Critical Review of the current Policies, Strategies and Programs of Preventive, Protective and Control measures of Diabetes in Nepal

1. Critical review of the current
Policies, Strategies and Programs
of Preventive, Protective and
Control measures of Diabetes in
Nepal
Presented by:
Mohammad Aslam Shaiekh
Master of Public Health (MPH)

2. Background
 Non communicable diseases (NCDs) cause 63%
of deaths globally and nearly 80% of deaths in
low and middle income countries (WHO 2010).
 WHO recognizes diabetes as one of the four
high-burden NCDs. The total number of people
with diabetes is projected to rise from 171 million
in 2000 to 366 million in 2030.
 In 2012, an estimated 1.5 million deaths were
attributed to diabetes worldwide and more
than 80% of these deaths occurred in LMI
countries.
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3.  Diabetes is an emerging public-health
epidemic in the WHO South-East Asia Region.
The International Diabetes Federation (IDF)
estimates that 72 million adults in Bangladesh,
India, Nepal and Sri Lanka were living with
diabetes in 2013 and, by 2035, the equivalent
number is projected to exceed 123 million.
 Diabetes and other NCDs pose a major
challenge to Nepal‟s health-care system; the
proportion of deaths attributable to all NCDs
has increased from 51% in 2010 to 60% in 2014.
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4.  The WHO NCD Country profile 2014 reports that
CVD was responsible for 22% of all deaths in
Nepal, followed by chronic respiratory disease
(13%), cancer (8%) and diabetes (3%); together,
these four NCDs accounted for 22% of all
premature deaths in Nepal.
 According to “The world health report 2002”,
the four behavioral risk factors; tobacco,
alcohol, diet and physical activity and four
metabolic risk factors; raised blood pressure,
blood glucose, blood cholesterol and
overweight/ obesity – account for 22% of the
NCDs including diabetes.
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5. Policies, Strategies and Programs
of Preventive, Protective and
Control measures
 There are wide variations in the availability of
diabetes care services, and their utilization
across different socioeconomic and
geographical population groups, indicating the
challenge of access and equity.
 Diabetes services are provided by the public
and private sectors through different levels of
health workforce. The availability of diabetes
care services and quality of care are not
structured and uniform in the country.
Appropriate referrals and consultations are not
commonly practiced.
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6.  In the absence of national guidelines for
diabetes care, service providers use a range
of different guidelines.
 The categories of health workforce providing
diabetes care are endocrinologists,
ophthalmologists, primary care physicians,
ophthalmic assistants and dietitians. The
available health workforce in the country is
inadequate and not uniformly distributed.
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7.  Diabetes services are mainly centered in
urban areas and are inaccessible to many
Nepalese people.
 There are no government health financing
schemes for diabetes care and none of the
services are funded or subsidized by the
government. All services such as diagnosis,
treatment, medications and laboratory tests
are funded by individuals out of pocket.
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8.  There is no nationwide robust programme for
diabetes prevention in the country. Some non
governmental organizations support
occasional mass media awareness activities
and screening camps and organize national
events to commemorate World Diabetes Day.
Theme for World Diabetes day, (Nov 14,
2018/19): “The Family and Diabetes”
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9. WHO response to NCDs including
Diabetes
WHO has developed several policies and
technical guidelines for the member countries to
address NCDs, especially focusing on developing
countries. The documents relevant to the NCDs
prevention and control in Nepal include:
 Global Strategy for the Prevention and Control
of Non-Communicable Diseases (2000)
 WHO Framework Convention on Tobacco
Control (2003)
 Global Strategy on Diet, Physical Activity and
Health (2004)
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10. Contd…
 Resolution WHA60.23 on Prevention and
control of non communicable diseases:
implementation of the global strategy (2007)
 2008-2013 Action Plan for the Global Strategy
for the Prevention and Control of Non
communicable Diseases (2008)
 Global Strategy to Reduce the Harmful Use of
Alcohol in 2010 (WHA63.13)
 Global action plan, including indicators and
voluntary targets, through resolution WHA66.10
 Action Plan for the prevention and control of
NCDs in South-east Asia, 2013-2020 (2013)
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11. NCDs Risk Factors STEPS Survey
Nepal 2013
 With technical assistance from the WHO, the first
nationally representative NCDs STEPS survey was
conducted by NHRC under the supervision of the
MOHP in order to establish the rational and
evidence base for the development of a
Multisectoral NCDs Action Plan.
