Highlights of Health Promotion in
Nepal:
Dr BR Marasini
Ministry of Health and Population
Kathmandu, Nepal
30 March 2013
Concept of Health Promotion
It is any planned combination of health, educational,
economic, political, spiritual and organizational initiative
for actions to bring about positive, behavioral, social or
environmental change conducive to improving the health
of individuals, groups, or communities.
 Process of enabling people to increase control over and improve
their health (WHO 1948)
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Concept of Health Promotion
 Process of enhancing health and reducing risk of ill
health through the overlapping spheres health education,
health protection and disease prevention
 Health promotion is directed towards action on the
determinants or causes of health
 Health promotion at first identifies the target population
or the population at risk and then initiate the more
appropriate action through several means.
Concept of Health Promotion
 Government at both local and national levels has a
unique responsibility to act appropriately and in a
timely way to ensure that the ‘total’ environment,
which is beyond the control of individuals and
groups, is conducive to health.
History of Health Promotion
 1948: WHO established
 Health is a complete state of…..
 Governments have a responsibility …….adequate health
and social measures.
 1978: Alma-Ata Conference
 1981: Global Strategy for Health for All by 2000
 International Conferences on health promotion
Why we need Health Promotion?
 Promotes quality of life
 Reduce inequalities in health
 Reduces pressure on services
 “Adds life to year, Adds year to life”.
 “Health
promotion is concerned with making
healthier choices, easier choices”.
 It is cost effective and efficient
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Health Promotion in Nepal
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ANCIENT ERA
 Ayurveda:-Developed around 5000 BC, Ayurveda is
believed to be the oldest formal health care system in
Nepal and hence health promotion measures.
 Ayurveda focuses on building a healthy metabolic system
and proper excretion of toxic elements, on top of regular
exercise, yoga and meditation which ultimately enable
people to increase control over and improve their health.
 The asset of ayurveda; yoga and meditation contribute to
the development of a healthy body, a healthy mind,
healthy thought leading to healthy living.
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 The Himalayan herbs and medicinal plants are used in
different forms as health promoting agents such as
toiletries, natural manures, pesticides, environmental
cleaning and protection .
 Lichchhavi Kings also issued rules and directives to be
followed by the general population on the safe motherhood
practices. These directives were identifying husband
responsible for care of the pregnant and post natal wife
and warning punishment in case of negligent behavior or
death (Narendra Dev).
 Cutting umbilical cord immediately after the baby is born
and not to wait till the placenta is expelled (Amshu
Verma).
 Traditional birth attendants denying to attend woman in
labour should be punished-King Jayasthiti Malla, Kantipur
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MEDIEVAL ERA
 In 1661 AD Jesuit Father Grueber and Dorville and
associates entered Nepal via Lhasa from Christian Mission
office in Peking, China and established missionary office in
Kathmandu.
 Plague elimination:- The first noted health promotion
activities during this period was elimination of plague by
Christian missionaries in Kathmandu
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MEDIEVAL ERA
 Pratap Malla the king of Kantipur (now Kathmandu)
allowed the missionaries to stay in Kantipur for which one
of the reason might be periodical epidemic of plague and
cholera in Kathmandu, which were serious health
problems, and the king might have heard about the
prevention and treatment from the missionaries.
 The missionaries then started health promoting activities
and their intervention played a great contribution in
elimination of plague.
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MODERN ERA: Rana Regime
(1846-1950 AD)
 Initiated environmental cleanliness campaign in Kathmandu
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valley.
Safe drinking water supply in Kathmandu
Introduced School Health Programme (1st health
programme) in 1946 AD but was closed later.
Dr. H.A. Oldfield appointed as the resident doctor in 1850
to 1863 AD introduced vaccination in 1850 AD in for first
time ,with vaccination of the children of the family of the
Prime Minister Jung Bahadur Rana.
Tuberculosis and Leprosy Sanatoriums started
Post -Democracy (1951 onwards)
 First Five Year Plan (1956-1961): Emphasized on sanitation
and hygiene.
 Foundation of preventive and promotive health care in Nepal
started with opening of Insect Borne Disease Research and
Control Project at Rapti Doon Valley by USAID in 1954.
 Family Planning Association of Nepal launched Family
Planning services in 1956
 Institutionalization of promotive health care by establishing
the Health Education and Sanitation Section in 1961 under
Department of Health Services.
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Health and Sanitation Section
The significance at the beginning of the program was as
followso Target audience: general people and sick persons
o Education methods: Mini-lecture, motivational
question/answer or discussion, interpersonal sessions
followed by instructional education
o Media: Mass media i.e. radio, print materials, Cinema
o Messages: mostly instructional, descriptive
o Sanitation activities
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Post-Democracy (1951 onwards)
 Second Three Year Plan (1962-1965)
 45,000 people were inoculated against small-pox in
Kathmandu.
