Multisectoral Action Plan for the Prevention and Control of Non Communicable Diseases (2014-2020)

There is no exact national policy related to Non-Communicable Diseases (NCDs), however, there is Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2014-2020). 

In the year 2000, World Health Assembly resolution endorsed the global strategy for the prevention and control of NCDs, with a particular focus on developing countries. The global commitment to prevention and control of NCDs was further strengthened with the adoption of the Political Declaration at the High-level Meeting of the UN General Assembly (UNGA) on the Prevention and Control of NCDs by Head of the States in September 2011 in New York in which Nepal is a signatory.

Some documents relevant to the NCD prevention and control in Nepal include:

1. Global Strategy for the Prevention and Control of Non-Communicable Diseases (2000)
2. WHO Framework Convention on Tobacco Control (2003)
3. Global Strategy on Diet, Physical Activity and Health (2004)
4. Resolution WHA60.23 on Prevention and control of non-communicable diseases: implementation of the global strategy (2007)
5. 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of Non communicable Diseases (2008)
6. Global Strategy to Reduce the Harmful Use of Alcohol in 2010 (WHA63.13).
7. Action Plan for the prevention and control of NCDs in South-east Asia, 2013-2020 (2013)

As a follow up of High-Level Political Declaration, the Government of Nepal had decided to deliver on its commitment through a multisectoral approach. The Multisectoral Action Plan was developed between July and December 2013 with the financial support from WHO and the Government of Russia which is titled as "Multisectoral Action Plan on the Prevention and Control of NCD in Nepal, 2014-2020".

Twelve thematic groups were formed namely:

1. Cardiovascular Diseases
2. Chronic Obstructive Lung Diseases
3. Cancer
4. Diabetes Mellitus
5. Oral Health
6. Mental Health
7. Road Traffic Injuries
8. Tobacco
9. Alcohol
10. Unhealthy Diet
11. Physical Exercise and Healthy Behavior
12. Air Pollution

Action Plan for Prevention and Control of NCDs for Nepal (2014-2020)

The vision, goal, objectives, and targets of the multisectoral plan are as follows:

Vision

All people of Nepal enjoy the highest attainable status of health, well-being, and quality of life at every age, free of preventable NCDs, avoidable disability, and premature death.

Goal
The goal of the multisectoral action plan is to reduce preventable morbidity, avoidable disability and premature mortality due to NCDs in Nepal.

Specific Objectives

1. To raise the priority accorded to the prevention and control of NCDs in the national agendas and policies according to internationally agreed development goals through strengthened international cooperation and advocacy
2. To strengthen national capacity, leadership, governance, multisectoral action, and partnership to accelerate country response for the prevention and control of NCDs
3. To reduce modifiable risk factors for NCDs and underlying social determinants through creation of health-promoting environments
4. To strengthen and orient health systems to address the prevention and control of NCDs and underlying social determinants through people centered primary health care and universal health coverage.
5. To promote and support national capacity for high quality research and development for the prevention and control of NCDs
6. To monitor the trends and determinants of NCDs and evaluate progress in their prevention and control

Targets

In line with the sentiments of South East Asia Regional NCD targets, Nepal also adopts the same 10 targets to be achieved by 2025.

1. 25% relative decrement in overall mortality from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases
2. 10% relative decrement in harmful use of alcohol
3. 30% relative decrement in the prevalence of current tobacco use in persons aged over 15 years
4. 50% relative decrement in the proportion of households using solid fuels as the primary source of cooking
5. 30% relative decrement in mean population intake of salt/sodium
6. 25% reduction in the prevalence of raised blood pressure
7. Halt the rise in obesity and diabetes
8. 10% relative decrement in the prevalence of insufficient physical activity
9. 50% of eligible people receive drug therapy and counseling (including glycemic control) to prevent heart attacks and strokes
10. 80% availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities

Eleven Strategic Policies (Further Description)

• High political commitment
• Multisectoral response
• Tobacco
• Alcohol
• Unhealthy diet
• Physical inactivity
• Indoor air pollution
• Essential NCDs (CVDs, COPDs, diabetes, and cancer)
• Oral health
• Mental health
• Surveillance, research, monitoring, and evaluation

