![Page 1: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/1.jpg)
Overview of Health Promotion and Non-Communicable Diseases in Nepal
Dr BR MarasiniSenior Health Administrator
Ministry of Health and PopulationKathmandu, Nepal
![Page 2: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/2.jpg)
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
![Page 3: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/3.jpg)
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
![Page 4: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/4.jpg)
Prevalence of NCD Risk Factors-1 (NCD Risk Factor Survey-2008)
Risk factors Prevalence rate Remarks Tobacco use 35.6% Both smoke and
smokelessAlcohol use 33.3% Use alcohol 4 or more
days last weekIndoor 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 valueIntake of fruit and vegetables <5 servings per day
61.9% Low intake
![Page 5: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/5.jpg)
Prevalence of NCD Risk Factors-2Risk factors Prevalence rate Remarks Thyrotoxic foods Unknown Hypothyroid
Consanguineous marriage 400 persons Thalassemia
![Page 6: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/6.jpg)
Non- Communicable Disease Prevalence in Nepal
Diseases Prevalence Rate Remarks Cancer 0.30% NLSS-2011Hypertension 21.5% NCD Risk Factor
Survey-2008Chronic respiratory diseases
13.2% NLSS-2011
Stroke -
Diabetes mellitus 10.8% NCD Risk Factor Survey-2011
Other Cardiovascular diseases
- -
![Page 7: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/7.jpg)
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
![Page 8: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/8.jpg)
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
![Page 9: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/9.jpg)
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
![Page 10: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/10.jpg)
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
![Page 11: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/11.jpg)
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
![Page 12: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/12.jpg)
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
![Page 13: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/13.jpg)
Contribution of Non-State Actors in NCD and Health Promotion
13
Anti-tobacco campaignAnti-alcohol campaignOral health Campaign against arsenic contaminated water in
TeraiBlindness preventionHelp to install improved cook stoves in rural areasSanitation Media-in many aspects of health promotions
![Page 14: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/14.jpg)
Contribution of Public Sector Agencies in NCD Health Promotion
14
• 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 with illicit liquor control- Inland Revenue Department, Nepal Police
• Nutrition Promotion- Ministry of Agriculture, Ministry of Local Development
![Page 15: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/15.jpg)
Contribution of Public Sector Agencies in NCD and Health Promotion
15
• Outdoor air pollution-Ministry of Environment• Education - Department of Education
![Page 16: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/16.jpg)
NCD & Health Promotion
![Page 17: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/17.jpg)
![Page 18: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/18.jpg)
![Page 19: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/19.jpg)
![Page 20: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/20.jpg)
![Page 21: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/21.jpg)
![Page 22: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/22.jpg)
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
![Page 23: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/23.jpg)
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
![Page 24: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/24.jpg)
Challenges on NCD Control and Health Promotion
24
• 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
![Page 25: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/25.jpg)
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
![Page 26: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/26.jpg)
Effective Partnerships on NCD Control
![Page 27: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/27.jpg)
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
![Page 28: Overview of Health Promotion and Non-Communicable Diseases in Nepal](https://reader036.vdocuments.us/reader036/viewer/2022062302/5681658f550346895dd85c1c/html5/thumbnails/28.jpg)
Thank you for your kind attention