This document summarizes several national health programs and policies in Nepal related to the prevention and control of non-communicable diseases (NCDs). It outlines policies such as the Integrated NCD Prevention and Control Policy, the Multi-Sectoral Action Plan for NCD Prevention and Control (2014-2020), and the National Policy and Plan for NCD Prevention and Control (2013-2017). It also discusses the Health Education, Information and Communication Program and policies within the Second Long Term Health Plan, Nepal Health Sector Strategy, and other documents. The document analyzes some of the systematic challenges facing NCD prevention in Nepal, such as limited funding for primary prevention and a lack of coordination between sectors.

1. NATIONAL HEALTH PROGRAMS AND
POLICIES FOR PREVENTION AND
CONTROL OF NCDS
Pawan Dhami
Lecturer
National Open College
1

2. LIST OF POLICIES
 Integrated Non-Communicable Diseases (NCDs) Prevention
and Control Policy of Nepal
 Multi-sectoral Action Plan for the Prevention and Control of Non
Communicable Diseases (2014-2020)
 Second Long term Health plan (1997-2017 )
 Nepal Health Sector Strategy (2015-2020)
 National Policy & Plan for Non-Communicable Diseases
(NCDs) Prevention and Control (2013-2017)
 Health Education, Information and Communication (HEIC)
Program in Nepal
 Integrated Non-Communicable Diseases (NCDs) Prevention
and Control Policy of Nepal 2

3. INTEGRATED NON-COMMUNICABLE DISEASES (NCDS) PREVENTION AND
CONTROL POLICY OF
NEPAL
 Vision: Gain best possible quality of life and longevity by
preventing and controlling NCDs in Nepal
 Mission: Promote healthy life styles by empowering people,
strengthening health services and creating conducive socio-
economic environment
 Goals: Reduce morbidity and mortality related to NCDs.
 Objectives:
 Reduce the major risk factors (tobacco use, alcohol consumption,
physical inactivity and unhealthy diet)
 Strengthen capacity of health personnel, institutions and other
stakeholders for identification of the major risk factors and to use
comprehensive approach for health promotion and primary prevention.
 Strengthen capacity of health system to prevent, diagnose and manage
NCDs through standard guidelines and protocol appropriate to various
level of health care.
 Develop a national surveillance system for NCDs and their risk factors
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4. Targets:
 By 2015, tobacoo use and alcohol consumption will be
reduced to half of the current level.
 By the end of 2010, all concerned health personnel will be
trained and necessary infrastructures will be in place
 By the mid of 2008, necessary guidelines will be developed
and endorsed.
 By the end of 2008, a national surveillance system will be in
place.
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5. Strategies
 Develop and endorse legislation & regulation for the effective
implementation of FCTC taxation on junk food and to provide insurance for
NCD victims
 Do advocacy, communication and community mobilization for the inclusion
of NCD in School Curricula, development and dissemination of NCD
messages.
 Re-orient health services for mobilizing existing health network for NCD at
various levels
 Incorporate major NCDs and their risk factors in HMIS reporting formats
 Build capacity for developing and organizing standard curricula for in
service training of health workers, for specialists and super specialists for
secondary and tertiary care and for ancillary paramedics about NCDs and
their major risk factors
 Establish surveillance system of NCDs and their risk factors
 Establish networking of hospitals dealing with NCDs in private, I/NGOs &
GOs and other bilateral organizations.
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6.  Regular and periodic dissemination of surveillance
findings to all Stakeholder of NCD
 Map up of the organizations and their NCD activities
across Public, Private & I/NGOs
 Develop mechanism to monitor activities of
organizations involved in NCDs
 Allocate tobacco and alcohol tax “ Sin tax” for NCD
disease prevention and control
 Incorporate NCD activities in regular budget;
Mobilization of external resources
 Allocate local revenue for NCD prevention activities
 Identify all stakeholders of NCDs in program planning
and implementation
 Prioritize low cost, cost effective socio-culturally
acceptable measures in planning and implementation
of NCD prevention and control 6