The Nepal Multisectoral Action Plan also relies on the following overarching principles and approaches:

• Focus on equity
• Multisectoral actions and multi-stakeholder involvement
• Life-course approach
• Balance between population-based and individual approaches
• Empowerment of people and communities
• Health system strengthening
• Universal health coverage
• Evidence-based strategies
• Management of real, perceived or potential conflicts of interest

References:

GoN, WHO Nepal, Multisectoral Action Plan for the Prevention and Control of Non Communicable Diseases (2014-2020)

National Initiatives for Violence in Nepal

Nepal has made strong normative and legal commitments to end gender-based violence and inequality. Some of the initiatives are as follows:

1. Nepal has ratified the Convention on the Elimination of all forms of Discrimination Against Women (CEDAW).
2. Nepal supports the implementation of the Beijing Platform for Action and International Conference on Population and Development Programme of Action; and has accordingly adopted nation action plans.
3. Nepal has enacted the Domestic Violence (Crime and Punishment) Act, Witchcraft related Accusation (Crime and Punishment) Act, The Sexual Harassment at the Workplace (Elimination) Act, Directives to Regulate Domestic Workers to Work in Gulf Countries, National Action Plan on Foreign Employment, the Act to Amend Some Nepal Acts for Maintaining Gender Equality and Ending Gender Based Violence.
4. Nepal has put in place a five-year national strategy and action plan (2012-2017) for ending gender-based violence.
5. The major political parties signed a declaration to end violence against women.
6. A Human Trafficking and Transportation (Control Act) has been adopted.
7. A Girl's Education Strategy Paper and Policy Guideline on Corporal Punishment and Consolidated Equity Strategy Paper is in place to prevent and end school-related gender based violence.
8. A Prime Ministerial unit to address gender-based violence was adopted in 2010.
9. The Government undertook a COMMIT Pledge in 2013, which states that the Government is committed to investing in gender equality and women's empowerment to tackle root causes of violence against women and girls.
10. Nepal also agreed to implement the 57th session of the Commission on the Status of Women agreed conclusions on elimination of violence against women.
11. Ministry of Foreign Affairs of Nepal participated in June 2014, Global Summit to End Sexual Violence in Conflict.
12. The new constitution of Nepal, adopted in 2015, guarantees the right of women to protection against any forms of violence as the fundamental right. The Constitution also recognizes right if victims of crime to be informed about the investigation and proceedings of the case regarding her victimization and guarantees justice, social rehabilitation and compensation for the first time in the Constitutional history of Nepal.

The UN System in Nepal is fully committed to support Government of Nepal and civil society in concrete actions to realize the rights of all women and girls, and a framework is provided by the 57th Session of the Commission on the Status of Women agreed conclusions, the Secretary-General's UNITE to End Violence against Women campaign as well as Nepal's United Nations Development Assistance Framework (UNDAF 2013-2017).

Other supportive programs, activities; NGOs/INGOs are as follows:

• Sixteen Days of Activism Against Gender Violence Campaign
• Child Marriage and Dowry Eradication National Campaign by BHORE Nepal
• Various NGOs, CBOs like Maiti Nepal, WOREC
• One-Stop Crisis Management Centers at different levels of health facility
• Chaupadi Elimination Campaign
• Community-based Reproductive Health and Counseling Center and Gender-Based Violence Program

Furthermore, the South Asia Initiative to End Violence Against Children (SAIEVAC) is a SAARC Apex body which is an inter-governmental body with a vision that all children, girls, and boys, throughout South Asia enjoy their right to an environment free from all forms of violence, abuse, exploitation, neglect and discrimination.

Existing Nutrition Programs in Nepal

There are nationwide nutrition programs and scale-up programs. They are listed as follows:

   1)  Nationwide Programs:

• Growth Monitoring and Counseling
• Prevention and Control of Iron Deficiency Anemia
• Prevention, Control and Treatment of Vitamin A Deficiency
• Prevention of Iodine Deficiency Disorders
• Control of Parasitic Infestation by Deworming
• Flour Fortification via Large Roller Mills

   2)  Scale-up Programs:

• Maternal, Infant and Young Child Nutrition (MIYCN) Program
• Integrated Management of Acute Malnutrition (IMAM) 
• Micronutrient Powder (MNP) distribution linked with IYCF
• School Health and Nutrition Program
• Vitamin A Supplementation to address low coverage in 6 - 11 months
• Multisector Nutrition Plan (MSNP)

Vision, Mission, Goals and Objectives of Nutrition Programs:

        

        A.  Vision:
All Nepalese people living with adequate nutrition, food safety and food security for adequate physical, mental and social growth and development and survival.

