Nepal

Chronic respiratory diseases. Section 9.4, including Tables 9.5 and 9.6 and Figures 9.5 and
9.6, explores the availability of services for chronic respiratory diseases and the readiness of
facilities to provide these services.
9.1 MAJOR NON-COMMUNICABLE DISEASES IN NEPAL
In Nepal, as in many other countries, NCDs and their risk factors constitute a public health problem
(Neupane & Kallestrop, 2013). In fiscal year 2014/15, 85 percent of inpatient visits were for noncommunicable
diseases, and 80 percent of deaths were caused by NCDs (DoHS Annual report 2014/15).
The growing burden of NCDs in Nepal is not receiving the necessary attention from the government,
academicians, and development partners. Simple measures at the population and individual levels have not
been implemented in an effective way. For instance, Neupane & Kallestrop (2013) found that there is no
clear vision to address non-communicable diseases at primary health care level. On the contrary, after testing
and potential positive outcome for scaleup, there is opportunity for the integration of non-communicable
diseases into the existing communicable diseases interventions as soon as possible (Neupane & Kallestrop,
2013).
There is a lack of information on NCDs in Nepal. However, available hospital records indicate the
growing burden caused by these diseases. It is evident that there is a need to strengthen the complete
spectrum of NCD prevention interventions.
To overcome the challenges of the growing NCD burden, the 2012 National Health Communication
Policy seeks to raise health awareness and knowledge and promote healthy behaviors among all citizens;
raise awareness among the public about preventative measures and encourage the adoption of those
measures; and intensify and strengthen action against tobacco use (both smoked and smokeless), excessive
use of alcohol, unhealthy diets, and physical inactivity (Ministry of Health, 2012).
Similarly, the government of Nepal has developed the multisectoral Action Plan for the Prevention
and Control of Non-communicable Diseases (2014-2020) (GoN 2014) to reduce preventable morbidity,
avoidable disability, and premature mortality due to NCDs in Nepal. As outlined in this plan, some of the
key objectives in managing NCDs in Nepal include strengthening national capacity, leadership, and
governance; adopting multisectoral actions and partnerships to accelerate the country’s efforts toward the
prevention and control of non-communicable diseases; reducing modifiable NCD risk factors and underlying
social determinants through creation of health-promoting environments; and strengthening and orienting
health systems to address the prevention and control of non-communicable diseases and underlying social
determinants through people-centered primary health care and universal health coverage. In addition, health
promotion related to NCDs has been given priority in the National Health Policy 2014 and the National
Health Sector Strategy 2015-2020.
In Nepal, NCD control services are decentralized at the health post (HP), primary health care center
(PHCC), and hospital levels for early detection and management at the community level as recommended in
the WHO Package of Essential Non-communicable Disease Interventions (PEN). Recently, Nepal developed
the PEN Implementation Plan 2016-2020, with screening, diagnosis, treatment, and referral interventions
for CVDs, Chronic obstructive pulmonary disease (COPD), cancer, and diabetes at the hospital and primary
health care levels.
9.1.1 Diabetes
Diabetes is defined by a fasting blood glucose level of 7.0 mmol/L or above (WHO 2006). Estimates
of the prevalence of diabetes in Nepal vary. According to one estimate, the prevalence is 3.3 percent among
adults, and the health cost per person with diabetes is US$68.50 (International Diabetes Federation 2015). A
recent nationwide survey revealed a diabetes prevalence of 4 percent (5 percent among men and 3 percent
among women) (STEPS Survey, Nepal 2013); A cross-sectional study conducted in non-specialist
184 • Non-Communicable Diseases