7. HEALTH EDUCATION, INFORMATION AND COMMUNICATION
(HEIC) PROGRAM IN NEPAL (2060)
 Established under DOHS in 1961planning, implementing
and evaluating health education activities in the country.
 National Health Policy 1991, it is clearly stated that " one of
the main reasons for the low health standards of the people
is the lack of public awareness of health matters.
 In Strategic HEIC Policy
 HEIC program will be a priority 1 program including supporting
role to national health programs i.e. reproductive health, child
health and other communicable and non-communicable diseases.
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8. SECOND LONG TERM HEALTH PLAN (1997-2017 )
 First long term health plan (1975-1990)
 The National Health Policy (1991) established a policy
framework to guide health sector development.
 The principle objective of the National Health Policy to
upgrade the health standards of the majority of the rural
population by strengthening the primary health care
system, making effective health care services readily
available at the local level.
 “Preventive and promotive health services”; kept as
specific policy objective as main addressing area. 8

9.  ‘Principle Policies to be Pursued in the Second Long Term Health
Plan’; includes addressing the changing trends of communicable
and non-communicable diseases and emerging health issues .
 ‘Policy implications for population’;
 with the projected gradual increase in elderly population there is
an increasing need to focus on degenerative and non-
communicable diseases in the next century.
 For Non-communicable diseases
 measures to reduce risk factors common to some or most of them, like
tobacco use, lack of physical activity, excessive consumption of alcohol
and poor dietary habits; behaviors and life style, environmental and
occupational hazard;
 identification and screening of high risk groups;
 early diagnosis and where necessary, long term treatment and long
term follow up
 increased coverage by the involvement of the PHC infrastructure and
communities.
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10. POLICY ISSUES/POLICY IMPLICATIONS FOR COMMUNICABLE AND NON-
COMMUNICABLE DISEASES
 There is a need to address the changing trends of
communicable and non-communicable diseases within
the context of the "Essential Health Care Services at the
District".
 Changing trends in diseases
 10th Five Year Plan 2002-2007
 - Focus on HIV/AIDS and Non-Communicable Diseases
 11th Five Year Plan 2007-2012
 Control Of NCDs and emerging diseases like HIV/AIDS
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11. NATIONAL POLICY & PLAN FOR NON-COMMUNICABLE DISEASES (NCDS)
PREVENTION AND CONTROL (2013-2017)
 Goal: To reduce the burden due to chronic NCDs by promoting healthy lifestyles,
reducing the prevalence of common risk factors and providing integrated evidenced-
based treatment options to those diagnosed with NCDs in the most cost-effective way.
STRATEGIC OBJECTIVES
 CNCD-related mortality reduced by 2% annually over the next 5 years
 Hospital admissions for diabetes, cardiovascular diseases and asthma, reduced by 10%
and complications from these conditions declined by 1% annually.
 Level of quality for chronic illness care improved in all health care facilities, as evidenced
by patients’ self-management and positive clinical outcomes.
 Proportion of persons using NCD-related health services (e.g. mammography,
colonoscopy etc) for annual personal checkups increased by 15% by 2016
 Common risk factors for NCDs on clinic records for adults, reduced by 10% by 2017.
 Development/adaptation of healthy public policies and the creation of supportive
environment
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12. NEPAL HEALTH SECTOR STRATEGY (2015-2020)
 Under the auspices of National Health Policy 2014, Nepal
Health Sector Strategy 2015-2020 (NHSS) is the primary
instrument to guide the health sector for the next 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.
 It articulates nation’s commitment towards achieving Universal
Health Coverage (UHC) and provides the basis for garnering
required resources and investments.
 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.
 Promoting healthy lifestyles and healthy environment
through multi-sectoral action
 Providing information and promoting positive choices on issues such
as regular exercise, healthy eating, avoiding smoking and harmful
alcohol intake is seen as essential to stem the tide of increasing non-
communicable diseases. 12