        B.  Mission:
Improve the overall nutritional status of children, women of childbearing age, pregnant women, and all ages.

        C.  Goal:
To achieve nutritional well-being of all people to maintain a healthy life

      D.1. General Objectives:
To enhance nutritional well-being, reduce child and maternal mortality and to contribute for the equitable human development

      D.2  Specific Objectives:

• To reduce Protein-Energy Malnutrition (PEM) in children and reproductive aged women
• To reduce the prevalence of anemia among women and children <40% by 2017
• To virtually eliminate Iodine Deficiency Disorders and Vitamin A Deficiency
• To reduce the infestation of intestinal worms among children and pregnant women
• To reduce the prevalence of low birth weight

Overall strategies of Nutrition Programs are as follows:

• Promotion of food-based approach
• Food Fortification
• Supplementation of Foods
• Promotion of Public Health Measures

There are several other projects on Nutrition like:

• SUAAHARA
• Agriculture and Food Security Project (AFSP)
• Golden 1000 Days Project
• SABAL Project

Moreover, CB-IMNCI, which was initiated in 2015, also addresses major childhood killer diseases, and malnutrition is one of them, which is on priority.

References:

MoHP, DoHS, National Annual Report, FY(2071/72)

Nepal Initiatives on Nutrition

Implementation of nutrition programmes and interventions have historically been led by the health sector. The health sector in Nepal is guided by the Interim Constitution, which has provisioned health as the fundamental right for every citizen.

The 2014 National Health Policy translates the constitutional provisions by ensuring access to basic health services especially by the poor and marginalized population. It has also made important directions towards nutritional well-being via utilization and promotion of quality and nutritious foods generated from community level to fight against malnutrition.

Health Sector Strategy, which came into effect in 2004, focused on providing efficient, equitable and quality health and nutrition services by reforming the organization and providing cost-effective and priority interventions.

After the Breast Milk Substitutes Act of 1992 and the Global Strategy for IYCF 2002, Government of Nepal (GoN) reinforced its approach to protect, promote and support IYCF (Infant and Young Child Feeding), which is well reflected in the National Nutrition Policy and Strategy 2004. The strategy underscores the provision of nutrition services through health sector to address the problem of malnutrition, particularly among women and children.

It is interesting to note that Nepal adopted a multisectoral approach for nutrition way back in the late seventies when the first National Nutrition Policy and Strategy was formulated in 1978. It identified four sectors: Agriculture, education, health and local development.

Nutrition Assessment and Gap Analysis (NAGA) was undertaken to provide the synthesis of information necessary to develop a detailed multisector Nutrition Action Plan for the next five years.

Thus, in 2012, GoN, in form of Multisector Nutrition Plan (MSNP), has shown a strong commitment to accelerating the interventions for sustained reduction of undernutrition with the focus on first 1000 days. It involves key sectors like health, agriculture, education, WASH (Water, Sanitation, and Hygiene), local development, and women and children.

Challenges and Changing Context in the 21st Century for Health Promotion and Education

1. Changing Health Burden, and Complex Determinants of Health:

Both developing and developed countries are confronting a developing extent of elderly population and a population with more chronic conditions and non-communicable diseases. In addition, many developing countries are still facing with infectious diseases, and gradually more injuries and violence as their economies grow. Changing lifestyle brings more stress, and along these lines a threat to mental health of those in both developed and developing countries alike. With extensive population mobility, international travel, no country is safe from potential major communicable diseases outbreaks such as SARS or human influenza or even not-yet-known emerging diseases. Environmental changes are influencing an extensive number of nations either through sweeping worldwide climatic changes or geographically related natural disasters, such as tsunami, storm causing thousands of deaths by one stroke. Fundamentally all countries are facing numerous, rather than single type of health burden, the basic causes of which are highly pertinent for actions in health promotion.