 The primary objective of this survey was to provide
relevant and up to date evidence on the
magnitude and distribution of prevalence of
conditions like Diabetes Mellitus and Hypertension,
key NCDs risk factors and oral health status.
 Understanding the risk populations demography,
behavioral pattern and risk factors prevalence is
essential for designing the effective response
(promotive and preventive as well as early
diagnosis, treatment and control).
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12. Cont…
 A population based study of adults aged 15-69
years Was carried out from July 2012 – June 2013.
 The survey was done in a paperless environment.
Instead of printed questionnaires and data sheets,
PDAs were used for direct data recording.
 Step I - Socio demographic and behavioral
information was collected.
 Step II - Physical measurements such as height,
weight and blood pressure were collected.
 Step III - Biochemical measurements were
collected to assess blood glucose and
cholesterol levels.
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13. Multisectoral Action Plan on the
Prevention and Control of NCDs in
Nepal 2014-2020
 The Political Declaration of the High-level
Meeting of the United Nations General
Assembly on the Prevention and Control of
NCDs, to which Nepal is a signatory, the
Government of Nepal has developed the
national Multisectoral Action Plan for the
prevention and control of NCDs (2014–2020).
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14. Cont…
Vision: All people of Nepal enjoy the highest
attainable status of health, well-being and
quality of life at every age, free of preventable
NCDs, avoidable disability and premature
death.
Goal: The goal of the Multisectoral Action Plan is
to reduce preventable morbidity, avoidable
disability and premature mortality due to NCDs
in Nepal.
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15. Cont…
Specific Objectives:
 To raise the priority accorded to the prevention and control of
NCDs in the national agendas and policies according to
international agreed development goals through strengthened
international cooperation and advocacy
 To strengthen national capacity, leadership, governance,
multisectoral action and partnership to accelerate country
response for the prevention and control of NCDs
 To reduce modifiable risk factors for non-communicable
diseases and underlying social determinants through creation
of health-promoting environments
 To strengthen and orient 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
 To promote and support national capacity for high quality
research and development for the prevention and control of
NCDs
 To monitor the trends and determinants of non-communicable
diseases and evaluate progress in their prevention and control
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16. Cont…
Targets: In line with the sentiments of South East
Asia Regional NCD targets, Nepal also adopts
the same 10 targets to be achieved by 2025.
1. 25% relative reduction in overall mortality from
cardiovascular diseases, cancers, diabetes, or
chronic respiratory diseases
2. 10% relative reduction in the harmful use of
alcohol
3. 30% relative reduction in prevalence of current
tobacco use in persons aged over 15 years
4. 50% relative reduction in the proportion of
households using solid fuels as the primary source
of cooking
5. 30% relative reduction in mean population intake
of salt/sodium
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17. Cont…
6. 25% reduction in prevalence of raised blood
pressure
7. Halt the rise in obesity and diabetes
8. 10% relative reduction in prevalence of insufficient
physical activity
9. 50% of eligible people receive drug therapy and
counseling (including glycemic control) to prevent
heart attacks and strokes
10. 80% availability of affordable basic technologies
and essential medicines, including generics,
required to treat major NCDs in both public and
private facilities
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18. Package of Essential Non-
communicable (PEN) Disease
Interventions for Primary Health Care
 The World Health Organization meeting on
Package of essential NCDs interventions for primary
health care in low resource settings, was held
Geneva, on 1–2 December 2008.
 The WHO PEN interventions for primary care in low
resource settings is an innovative and action-
oriented response to LMICs.
