The document discusses tuberculosis (TB) control programs in Nepal. It notes that TB affects thousands in Nepal each year and is the sixth leading cause of death. The National TB Program aims to diagnose 70% of new cases and cure 85% by preventing 30,000 deaths in the next five years. The program registers over 30,000 TB cases annually and follows the WHO End TB Strategy and DOTS treatment model to control the disease.

1. TB Control Programs In
Nepal
Prepared and Presented by:
Surakshya Poudel
BPH 2nd batch (3rd yr)
UCMS

2. Background
• Tuberculosis (TB) is a public health problem in Nepal that affects
thousands of people each year and is the sixth leading cause of death
in the country.
• WHO estimates that 44,000 people develop active TB every year and
out of them 20,500 have infectious pulmonary disease and can
spread the disease to others.
• The achievement of the global targets of diagnosing 70 percent of
new infectious cases and curing 85 percent of these patients will
prevent 30,000 deaths in Nepal over the next five years.

3. • In 2073/74, the National Tuberculosis Programme (NTP) registered
31,764 TB cases.
• Among them 16,927 (53.28%) were new and relapse pulmonary
smear positive TB cases.
• 427 (1.34%) were smear positive retreatment cases.
• 5,216 (16.42%) were sputum smear negative .
• 9,194 (28.94%) were extra-pulmonary TB cases.
• Of all registered cases 20,364 (64.1%) were male and 11,400 (35.9%)
female.

4. National TB Programme
• National TB programme is a “priority one” program of GON.
• The NTP has coordinated with the public sector, private sector, local
government, I/NGOs, social workers, educational institutions and
other sectors to expand DOTS and sustain the good progress achieved
by the NTP.

5. National TB Programme
• Vision: Nepal free of tuberculosis.
• Long term goal: End the tuberculosis epidemic by 2050.
• Short term goal: Reduce TB incidence by 20% by 2021
compared to 2015 and increase case notifications by a
cumulative total of 20,000 from July 2016 to July 2021.

6. Objectives:
• Increase case notification through improved health facility-based
diagnosis.
• Maintain the treatment success rate at 90% of patients (for all forms
of TB) through to 2021.
• Provide drug resistance diagnostic services for 50% of persons with
presumptive drug resistant TB by 2018 and 100% by 2021 and
successfully treat at least 75% of diagnosed drug resistant patients.
• Further expand case finding by engaging the private sector.

7. • Strengthen community systems for the management, advocacy, support
and rights of TB patients in order to create an enabling environment to
detect and manage TB cases in 60% of all districts by 2018 and 100% of
districts by 2021.
• Contribute to health system strengthening through TB human resource
management, capacity development, financial management, infrastructure,
procurement and supply management.
• Develop a comprehensive TB surveillance, monitoring and evaluation
system.
• Develop a plan to continue NTP services in the aftermath of natural
disasters and public health emergencies.

8. The End TB Strategy
• The End TB Strategy was unanimously endorsed by the World Health
Assembly in 2014. Its three overarching indicators are
i) the number of TB deaths per year,
ii) TB incidence rate per year, and
iii) the percentage of TB-affected households that experience
catastrophic costs as a result of TB.
• These indicators have related targets for 2030 and 2035.

9. End TB Strategy
• VISION: A world free of TB
Zero deaths, disease and suffering due to TB
• GOAL: End the Global TB Epidemic
• MILESTONES FOR 2025:
 75% reduction in TB deaths (compared with 2015)
 50% reduction in TB incidence rate (less than 55 TB cases per
100,000 population)
 No affected families facing catastrophic costs due to TB

10. • TARGETS FOR 2035:
 95% reduction in TB deaths (compared with 2015)
 90% reduction in TB incidence rate (less than 10 TB cases per
100,000 population)
 No affected families facing catastrophic costs due to TB

11. PRINCIPLES:
• Government stewardship and accountability, with monitoring and
evaluation
• Strong coalition with civil society organizations and communities
• Protection and promotion of human rights, ethics and equity
• Adaptation of the strategy and targets at country level, with global
collaboration

12. The strategy’s components (three pillars) and related strategies are as
follows:
1. Integrated, patient- entered care and prevention:
 Early diagnosis of TB including universal drug-susceptibility testing, and
systematic screening of contacts and high-risk groups.
Treatment of all people with TB including drug-resistant TB.
 Collaborative TB/HIV activities and the management of co-morbidities.
The preventive treatment of persons at high risk, and vaccination against
TB.

13. 2. Bold policies and supportive systems:
Political commitment with adequate resources for TB care and prevention.
 The engagement of communities, civil society organizations, and public and
private care providers.
 Universal health coverage policy and regulatory frameworks for case
notification,vital registration, quality and rational use of medicines, and
infection control
Social protection, poverty alleviation and actions on other determinants of TB.
3. Intensified research and innovation:
 The discovery, development and rapid uptake of new tools, interventions and
strategies.

14. DOTS Programme in Nepal
• Directly Observed Treatment Short course (DOTS) is the most effective
strategy available today for tuberculosis control.
• The World Health Organization (WHO) recommended treatment strategy
for detection and cure of TB.
• In 1994, WHO Framework for effective TB control recommended the five
core elements for TB treatment and control (later known as DOTS)
recommended the establishment of microscopy service and “if additional
resources are made available, establish culture and susceptibility testing in
order to monitor drug resistance”.

15. Situation of DOTS in Nepal
• DOTS is one of the significant programs that has been implemented
throughout the country since April 2001.
• National Tuberculosis Program (NTP) has rapidly expanded DOTS strategy in
1996 with 4 pilot centres. This cost effective and highly successful
treatment strategy has reduced TB mortality and morbidity in Nepal.
• The NTP has achieved sustain the good progress in the DOTS program and
has expanded the program with the coordination of public sector, private
sector, local government, I/NGOs, social workers, educational institutions
and other sectors.
• There are 4,344 DOTS treatment centres in Nepal and the NTP has
adopted the global End TB Strategy and the achievement of the SDGs as
the country’s TB control strategy.