Overview of Health Promotion and NonCommunicable Diseases in Nepal
Dr BR Marasini
Senior Health Administrator
Ministry of Health and Population
Kathmandu, Nepal
Global Context
• Health of people in recent years is more affected
by non-health factors such as tobacco, alcohol
and air pollution than diseases caused by
microbes
• In an effort to help member states initiate actions
UN General Assembly passed resolution on Road
Safety and non-communicable diseases in 2010
and 2011 respectively
Background
• Burden of NCDs in Nepal started to increase since
1990s
• Hospital based study -2010 in Nepal showed
burden of communicable, maternal, child and
nutrition diseases Vs Non-Communicable
Diseases is nearly equal and health sector in
Nepal is experiencing double burden of diseases
• Life style, food behaviour has slowly changed in
last 30 years or so in Nepal
Prevalence of NCD Risk Factors-1 (NCD
Risk Factor Survey-2008)
Risk factors
Prevalence rate
Remarks
Tobacco use
35.6%
Both smoke and
smokeless
Alcohol use
33.3%
Use alcohol 4 or more
days last week
Indoor air pollution-houses
using traditional cook stoves
52%
64% use firewood as
fuel & 3% use smokeless
stove-NLSS-2011
Salt intake per capita /day
>5 gm% (81% in
above 20
populations)
Hypertension in Nepal 1983
Physical activity- high level
83%
>6 MET value
Intake of fruit and vegetables 61.9%
<5 servings per day
Low intake
Prevalence of NCD Risk Factors-2
Risk factors
Prevalence rate
Remarks
Thyrotoxic foods
Unknown
Hypothyroid
Consanguineous marriage
400 persons
Thalassemia
Non- Communicable Disease
Prevalence in Nepal
Diseases
Prevalence Rate
Remarks
Cancer
Hypertension
0.30%
21.5%
Chronic respiratory
diseases
Stroke
13.2%
NLSS-2011
NCD Risk Factor
Survey-2008
NLSS-2011
Diabetes mellitus
10.8%
Other Cardiovascular
diseases
-
-
NCD Risk Factor
Survey-2011
-
National Policies, Acts and Regulations
•
•
•
•
•
Alcohol Control Act-1974
Tobacco Control Act-2011
Food Act-1966
Sports Act-1992
BP Koirala Memorial Cancer Hospital Act
(1997)-for cancer control & prevention
• Shahid Gangalal National Heart Center Act
(2001)- for CVD prevention and control
Policies, Acts and Regulations
•
•
•
•
Alternative energy promotion policy
Health tax fund in 1996
Environmental Act-1997
Ban on tobacco and alcohol advertisement in
electronic media- 1996 by executive order
• National guideline to support treatment of five
NCD (heart disease, cancer, chronic renal
diseases, Alzheimer's disease and Parkinson's
disease) for ultra-poor-2008
NCD Prevention and Health Promotion
in Nepal
• Hepatitis B immunization –for all infants
• Green energy promotion with high subsidy by
GoN to installation of improved cook stoves,
micro-hydel, Bio-Gas plants, solar energy
• Small scale immunization against HPV
• Cervical cancer screening-limited areas
• Yoga and physical exercise-becoming popular
NCD Prevention and Health Promotion
in Nepal
• 75% of space of cigarette packet should
include danger signs (legally mandatory)
• Separate licensing for to maintain separate
shops for alcohol
• Campaign against drunk driving by Nepal
police
• Ban on junk foods in schools premises by
Department of Education
Financing of NCD
• Health tax fund established in 1996-health tax on
tobacco and alcohol – 5 million USD collected
annually
• Ultra poor receive up to NRs 50,000.00 (=600.00
USD) for treatment of five NCDs –Chronic heart
disease, Kidney disease, cancer, Alzhimer’s
disease and Parkinson's disease
• Under 14 children and senior citizens above 75
years get free heart surgery and senior citizens
above 75 years and some endangered ethnic
groups get free dialysis treatment
Research and Health Information
Management
• Indoor Air pollution and Chronic Obstructive
Respiratory Disease Survey-1982
• Hypertension in Nepal- 1983
• Indoor Air pollution and ARI in Under five
Children -1985
• Ministry of Health & Population has adopted
ICD-10 for reporting of hospital data
• WHO-STEP- II in 2008 & STEP III Survey
ongoing
Contribution of Non-State Actors in
NCD and Health Promotion
 Anti-tobacco campaign
 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
13
Contribution of Public Sector Agencies
in NCD Health Promotion
• Green Energy Promotion-Install improved cook
stoves in rural households, reforestation, microhydel, bio-gas, solar energy- Alternative Energy
Promotion Center
• Anti-tobacco campaign- Ministry of Home and
Nepal police
• Anti- alcohol campaign with illicit liquor controlInland Revenue Department, Nepal Police
• Nutrition Promotion- Ministry of Agriculture,
Ministry of Local Development
14
Contribution of Public Sector Agencies
in NCD and Health Promotion
• Outdoor air pollution-Ministry of Environment
• Education - Department of Education
15
NCD & Health Promotion
Community initiated NCD and health
promotion activities
• Alcohol dry districts-27 districts since 1980s
and failed last year Achham also lifted the ban
• Anti alcohol campaign by women's groups,
teachers and community youths in villages
• Yoga camps, Gyms and physical exercises
• Installation of improved cook stoves
• Community forestry scheme
Challenges on NCD Control and Health
Promotion
• Reform in health services from communicable
diseases focus to non-communicable diseases
as well
• Reform in medical education and other health
science curricula- include more chapters in
health promotion
• Enhancement of national capacity in health
promotion
• Social and cultural norms on alcohol control
Challenges on NCD Control and Health
Promotion
• Coordination and collaboration with state and
non-state organizations
• Control of non-communicable diseases risk
factors through legislation, behaviour change
communication and prevention
• Increase investment in health promotion
• Language complexities –too many ethnic
groups and languages
• Partnerships
24
Future Plans in NCDs Control and
Prevention
• Training all health workers at primary health
care services
• Enhance coordinated health promotion
towards-NCDs at all level
• Upgrade selected rural health facilities into
hospitals in rural and remote areas
• Build partnerships at all level
• Research
Effective Partnerships on NCD Control
Government
Academia
Media
Prevention
and control
of NCDs
Private sector
Civil Society
Conclusion
• Health promotion is a very effective and efficient
intervention (s) against the control of NCDs
• Double burden of disease and difficulty on finding
additional resources for health promotion and
treatment of NCDs and this requires to find new
innovative financing schemes
• Multi-sectoral coordination mechanism is the key for
NCD Prevention and Control and this mechanism
should be supported by non-state actors
• Effective health promotion activities initiated by local
communities needs to be supported and sustained
Thank you for your kind attention