 Initiation of vertical projects: malaria eradication,
TB/Leprosy control project, FP/MCH projects.
 Third Five Year Plan (1965-1970): More focus on
prevention .
 Strengthening of vertical projects i.e. Leprosy
Eradication Project 1965, Small Pox Eradication Project
1967, FP/MCH project 1968.
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 Health education and promotion program might
have been priority component of those vertical
program, but they had their own health education
unit being operated from the center to the periphery
within the project area only.
 It was learnt that, because of weak coordination and
lack of needful provision, the process of health
education program development, its expansion and
overall responsibility management and sharing as
well by relevant governmental /INGO/NGO and
private remain deficient.
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First Long Term Health Plan (1975-1990): The first
perspective health plan
 Fourth Five Year Plan (1970-1975): Introduced
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Community Health and Integrated Division
Fifth Plan Period: Nepal signed the Alma-Ata Declaration
and adopted PHC for achieving HFA by 2000.
Initiated integration of vertical health program into basic
health services.
Sixth Plan Period: Its real objective was Nepalese should
not live by health interventions only.
It stressed on increasing food supply and provision of safe
drinking water.
 Idea of COMBINA (Child spacing, Oral rehydration,
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Maternal Health, Breast Feeding, Immunization,
Nutrition) was mooted.
Seventh Plan period(1985-1990):
Emphasized on Basic Minimum Health Needs.
During the Long Term Health Plan the Health
education program was given due priority for health
promotion and provided to people at doorstep covering
all components of primary health care.
Health education program was launched with specific
strategic way, which was further named as health
education, information and communication program.
National Health Policy 1991
 One of the areas addressed by National Health Policy
adopted in 1991 is the promotive health services.
 Promotive Health Services: The programme that enable
people to live healthy lives will be given priority. The
services includes such practices which are aimed not only
at destroying the factors that may lead to specific disease
but also at raising the health condition of the people to its
maximum level. It includes health education, balanced diet,
healthy living , regular health checkup, FP/MCH etc.
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 The components of health included in this services are: Health education and involvement of community from central to
rural level
 Nutrition programme: Promotion of breast feeding, growth
monitoring, prevention of iodine deficiency disorder, iron and
vitamin A deficiency.
 Environmental sanitation programmes: Inform people about personal
hygiene, inspect and examine hotel food, drinking water, manage solid
waste, etc
 For this the National Health Policy 1991, has given ultimate mandate
to HEIC authority, to plan, manage and implement health education
and promotion program to encourage people to utilize best the health
services so that their health standard would be upgraded by
themselves and ultimately achieved productive, happiest and long life.
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National Health Education Information and Communication
Centre (NHEICC), 1993
 NHEICC was established in 1993.
 The centre has been working as an institution for
planning, implementation, monitoring and evaluation
of advocacy, community mobilization and behavior
change communication programs of all health
services and programs at different levels in an
coordinated approach and through one door system.
 Health education adopters are expected to inform,
encourage, persuade and motivate to have positive
behavior changes in the specific audiences and to
adopt healthy behavior.
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Second Long Term Health Plan 19972017
 Second Long Term Health Plan, 1997-2017 has
mentioned that National Health Education, Information
and Communication Centre (NHEICC) is a focal point for
Ministry of Health Population for planning,
implementation, monitoring and evaluation of health
promotional activities.
 The plan clearly states that NHEICC is responsible for the
development, production, dissemination, publication and
distribution of correct health messages through
appropriate communication media in collaboration with
other departments, divisions and centres.
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Essential Health Care Services 2000
 Areas addressed by EHCS with regard to health
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promotion are:Reproductive Health Services
EPI including Hepatitis B Vaccine
Condom Promotion and Distribution
Leprosy Control
TB Control
Integrated Management of Childhood Illness
Nutritional Supplementation, Enrichment,Nutrition
Education
Essential Health Care Services 2000
 Prevention and Control of Blindness
 Environmental Sanitation
 School Health Service
 Vector Borne Disease Control
 Oral Health Services
 Prevention of Deafness
 Substance abuse including Tobacco and Alcohol Control
 Occupational Health
 Emergency Preparedness and Management
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Collapse of vertical projects and
initiation of basic health services
 8th Plan period (1992-1997)
 First time launched polio elimination campaign targeting to
reach 3.3 million children of 0-5 years in 1996/1997 by
organizing national immunization day to support polio
eradication by 2000.