2. Inequity and Health:

In most countries, health is improving. In some countries the trend is reverse, e.g. due to HIV/AIDS, war and civil unrest, and excessive alcohol consumption. Widening health gaps between and within countries is a global concern.

3. The Communication Revolution:

Access to dependable information about what determines health and appropriate channels to communicate health needs of the communities should be a public commodity that is to be available for all.

4. Expanding and Increasing Democratization in Countries around the Globe:

Such changes and concerns make another setting that ought to legitimately drive activities in health promotion, especially with regards to creating healthy public policies, and community empowerment. The two areas still need to be further developed in many countries.

5. Globalization and Urbanization:

The dynamics of globalization and urbanization influence health in many ways: physical and cultural environment, trade, transports, tourism, economic transactions, production of goods and working environment.

6. The Threat of War and Terrorism: 

The definitive threat to good health is the perilous condition made by war and violence.

Abbreviations used in Public Health

AAC	Anaesthesia Assistant Course
ABER	Annual Blood Examination Rate
ADRA	Adventist Development and Relief Agency
AFR	African Region
AFRIM	Arm Force Research Institute of Medical Science
AFSP	Agriculture and Food Security Project
AHW	Auxiliary Health Worker
AIDS	Acquired Immune Deficiency Syndrome
AMR	Region of the Americas
ANC	Ante-Natal Care
ANM	Auxiliary Nurse Midwife
APIP	Annual Program Implementation Plan
APR	Annual Program Review
ARI	Acute Respiratory Infection
ART	Antiretroviral Therapy
ASFR	Age Specific Fertility Rate
ASRH	Adolescent and Sexual Reproductive Health
B/CEOC	Basic/ Comprehensive Emergency Obstetric Care
BCC	Behavior Change Communication
BCG	Bacillus Calmette Guerin
BMET	Biomedical equipment technician Training
BNMT	Britain Nepal Medical Trust
BNMT	Birat Nepal Medical Trust
BoD	Burden of Disease
BPH	Bachelor in Public Health
BPKIHS	Bishweshwar Prasad Koirala Institute of Health Science
BPKMCH	Bishweshwar Prasad Koirala Memorial Cancer Hospital
BSNP	Basic Nutrition Services Package
CAC	Comprehensive Abortion Care
CB-IMCI	Community Based Integrated Management of Childhood Illness
CB-IMNCI	Community Based Integrated Management Of Neonatal And Childhood Illnesses
CB-NCP	Community Based Neonatal Care Programme
CBO	Community Based Organization
CBR	Crude Birth Rate
CBS	Central Bureau of Statistics
CCC	Central Chest Clinic
CCC	Community Care Centre
CD	Community Diagnosis
CDC	Center for Disease Control and Prevention
CDD	Control of Diarrhoeal Diseases
CDMA	Code Digital Multiple Access
CDO	Chief District Officer
CDP	Community Drug Programme
CDR	Crude Death Rate
CERF	Central Emergency Response Fund
CFP	Certified Financial Planner
CHD	Child Health Division
CHD	Community Health Diagnosis
CHI	Community Health Insurance
CMA	Community Medical Assistant
CMAM	Community-based Management of  Acute Malnutrition
CMR	Child Mortality Rate
COPD	Chronic Obstructive Pulmonary Disease
CPD	Continue Professional Development
CPR	Contraceptive Prevalence Rate
CRS	Contraceptive Retail Sales
CTEVT	Council for Technical Education and Vocational Training
CTS	Clinical Training Skills
CYP	Couple Years of Protection
DACC	District Aids Co-ordination Committee
DALYs	Disability Adjusted Life Years
DDA	Department of Drug Administration
DDC	District Development Committee
DEO	District Education Office
DEP	Directly Executed Projects
DEPO	Depo Provera
DfID	Department for International Development
DG	Director General
DHMT	District Health Management Team
DHS	Demographic Health Survey
