlling
zoonoses.
• To enhance the judicious use of tissue culture, ARV and ASVS in health facilities.
• To reduce the burden of zoonotic diseases (especially rabies and six other priority zoonoses)
through public awareness programmes.
• To provide tissue culture ARV as a post-exposure treatment to all victims bitten by suspicious
or rabid animals.
• To reduce the mortality rate in humans by providing ASVS and ARV.
• To train medical officers and paramedics on snake bite management and the effective use of
ARS.
• To reduce the number of rabid and other suspicious animal bites.
• To reduce the annual death rate due to rabies.
 Leprosy
• The establishment of the Khokana leprosarium in the nineteenth century was the beginning
of organized leprosy services in Nepal
Vision — To make a leprosy free society where there are no new leprosy cases and all the needs
of leprosy affected persons are fully met.
Mission — To provide accessible and acceptable cost effective quality leprosy services including
rehabilitation and to continue to provide such services as long as and wherever needed.
Goal — To reduce further the burden of leprosy and to break the channel of transmission from
person to person by providing quality services to all affected communities.
Objectives:
• To eliminate leprosy (= prevalence rate below 1/10,000 population) and further reduce the
disease burden.
• To reduce disability due to leprosy.
• To reduce the stigma in communities against leprosy.
• To provide high quality services for all persons affected by leprosy.
• To integrate leprosy in integrated health care delivery for the provision of quality services.
 Leprosy :Strategies
• The national strategy envisions delivering quality leprosy services through the meaningful involvement of
people affected by leprosy and a rights-based approach to leprosy services as follows:
• Early new case detection and timely and complete management.
• The provision of quality leprosy services in an integrated setup by qualified health workers.
• The prevention of impairment and disability associated with leprosy.
• The rehabilitation of people affected by leprosy, including medical and community-based
rehabilitation.
• Reduce stigma and discrimination against people with leprosy through advocacy, social
mobilization and IEC activities and to address gender equality and social inclusion.
• Strengthen referral centres for complications management.
• Meaningfully involve people affected by leprosy in leprosy services and address human rights
issues.
• Promote and conduct operational research and studies.
• Monitor activities and provide supportive supervision, including on-site coaching, surveillance
and evaluation, to strengthen quality leprosy services.
• Strengthen partnership, co-operation and coordination with local government, external
development partners, civil society and community based organizations.
 Tuberculosis
• Tuberculosis (TB) is a public health problem in Nepal that affects thousands of people each year and is the sixth leading
cause of death in the country. WHO estimates that 44,000 people develop active TB every year and out of them 20,500 have
infectious pulmonary disease and can spread the disease to others.
Vision: Nepal free of tuberculosis.
Long term goal: End the tuberculosis epidemic by 2050.Short term goal: Reduce TB incidence by 20%
by 2021 compared to 2015 and increase case notifications by a cumulative total of 20,000 from July
2016 to July 2021.
Objectives:
• Increase case notification through improved health facility-based diagnosis.
• •Maintain the treatment success rate at 90% of patients (for all forms of TB) through to 2021.
• Provide drug resistance diagnostic services for 50% of persons with presumptive drug resistant
• TB by 2018 and 100% by 2021 and successfully treat at least 75% of diagnosed drug resistant patients.
• Further expand case finding by engaging the private sector.
• Strengthen community systems for the management, advocacy, support and rights of TB patients in order to create an
enabling environment to detect and manage TB cases in 100% of districts by 2021.
• Contribute to health system strengthening through TB human resource management, capacity development, financial
management, infrastructure, procurement and supply management.
• Develop a comprehensive TB surveillance, monitoring and evaluation system
• Develop a plan to continue NTP services in the aftermath of natural disasters and public health emergencies.
SDG31 global targets:
• By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and
other communicable diseases.
SDG and End TB Strategy related targets:
• Detect 100% of new sputum smear-positive TB cases and cure at least 85% of these cases.
• By 2050, eliminate TB as a public health problem (threshold of <1 case per million population).
 The End TB Strategy
The End TB Strategy was unanimously endorsed by the World Health Assembly in 2014. Its three overarching indicators are
i) the number of TB deaths per year,
ii) TB incidence rate per year, and
iii) the percentage of TB-affected households that experience catastrophic costs as a result of TB.
These indicators have related targets for 2030 and 2035.
The main principles for implementing the strategy are:
• government stewardship and accountability, with monitoring and evaluation;
 strong coalitions with civil society organizations and communities;
 the protection and promotion of human rights, ethics and equity; and
 the adaptation of the strategy and targets at country levels, with global collaboration.
The strategy’s components (three pillars) and related strategies are as follows:
1. Integrated, patient- entered care and prevention:
• Early diagnosis of TB including universal drug-susceptibility testing, and systematic screening of contacts and high-risk
groups.
• Treatment of all people with TB including drug-resistant TB.
• Collaborative TB/HIV activities and the management of co-morbidities.
• The preventive treatment of persons at high risk, and vaccination against TB.
2. Bold policies and supportive systems:
• Political commitment with adequate resources for TB care and prevention.
• The engagement of communities, civil society organizations, and public and private care
providers.
• Universal health coverage policy and regulatory frameworks for case notification, vital
registration, quality and rational use of medicines, and infection control.
• Social protection, poverty alleviation and actions on other determinants of TB.
3. Intensified research and innovation:
• The discovery, development and rapid uptake of new tools, interventions and strategies.
• Research to optimize implementation and impact, and promote innovations.
 HIV/AIDS and STI
• Nepal began its policy response to the HIV epidemic through its first National Policy on Acquired