 Sin tax on tobacco and alcohol (now health tax) and ban on
alcohol and tobacco advertisement through electronic media
in 1996
 Initiated improved cook stoves in rural areas
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NHSP
 Nepal Health Sector Program: Implementation Plan
(NHSP:IP) 2004-2009 had recognized and accepted health
communication as a cross cutting issue for all health
programs.
 It has stated that behavioral change communication
program to support Essential Health Care Service
(EHCS) Package.
 The plan has also stressed on the importance of
behavioral change communication to address noncommunicable disease risk factors emphasizing on the
reduction of tobacco and harmful use of alcohol..
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 It has mentioned about integrating information,
education and communication in all EHCS package
and to use all possible mass communication media for
health promotion.
 Nepal Health Sector Program II (NHSP II), 20102015 has prioritized and included public health
promotion programs under health education and
communication heading.
 The program plan has emphasized on planning,
implementation, monitoring and evaluation of
advocacy, social mobilization and behavior change
communication programs in an integrated manner to
promote and increase utilization of all essential health
services and programs, and control communicable and
non-communicable diseases.
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NHSP2
 The plan has focused on promoting healthy behavior
by using all possible multi mass media and channels
for health promotion and communication.
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Health Promotion Current activities
 NHEICC act as a centre for the Ministry of Health
and Population and have an integrated approach and
one door system for advocacy, community
mobilization, behavior change communication and
health service and program promotion activities.
 The mission of Health Promotion or HEIC program
is "Today's preparation determines tomorrow's
achievements" in the shape of achieved healthier life
style by Nepalese people.
 It has developed National Health Communication
Policy 2012.
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 There are some objectively used key terms in health
promotion in the following which mean that Information : Inform target groups about the cause
of disease, its transmission and how to prevent the
disease.
 Education : Educate target groups about techniques
of disease prevention and mode of transmission.
 Communication : A process that informs,
motivates and helps people to adopt and maintain
healthy practices by using techniques to spread
the knowledge on the disease prevention and
health promotion
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 Health Education : Any combination of planned
activities leading to a situation where people want to
be healthy; know how to attain health; do what they
can individually and collectively and seek help when
needed.
 Health promotion: Social, educational and political
actions that enhance public awareness of health,
fosters healthy lifestyles and community action in
support of health, and empowers people to exercise
their rights and responsibilities in shaping
environments, systems and policies that are conducive
to health and wellbeing.
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Activities of NHEICC
 Promotive health messages are broadcasted directly
through radio programs ,national television channels
and published through paper media.
 Various public awareness programs are being
conducted through district health and public health
offices to disseminate health messages or information
up to the rural level.
 Local media and languages are used in the district so
that local people can understand health message
clearly.
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 Established health education corner at health service
delivery facilities, equiped with audio visual
equipment and BCC materials.
 Health Education Technicians at District Health/
Public Health Offices assist in the implementation of
these activities.
 Audio visual programs and IEC materials are
produced and aired also for tobacco control and
NCDs.
 Implement activities to create a supportive
environment for health promotion and health
education.
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 BCC program on different health issues .
 Conducts refresher program at various level for health
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education and promotion
Conducts capacity building activities to develop knowledge,
attitude and skills individually and in groups for health
education and promotion.
Celebrate health event, days .
Conduct different health promotional programs in hospitals,
schools, communities, working places, industries and
occupational settings.
Plan, implement, monitor and evaluate policy, strategy,
program and activities for prevention and control of using
tobacco, alcohol and other addictives.
Health education and promotion
 Realizing
the importance of health communication
activities, different strategies which are related to
reproductive health, child health, tuberculosis control,
HIV/AIDS/STI Control, vector borne disease control,
leprosy control and all other health service and programs
have stated about the development, production and
dissemination of health messages or information and
materials and activities for health promotion.
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Health education and promotion
 Some of these activities are:-
 Celebration of Breast feeding, School Health and
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Nutrition week
School level adolescent focused peer group
programme
Ama Communication Programme
National Immunization Day.
School Immunization Programme against tetanus.
Health education and promotion
 Health education and BCC on essential new born care
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practice.
Infant Young and Child Feeding Practice promotional
message.
Health education message to promote community
awareness about HIV and AIDS ,Leprosy, Malaria etc.
Family planning counselling.
Promotion and Condom distribution.
Mobilization of local bodies like consumer groups,
mother groups, local clubs in health promotion
activities.
Achievements
 Increase percentage of women and men (86 %of
women and 97% men) of age 15-49 who have heard
about AIDS.
 Knowledge of at least one contraceptive method is
nearly universal (99.9%)to both male and female.