 PEN is an essential package of cost-effective
interventions with high impact, including those for
early detection and management of type 2
diabetes, which are feasible for application in
resource poor settings. The package will be
introduced in the first two years and then expanded
to other districts in the country. In this process,
diagnostic services will be made available in
primary health care settings.
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19. National Health Policy 2014
 The Nepal National Health Policy 2014 calls for a
people centered approach to quality health
services that are more effective and
accountable to the citizens. Health is placed
central to overall development, building
partnerships and establishing multisectoral
collaboration. NCDs, including diabetes, are
addressed in the National Health Policy 2014.
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20. Nepal Health Sector Strategy
(NHSS)III 2015 - 2020
 NHSS III is the primary instrument to guide the health
sector for five years. It adopts the vision and mission
set forth by the National Health Policy and carries
the ethos of Constitutional provision to guarantee
access to basic health services as a fundamental
right of every citizen.
 NHSS places health at the centre of overall socio-
economic development. It guides the health
sector‟s response in realizing government‟s vision to
graduate Nepal from „Least Developed Country‟ to
„Middle Income Developing Country‟ by 2022.
 The basic health service package of NHSS III has
incorporated diabetes screening, counseling and
laboratory services at all levels of health care.
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21. Tobacco products (Control
and Regulatory Act), 2011
 Legal provision to reduce, control and regulate
the import, production, sales and distribution
and consumption of tobacco products.
 Prohibition to smoke or consume tobacco in public
places
 Display of a Public Notice
 Label, Trademarks, Wrappers and Packaging
 Prohibition on Advertisement and sponsorship
 Prohibition in sale, distribution and display
 Inspection may be conducted
 Punishment etc…
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22. Increment of taxes on Tobacco
products (F.Y. 2018/19)
 Health Risk Tax has been introduced
 Applicable on cigarette, bidi, cigar, chewing tobacco,
khaini, Ghutkha, Paan Masala
 Tax to be levied at 25 paisa per piece in case of
cigarette, bidi, cigar and Rs. 25 per Kilogram in
case of tobacco, khaini, Ghutkha, Paan Masala
 Applicable on import and production
 Collection at the customs point in case of import
 Collection at the time of issuance from
enterprises in case of domestic production
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23. Bibliography
 Non communicable diseases country profiles 2014. Geneva: World
Health Organization; 2014 (http://apps.who.int/iris/
bitstream/10665/128038/1/9789241507509_eng.pdf?ua=1, accessed
19 January 2016).
 Jayawardena R, Ranasinghe P, Byrne NM, Soares MJ, Katulanda P,
Hills AP. Prevalence and trends of the diabetes epidemic in South
Asia: a systematic review and meta-analysis. BMC Public Health.
2012;12:380.
 Package of Essential Non communicable (PEN) disease interventions
for primary health care in low-resource settings. Geneva: World
Health Organization; 2010
(http://www.who.int/nmh/publications/essential_
ncd_interventions_lr_settings.pdf, accessed 19 January 2016).
 Nepal Health Sector Strategy III (2015–2020). Kathmandu: Ministry of
Health and Population Government of Nepal; 2015 http://nhsp.org.
np/nepal-health-sector-strategy-cabinet-endorsed-nepali/,
accessed 19 January 2016).
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24. Bibliography
 Government of Nepal Ministry of Health and Population. National
Health Policy 2014 (http://nhsp.org.np/Document/national-
healthpolicy- 2014/, accessed 19 January 2016).
 Government of Nepal. Multisectoral Action Plan for the
Prevention and Control of Non Communicable Diseases (2014–
2020). Kathmandu: World Health Organization Country Office for
Nepal; 2014 (http://
www.searo.who.int/nepal/mediacentre/ncd_multisectoral_actio
n_plan. pdf, accessed 19 January 2016).
 Upreti et al.: Strengthening policy and governance to address the
growing burden of diabetes in Nepal
 Non Communicable Diseases Risk factors: STEPS Survey Nepal
2013
 Tobacco Product (Control and Regulatory) Act, 2011
 Nepal Tax Fact F.Y. 2018/19
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25. THANK YOU !!!
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