Immunity Deficiency Syndrome (AIDS) and Sexually Transmitted Disease (STD) Control (1995).
• Considering the dynamic nature of the epidemic the policy was revised in 2011 as the National
Policy on Human Immunodeficiency Virus (HIV) and Sexually Transmitted Infections (2011). Based
on the latest policy, the country implemented its fourth National HIV/AIDS Strategy (2011-2016).
A new National HIV Strategic Plan (2016-2021) was recently launched with the ambitious 90-90-
90 goal, that by 2020, 90 percent of all people living with HIV know their HIV status, 90 percent of
all people with diagnosed HIV infection receive sustained antiretroviral therapy and 90 percent of
all people receiving antiretroviral therapy have viral suppression.
Main policies
Nepal’s policy responses to HIV have come from the health and other development sectors to create
an enabling policy environment for containing HIV and to mitigate the impact of the epidemic
The National Policy on HIV and STI — The National Policy on HIV and STI (2011) accords HIV and
AIDS a high priority in national development. It calls for a multi-sectoral, decentralized and
inclusive response based on the ‘three ones’
i) agreed HIV/AIDS Action Framework that provides the basis for coordinating the work of all
partners,
ii) one national AIDS coordinating authority and
iii) one agreed country level M&E system.
 Contd...
The Nepal Health Sector Programme — NHSP-2 (2010-2015) embraced a plan to halt or reverse HIV
prevalence, and committed to scaling up HIV-related interventions under the essential health care
package within the broader framework of communicable diseases. It also recognized the need to
expand sexual and reproductive health (SRH) services and integrate HIV into them.
National HIV Strategic Plan — The National HIV Strategic Plan (2016-2021), aims to meet the global
90-90-90 goal by 2020. The plan is focused on building one consolidated, unified, rights based and
decentralized HIV programme with services that are integrated into general health services. It builds on
lessons learned from implementing the National AIDS Strategy (2011–2016), its mid-term review and
the Nepal HIV Investment Plan (2014–2016); and applies recommendations from the AIDS Epidemic
Model exercise.
National Health Sector Strategy (2015-2020) — The National Centre for AIDS and STD Control (NCASC) is
accountable for implementing the National HIV Strategic Plan through public health services. Its
implementation takes place in coordination with other public entities and the private sector, including
services provided by civil society and other non-government networks and organizations. Because
financing the HIV response in Nepal relies heavily on external funding, which is rapidly declining, it is
imperative that public-private partnerships are established and maintained, and that wise, evidence
informed investment choices are made. The commitment by Nepal to the global UNAIDS Strategy
(2016-2021) and the SDGs include commitments to fast-track the HIV response to achieve the 90-90-90
targets by 2020 and to end the AIDS epidemic as a public health threat by 2030.
Guidelines and documents — The Consolidated Guidelines on Treating and Preventing HIV in Nepal
(2014), National Guidelines on Monitoring and Evaluation of HIV Response in Nepal (2012), and
National Guidelines of Case Management of Sexually Transmitted Infections (STIs) (2014) guide the
response.
 Eye Care
• In 1999, WHO estimated there were 45 million blind people
and 135 million with low vision globally and that the number
of blind people would double in 20 years if existing trends
continued. Therefore, the global initiative of Vision 2020 ‘The
Right to Sight’ was launched in February 1999 by WHO and
the International Agency for the Prevention of Blindness.
Vision 2020 provides the guidelines, targets, and strategies
needed to reduce the prevalence of blindness in developing
countries to eliminate avoidable blindness by the year 2020.
Nepal adopted the Vision
• Following the launch of Vision 2020, the government’s eye
care programme introduced vertical programmes to manage
and treat cataracts, trachoma, xerophthalmia, refractive error
and low vision.
 DENGUE
• A mosquito-borne disease that occurs in Nepal as dengue fever,
dengue haemorrhagic fever (DHF) and dengue shock syndrome (DSS).
An outbreak of dengue fever occurred in Nepal during June to
November 2016, with a peak number of cases reported in September.
Goal — To reduce the morbidity and mortality due to dengue fever,
Dengue Haemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS).
OBJECTIVES:
• To develop an integrated vector management (IVM) approach for
prevention and control.
• To develop capacity on diagnosis and case management of dengue
fever, DHF and DSS.
• To intensify health education and IEC activities.
• To strengthen the surveillance system for prediction, early detection,
preparedness and early response to dengue outbreaks.
 Strategies:
• Early case detection, diagnosis, management
and reporting of dengue fever,DHF and DSS.
• Regular monitoring of dengue fever, DHF and
DSS cases and surveillance through the EWARS.
• Mosquito vector surveillance in municipalities.
• The integrated vector control approach where a
combination of several approaches are directed
towards containment and source reduction.
 Lymphatic Filariasis
• Lymphatic filariasis is a public health problem in Nepal. Mapping of the disease in 2012 using ICT (immune-
chromatography test card) revealed 13 percent average prevalence of lymphatic filariasis infection in Nepal’s
districts, ranging from <1 percent to 39 percent. Based on the ICT survey, morbidity reporting and geo-ecological
comparability, 61 districts were identified as endemic for the disease.
Goal — The people of Nepal no longer suffer from lymphatic filariasis
Objectives:
• To eliminate lymphatic filariasis as a public health problem by 2020
• To interrupt the transmission of lymphatic filariasis
• To reduce and prevent morbidity
• To provide deworming through albendazole to endemic communities especially to children
• To reduce mosquito vectors by the application of suitable available vector control measures
(integrated vector management).
Strategies:
• Interrupt transmission by yearly mass drug administration using two drug regimens
(diethylcarbamazine citrate and albendazole) for six years
• Morbidity management by self-care and support using intensive simple, effective and local
hygienic techniques.
Targets:
• To scale up MDA to all endemic districts by 2014
• Achieve <1% prevalence (microfilaraemia rate) in endemic districts after six years of MDA by
2018.
Non-communicable diseases (NCDs)
 Non-communicable diseases (NCDs)