 74% female and 85% male are exposed to family
planning message in any specified media source.
 Knowledge of ORS is universal among women giving
birth in the five year preceding
Source: NDHS,2011
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Role of non-health sector in health
promotion
 There are many factors outside the health system
that influence people’s health.
 The Health sector alone cannot achieve a healthy
society.
 This requires a close co-operation between sectors
beyond health care reflecting the diversity of
conditions which influence health.
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Key Areas for inter-sectoral coordination for health
promotion
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Area
Importance
Non-health sector
involvement
Water and Sanitation
Hygiene
Address Main cause of child
death are WASH related disease
including skin disease, ARI and
Diarrhoea
Department of Water Supply
and Sanitation
Food and Nutrition
To promote physical and
cognitive development and to
reduce malnutrition
Ministry of Agriculture on
food security and promotion
of nutritious local foods,
Ministry of Industry on food
fortification
Rural Infrastructure and
Housing
Reduce journey time and cost
for accessing services
Physical Planning ministry
,local government
Education and
Information
Knowledge, Attitude and
Behaviour of people are key to
healthy goals
Ministry of education and
communication
Source: NHSP-II,2010-15
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Area
Importance
Non-health sector
involvement
Waste management
Key to healthy
Ministry of Local
environment and
Development, local
prevent health hazards government
Alternative fuels and
cooking stove designs
Reduce ARI, prevent
indoor air pollution
Ministry of Science
and Technology
Regulation and
legislation on
accidents, occupational
hazards, smoking and
alcohol
Promotion of safety
measures such as use
of seat belts and
helmets, occupational
health, discourage
alcohol and smoking
consumption by a
combination of
regulation and tax
measures
Department of Roads,
traffic police, Ministry
of industry.
Source: NHSP-II,2010-15
Contribution of Non-State Actors in
Health Promotion
 Condom promotion
 Anti-tobacco campaign
 Drug abuse
 Anti-alcohol campaign
 Oral health
 Campaign against arsenic contaminated water in Terai
 Blindness prevention
 Help to install improved cook stoves in rural areas
 Sanitation
 Media-in many aspects of health promotions
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Contribution of Public Sector
Agencies in Health Promotion
 Green Energy Promotion-Install improved cook
stoves in rural households, reforestation, micro-hydel,
bio-gas, solar energy- Alternative Energy Promotion
Center
 Anti-tobacco campaign- Ministry of Home and Nepal
police
 Anti- alcohol campaign- Inland Revenue Department, Nepal
Police
 Nutrition Promotion- Ministry of Agriculture, Ministry of
Local Development
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Contribution of Public Sector
Agencies in Health Promotion
 Safe drinking water and sanitation- Department of Water
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Supply and Sanitation
Solid waste management- Ministry of Local Development
Meat hygiene- Department of Live Stocks
Food hygiene- Department of Food Technology and Quality
Control
Outdoor air pollution-Ministry of Environment
Education- Department of Education
Challenges in Health Promotion
 Coordination and collaboration with state and non-state
organizations
 Control of risk factors through non-communicable diseases
 Increase investment in health promotion
 Language barrier –too many ethnic groups and languages
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WAY FORWARD
 Though
health promotion is recognized as
priority program in health policies and plan more
efforts is needed to apply it in practice. For this: Evidence
based health promotion policy
formulation and implementation.
 Community initiated approach addressing sociocultural, geographical, climatic, language diversity
is needed to achieve sustainability of health
promotion activities.
 Development of gender, and cultural sensitive
and language appropriate
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 Coordinated and integrated approach both between
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inter and intra-sectoral organizations
Strengthening public private partnership policy through joint
action .
Allocation of more health budget to health promotion
activities (less than 1% of total health budget is allocated to
NHEICC for FY 2069/70)
Allocation of budget from earmarked health tax to
promotional activities rather than to curative care such as in
advertisement of NCDs.
Designing effective strategies to implement health
promotion in school, workplace and community so as to
promote health behaviour and healthy lifestyle.
Reference
 Ministry of Health and Population Nepal. Nepal Health Sector
Programme-II 2010-15. Kathmandu, Nepal: Ministry of Health
and Population; 2010
 National Health Education Information and Communication
Centre, Ministry of Health and Population, Nepal. National
Health Communication Policy 2012, Kathmandu, Nepal: National
Health Education Information and Communication Centre; 2012
 National Health Education Information and Communication
Centre, Ministry of Health and Population, Nepal. Health
Education Information and Communication Program in Nepal
2060. Kathmandu, Nepal: National Health Education Information
and Communication Centre;2060 B.S.
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Thank you for your kind patience
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