This document discusses the management of non-communicable diseases (NCDs) in primary health care in Nepal. It notes that NCDs such as cardiovascular diseases, diabetes, and cancer place a large burden yet are primarily treated in tertiary hospitals. The WHO recommends protocols for managing NCDs at primary care levels through integrated care of conditions like diabetes and hypertension. However, managing NCDs in primary care in Nepal faces challenges of limited health workers, equipment, and budgets. Opportunities exist in guidelines, training, and donor support to strengthen NCD prevention and control.

1. Seminar on
Management of Non-communicable diseases in Primary Health
Care Level in Nepal: present scenario, opportunities and
challenges
Under cordial guidance of
Hari Prasad Kafle
Lecture (Public Health)
SHAS,PU
By
Sulaksha Paudel
Regd no- 2015-01-37-0034
At
Faculty of Health Sciences
Pokhara University
2016
19/26/2019

2. Introduction
• Non-communicable diseases (NCDs) refer to diseases or conditions that
occur in or are known to affect individuals over an extensive period of
time and for which there are no known causative agents that are
transmitted from one affected individual to another.
• Primary Health care(PHC) is a essential health care based on practical,
scientifically sound, socially acceptable by families and technology
made accessible to individuals and families in the community through
full participation and at a cost that the country and community can
afford to maintain in the spirit of self-reliance and self-determination.
9/26/2019 2

3. Contd…
• PHC- main aim is to improve the overall health status of public (specially
in rural area and vulnerable).
• Planning by community participations and health care providers are
multi-disciplinary teams and comprehensive interventions.
And the principles includes:
1. Equitable distribution
2. Community participations
3. Inter-sectoral approach
4. Appropriate technology
9/26/2019 3

4. Contd…
• In Nepal, most of the cases of NCDs are treated in the tertiary level
health institutions like central, regional, sub-regional, zonal, specialist
hospitals and medical colleges.
• District level hospitals have few facilities for the diagnosis and
treatment of NCD cases so they refer these cases to tertiary level health
institutions.
• Non communicable diseases (NCDs) are the leading cause of adult
mortality and morbidity worldwide including the Southeast Asia region
(SEAR) .
• The risk factors for many of the NCDs are associated with lifestyle
related choices, environmental and genetic factors.
9/26/2019 4

5. Contd…
• NCDs burden is increasing in the health facilities so the Government
of Nepal(GoN), Ministry of Health and Population (MoHP) and
World Health Organization (WHO) has close collaboration with
NHRC and had conducted survey from 2016 to 2018.
9/26/2019 5

6. Global Scenario of Non-communicable diseases
• The global prevalence of non-communicable diseases is increasing with the
greatest burden in developing countries
• Non-communicable diseases (NCD) began to cause major problems in
industrialized countries
• 70% of all deaths globally and three-quarters of these deaths occurs in the low
and middle income countries
• In the Maldives, non-communicable diseases account for 48% of all deaths
• An estimated 7.9 million lives are lost annually due to NCDs accounting for
55% of deaths in the South-East Asia Region
• Globally, cardiovascular diseases (CVDs), chronic respiratory diseases,
diabetes and cancer are the four major NCDs, and this is no different in the
South East Asia
9/26/2019 6

7. Contd…
• According to the WHO, an estimated 17 million people died from cardiovascular
disease (CVD) in 2014 comprising 30% of all global deaths and of these nearly
80% of deaths took place in low and middle income countries like India.
• Nearly 56% of the estimated deaths from cancer occur in the developing world.
9/26/2019 7

8. Deaths from non-communicable diseases in 2015 (as
percentage of all deaths)
India Sri Lanka Sub-Saharan
Africa
China
Cardiovascular
diseases
31.7 20.1 11.2 32.1
Diabetes mellitus 1.1 1.5 0.3 0.8
Cancer 7.4 5.6 6.2 20.5
Chronic
obstructive
pulmonary disease
and
2.5 1.6 1.9 17.8
9/26/2019 8