13. MULTI-SECTORAL ACTION PLAN FOR THE PREVENTION AND
CONTROL OF NON COMMUNICABLE DISEASES (2014-2020)
 In the year 2000, the World Health Assembly resolution WHA53.17,
endorsed the global strategy for the prevention and control of NCDs,
with a particular focus on developing countries.
 Further strengthened with the adoption of the Political Declaration at
the High-level Meeting of the UN General Assembly on the Prevention
and Control of Non-Communicable Diseases by the Head of the States
in September 2011 in New York in which Nepal is a signatory.
 WHO has developed several policy and technical guidelines for the
member countries to address NCDs, especially focusing on developing
countries. The documents relevant to the NCD prevention and control
in Nepal include:
1. Global Strategy for the Prevention and Control of Non-Communicable
Diseases (2000)
2. WHO Framework Convention on Tobacco Control (2003)
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14. 3. Global Strategy on Diet, Physical Activity and Health
(2004)
4. Resolution WHA60.23 on Prevention and control of non
communicable diseases:
implementation of the global strategy (2007)
5. 2008-2013 Action Plan for the Global Strategy for the
Prevention and Control of Non
communicable Diseases (2008)
6. Global Strategy to Reduce the Harmful Use of Alcohol in
2010 (WHA63.13).
7. Global action plan, including indicators and voluntary
targets, through resolution
WHA66.10
8. Action Plan for the prevention and control of NCDs in
South-east Asia, 2013-2020 (2013) 14

15. ACTION PLAN FOR PREVENTION AND CONTROL FOR
NCDS FOR NEPAL
 The UNGA resolution only calls upon member states to develop an
action plan for the 4 diseases/ 4 risk factors namely: Cardiovascular
diseases (CVDs), Chronic Respiratory Diseases (CRD), Cancers and
Diabetes and tobacco use, harmful use of alcohol, unhealthy diet, and
physical inactivity.

 The Nepal action plan in addition would address Indoor air pollution,
Road safety, Oral health and mental health as one additional risk factor
and 3 additional NCDs.
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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16. SPECIFIC OBJECTIVES
 To raise the priority accorded to the prevention and control of non-communicable
diseases 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
Noncommunicable diseases
 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 non-communicable diseases
 To monitor the trends and determinants of non-communicable diseases and
evaluate progress in their prevention and control
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17. 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.
 25% relative reduction in overall mortality from cardiovascular diseases,
cancers, diabetes, or chronic respiratory diseases
 10% relative reduction in the harmful use of alcohol
 30% relative reduction in prevalence of current tobacco use in persons
aged over 15 years
 50% relative reduction in the proportion of households using solid fuels
as the primary source of cooking
 30% relative reduction in mean population intake of salt/sodium
 25% reduction in prevalence of raised blood pressure
 Halt the rise in obesity and diabetes
 10% relative reduction in prevalence of insufficient physical activity
 50% of eligible people receive drug therapy and counseling (including
glycemic control) to prevent heart attacks and strokes
 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. SYSTEMATIC CHALLENGES FOR NCD PREVENTION IN NEPAL
 Provision of limited partial funding to the poor and destitute
for NCD is commendable; it is not helping the urgent need
for shifting toward primary prevention approaches.
 NCD policies, the Multisectoral Action Plan for Prevention
and Control of NCD (MAPPCN) 2014-2020, failed to set up
a functional and compelling policy structure for accelerated
action against NCD and their social determinants .
 Only focused to curative aspect for NCD rather than
primary prevention.
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19.  In 2016, the government initiated the Prevention of
Essential Non- communicable Disease (PEN)
programs in two districts of Nepal but again the
question will remain how effectively the program will
coordinate with other sectors to address the broader
social determinants.
 In addition, lack of accountability, corruption and poor
management are major causes of inefficiency in health
and social programs.
 This also poses threats to future NCD programs.
 In a country which spends less than 1% of its budget on
NCD , inefficiency, as much as 40% estimated by WHO
, can deter significant investment from prevention and
control efforts.
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20. POLICY STRUCTURE ENVISAGED BY THE MAPPCN 2014-2020
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21. 21
RECOMMENDED POLICY STRUCTURE FOR NCD PREVENTION IN NEPAL