NCDs CONTROL PROGRAMS

Ram Bhushan Das

MBBS 7th semester
 NCDs Burden and Trend in NEPAL
• In Nepal, a resource-limited country, the national
disease burden is being shifted towards NCDs as
major cause of illness/disease, disability and death.
• NCDs also have significant macroeconomic and
poverty impact.
• Deaths due to NCDs (Cardio-Vascular Disease,
diabetes, cancer and respiratory disease) have
increased from 60% of all deaths in 2014 to 66% in
2018 (WHO Nepal Country profile 2018).
 Nepal PEN program
• PEN Implementation Plan (2016–2020) has been
developed in line with the Multi-Sectorial Action
Plan (MSAP) for prevention and control of NCDs
(2014-2020).
• The WHO PEN Protocol was developed on risk-based
approach.
• Those people who are under high risk with high
symptoms will get medicine but
• Those people who are under low risk even symptoms
present will go through life style modification and
follow up.
 The PEN Intervention has Four protocols:

• Protocol I: Prevention of heart attack, stroke and

kidney disease through integrated management of
diabetes and hypertension.
• Protocol II: Health education and Counseling on
Healthy Behavior (For All)
• Protocol III: Management of chronic obstructive
pulmonary disease (COPD) and Asthma
• Protocol IV: Assessment and referral of women with
suspected cancer (Breast & Cervix)
GOALS
• Achieve universal access to high quality diagnosis &
patient-centred care
• Reduce suffering & socio-economic burden of major
NCDs
• Protect poor & vulnerable populations from major
NCDs
• Provide effective & affordable prevention &
treatment through PHC approach
• Support early detection, community engagement
and self-care
OBJECTIVES
• To timely diagnose, treat and
management of NCDs.
• To prevent and control risk factors of
NCDs.
• To bring uniformity in treatment of NCDs.
• To increase coordination between health
facility and community.
• To increase accessibility for Universal
Health Coverage (UHC).
• The Nepal PEN protocol I, II and concept note was
developed and endorsed in June, 2016 and started in
two pilot districts (Ilam and Kailali) on October, 2016
• Nepal PEN protocol III and IV was endorsed and the
program was scaled-up in the 8 districts (Palpa,
Myagdi, Baglung, Achham,Bardiya, Surkhet,
Makwanpur and Rautahat) for Fiscal Year 2073/74
• Then PEN protocol was extended in additional 6
districts in FY2074/2075 + 21 additional district plan
for 2075/2076 and plan for throught Nepal in
2077/2078.
 Strengths
• Accessible at Community level (PHCC and
HP)
• Functional National NCDs &Mental
Health Unit
• Health insurance & universal health
coverage including for NCDs prevention
and treatment services
• Multi-sectorial approach
 Weakness
• Only focused on Health Facility level and
treatment approach
• Focused on TIP ICEBERG only, of risk people
• Inadequate recording , reporting and
monitoring system
• Low level of community awareness
• No dedicated budget for NCDs, for promotion,
prevention, and research
• Several policies to modify NCD
 Challenges
• Unhealthy lifestyle seeking behavior and
lower value of health among the public
• Shortage of medical equipment, supplies and
health workers in public Health Facilities(HF)
and Low budget allocation for NCDs.
• Poor awareness and misconceptions about
the burden and consequences of NCDs,
among the policy makers, health professional
and the general public