9. WHO-recommended approaches to managing non
communicable diseases in primary health care:
• WHO has been providing number of tools and recommended
approaches to manage non communicable diseases and prevent
complications.
• The WHO has recommended total risk approach enables integrated
management of hypertension, diabetes and other cardiovascular risk
factors in primary care, and targets available resources at persons most
likely to develop heart attacks, stroke and diabetes complications.
9/26/2019 9

10. Contd…
So, The non-communicable diseases is managed as per the protocol
WHO PEN Protocol 1: Prevention of Heart Attacks, Strokes and Kidney
Disease through Integrated Management of Diabetes and Hypertension
Routine management of hypertension, Diabetes Mellitus and screening
targeting specific population.
WHO PEN Protocol 2: Health Education and Counseling on Healthy
Behaviors
Physical activity
Healthy diets
Attend regular medical follow-up
Control body weight and avoid overweight by reducing high calorie food
and taking adequate physical activity
9/26/2019 10

11. Contd…
WHO PEN Protocol 3:Management of Asthma and Management of
Management of Chronic Obstructive Pulmonary Disease
Increase the treatment for controlling the asthma and for COPD
Review asthma control every 3-6 month
Heart rate measure.
Stop working in areas with occupational dust or high air pollution
9/26/2019 11

12. WHO PEN Protocol 4: Assessment and referral of women with suspected
breast cancer at primary health care, Essential technologies and tools for
WHO PEN and Core list of medicines for WHO PEN
Assess signs and symptoms (i.e. history, intensity, duration, progression)
Identify relevant risk factors: age (30 years old and above)
Technologies=Thermometer, Blood pressure measurement device,
Measurement tape etc
Tools=Evidence based clinical protocols, Medical information register etc
And the core list of medicines are:
a. Insulin c. Paracetamol
b. Salbutamol d. Diazepam etc
9/26/2019 12

13. Opportunities
There is sufficient guideline provided by WHO for management
of NCD which can be effectively used in Nepal
Support by donors for training health care providers
Cost effective approach
Provide training material to enhance knowledge and skills for
NCD prevention and control.
9/26/2019 13

14. Challenges:
Limited health care workers
Unskilled personals
Lack of management equipements
Insufficient budget
Inequity in services delivery
Lack of proper referral and follow-up
9/26/2019 14

15. Bibliography
1. World Health Organization. Action plan for the prevention and control of
noncommunicable diseases in South-East Asia, 2013–2020. New Delhi:
World Health Organization Regional Office for South-East Asia; 2013.
2. Bhagyalaxmi A, Atul T, Shikha J. Prevalence of risk factors of non-
communicable diseases in a District of Gujarat, India. Journal of health,
population, and nutrition. 2013;31(1):78.
3. Bhandari GP, Angdembe MR, Dhimal M, Neupane S, Bhusal C. State of
non-communicable diseases in Nepal. BMC public health. 2014;14(1):23.
4. Boutayeb A. The double burden of communicable and non-communicable
diseases in developing countries. Transactions of the Royal society of
Tropical Medicine and Hygiene. 2006;100(3):191-9.
9/26/2019 15

16. Contd…
5. Organization WH. Implementation tools: package of essential
noncommunicable ( PEN) disease interventions for primary health care in
low-resource settings: World Health Organization; 2013.
6. Organization WH. Western Pacific Regional action plan for the prevention and
control of non communicable diseases (2014-2020). Manila: WHO Regional
Office for the Western Pacific; 2014.
7. Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in
South Asia. Bmj. 2004;328(7443):807-10.
8. Organization WH. Implementation tools: package of essential noncommunicable
( PEN) disease interventions for primary health care in low-resource settings:
World Health Organization; 2013.
9/26/2019 16

17. Contd…
9. Prevention and control of noncommunicable diseases; Guidelines
for primary health care, World Health Organization, 2012
9/26/2019 17

18. 9/26/2019 18