Nepal

Facilitating and promoting research
Strengthening TB program monitoring and evaluation
In 2015, the NTP adopted the End TB Strategy and its vision of zero deaths, zero TB infections, and
zero TB suffering in the country. The NTP is currently drafting the National Sub-Sector Strategy Plan for
TB Control (2016-2021); several major changes are incorporated in the plan, including shifts from the
Millennium Development Goals to the Sustainable Development Goals and from a stop TB strategy to an
end TB strategy. The plan focuses on addressing the needs of all vulnerable populations with equity and
social justice.
Directly Observed Treatment, Short Course
The current NTP TB treatment guideline calls for standardized treatment (using fixed-dose
combination therapy for six months) for all new cases in all health facilities, whether public or private. The
exception is TB meningitis, which is treated for nine months. All recurring cases must be treated for eight
months. The NTC, along with several NGOs and community-based organizations, operates communitybased
TB control interventions involving community volunteers and community health workers, who
provide important linkages with health facilities.
Multidrug-resistant TB
Nepal introduced MDR-TB management following a successful Green Light Committee application
for second-line anti-TB drugs in 2005. The NTP provides ambulatory MDR-TB services at the central and
district levels through 14 treatment centers and 81 treatment subcenters. In addition to these outpatient
services, inpatient and long-term non-ambulatory services for needy patients are provided through 10 Drug
Resistant hostels and one Drug Resistant home.
MDR-TB cases are treated for 20-24 months using second-line TB treatment, whereas treatment for
extensively drug-resistant TB can require 24-30 months. In Nepal, the treatment success rate for MDR-TB
is 70 percent, which is higher than the regional and global average of 50 percent. This higher success rate
could be due to the mixed approach of ambulatory and non-ambulatory services along with the additional
nutritional and psychosocial support packages offered to all MDR-TB patients.
Record Management of Tuberculosis Services
Monitoring and evaluation to track the program performance and impact of all aspects of DOTS is
an integral part of the TB control effort. The NTP continues to monitor the progress of program
implementation through quarterly and annual reports and reviews at the district, regional, and national levels.
All cases, suspected cases, and TB/HIV co-infected cases are entered into the TB program recording and
reporting system through pre-designed data collection tools (forms and registers). The NTP reports treatment
outcomes for all forms of TB in line with WHO recommendations. An electronic master register is planned
to be introduced in 2016, and data will be entered at the district level and reviewed on a monthly basis at the
regional and central levels.
10.2 AVAILABILITY OF TB SERVICES
Achieving effective TB control requires concerted efforts at all levels. As shown in Table 10.1, 44
percent of all health facilities carry out screening and referral of TB cases for diagnosis. The proportions
reporting that they screened and referred clients for TB diagnosis were higher among peripheral health
facilities (primary health care centers [PHCCs], 37 percent; health posts [HPs], 48 percent; and urban health
centers [UHCs], 35 percent) and district hospitals (33 percent) than among zonal and above (18 percent) and
private (15 percent) hospitals. Facilities in the mountain region were less likely than those in the terai and
hill regions to provide TB screening and referral services. These services were provided by 43 percent of
facilities in the 14 earthquake-affected districts.
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