• Emerging as the leading cause of death globally and

also in the South East Asia region.
• Due to many social determinants:
Unhealthy lifestyles,
Globalization,
Trade and marketing,
Demographic and economic transitions
Essential non-communicable disease with well
established common modifiable risk factors.
Cardiovascular diseases (CVD),
Chronic non-infectious
respiratory diseases (like COPD),
Cancers and Diabetes Mellitus

Additional NCDs in Nepal

Oral health,
Mental Health
And Road traffic Injuries
Behaviorally modifiable risk factors of NCDs:
Tobacco use,
Harmful alcohol use,
Unhealthy diet as consumption of less fruits and vegetables,
High salt and trans-fat consumption,
And physical inactivity
Metabolic risk factors
Overweight and obesity,
Raised blood pressure,
Raised blood glucose
And abnormal blood lipids

For some region and the country,

Indoor air pollution is another important modifiable behavioral risk
factor.
 Situation Analysis
Globally, NCDs account for almost 2/3 of the total
health burden in terms of mortality.

South-East Asia Region (SEAR)

NCDs are the leading cause of death
An estimated 7.9 million lives are lost due to NCDs
accounting for 55% of all deaths
In 2008, the proportion of deaths due to NCDs
below the age of 60 years was 34% in SEA
Region, compared to 23% in rest of the world.
 Burden of NCDs and determinants in Nepal

• NCD information on Nepal is

scanty.
• Available hospital records on
NCDs indicate growing
burden of NCDs.
• Accounted for 39 percent of
the total country’s disease
burden, and nearly half of all
deaths were due to NCDs.
 Diabetes mellitus
Prevalence of diabetes was 3.9 percent among adults (IDF 2010)
• A Nationwide survey shows a prevalence of Diabetes Mellitus
as 3.6% (men: 4.6% and women: 2.7%) among 15-69 years
population (STEPS Survey 2013).
• some sources indicated higher prevalence of about 11 percent
in certain areas.
Cancer
• 7 % of all deaths in the country were attributed to
cancers.
• By 2030, Cancer deaths are projected to increase
to 12 percent.
• Cancers of mouth and lungs were dominant in
males, whereas cancers of breast and cervix -
Uterus were the leading cancers in females.
 Chronic Respiratory Diseases(CRD)
• Account for about 7 percent of a country NCD burden.
• Prevalence of COPD in males was remarkably higher than
in females
• COPD in Kathmandu valley has increased by more than
70%
• The highest mortality and morbidity among the
hospitalized patient
Oral Health.
• STEPs survey 2013, found that about 9.5% of the
population has very poor state of oral health and
23.7% have had oral pain or discomfort.
• The survey also depicted 36% self reported
prevalence of dental caries among 15-69 years
old population in 2012/13.
 Mental Health.

• It is estimated that 18% of the NCD burden

is due to mental illness.
• approximately 2, 65,000 (1%) Nepalese may be affected with severe
mental disorders
• 3-5 million (10 - 20%) people have one or other minor mental health
problems.
• The burden may be even higher for Nepal
due to
10 years of armed conflict,
prolonged political instability,
mass youth migration abroad for employment,
ageing of the population,
poverty and unplanned urbanization.
Road safety

Nepal’s road crash fatality rate in fiscal year 2009- 010

was 17 per 10,000 registered vehicles, one of the highest
in both Asia and the world.
 Thank you
for your attention