DHS	District Health System
DoA	Department of Ayurved
DoHS	Department of Health Services
DOTS	Directly Observed Treatment Short-course
DPHO	District Public Health Office
DPT	Diphtheria Pertussis Tetanus
DRF	Debt Relief Fund
DTO	District Treasure Office
DTCO	District Treasury Controllers' Office
EBF	Exclusive Breast Feeding
EDCD	Epidemiology and Disease Control Division
EDPs	External Development Partners
EHCP	Essential Health Care Programme
EHCS	Essential Health Care Services
EHSP	Essential Health Support Programme
EMR	Eastern Mediterranean Region
ENT	Ear Nose Throat
EOC	Essential Obstetric Care
EPHS	Essential Package of Health Services
EPI	Expanded Programme on Immunization
EUR	European Region
FCGO	Financial Controller General Office
FCHVs	Female Community Health Volunteers
FEFO	First Expiry First Out
FGD	Focus Group Discussion
FHD	Family Health Division
FHI	Family Health International
FM	Frequency Modulation
FMIS	Financial Management Information System
FP	Family Planning
FPAN	Family Planning Association Nepal
FSNAU	Food Security and Nutrition Analysis Unit
FY	Fiscal Year
GDP	Gross Domestic Product
GFR	General Fertility Rate
GM	General Medicine
GOs	Governmental Organizations
GRR	Gross Reproduction Rate
GToT	General Training of Trainers
HA	Health Assistant
HEFU	Health Economics and Financing Unit
HF	Health Facility
HFMC	Health Facility Management Committee
HFOMC	Health Facility Operation and Management Committee
HH	House Hold
HI	Health Institution
HIS	Health Information Systems
HIV	Human Immuno-Deficiency Virus
HMIS	Health Management Information System
HP	Health Post
HPI	Health Post In charge
HPI	Human Poverty Index
HSIS	Health Sector Information System
HSRC	Health Sector Reform Committee
HSRS	Health Sector Reform Strategy
HuRDIS	Human Resource Development Information System
HWs	Health Workers
ICU	Intensive Care Unit
IDP	Internally displaced persons
IEC	Information, Education and Communication
IMAM	Integrated Management of Acute Malnutrition
IMCI	Integrated Management of Childhood Illness
IMF	International Monetary Fund
IMR	Infant Mortality Rate
INRUD	International Network for Rational Use of Drugs
IPD	Indoor Patient Department
IUCD	Intrauterine Contraceptive Device
IUD	Intra Uterine Device
IUDs	Intravenous Drug Users
IYCF	Infant and Young Child Feeding
JICA	Japan International Co-operation Agency
KAP	Knowledge Attitude Practice
LA	Lab Assistant
LAN	Local Area Network
LBI	Low Birth Index
LCD	Leprosy Control Division
LDO	Local Development Officer
LMD	Logistics Management Division
LMIS	Logistics Management Information System
LSGA	Local Self Governance Act
LTHP	Long Term Health Plan
M&E	Monitoring & Evaluation
MAP	Mini Action Project
MCH	Maternal and Child Health
MCHWs	Maternal and Child Health Workers
MD	Management Division
MDGs	Millennium Development Goals
MHP	Micro Health Project
MIS	Management Information System
MIYCF	Maternal, Infant and Young Child Feeding
MLP	Mid-Level Practicum
MMR	Maternal Mortality Ratio
MNP	Micronutrient Powder
MO	Medical Officer
MoE	Ministry of Education
MoF	Ministry of Finance
MoFALD	Ministry of Federal Affairs and Local Development
MOH	Ministry Of Health
MoHP	Ministry Of Health and Population
MOT	Mode of Transmission
MoPPW	Ministry of Physical Planning and Works
MSI	Marie Stopes International
MSNP	Multi-sector Nutrition Plan
MTEF	Medium Term Expenditure Framework
MToT	Master Training of Trainers
MUAC	Mid Upper Arm Circumference
MWRA	Married Women of Reproductive Age
NAGA	Nepal Nutrition Assessment and Gap Analysis
NATA	Nepal Anti-Tuberculosis Association
NCASC	National Centre for AIDS and STD Control
NCD	Non Communicable Disease
NCDR	New Case Detection Rate
NDHS	Nepal Demographic Health Survey
NGO/INGO	Non-governmental Organization/ International Non-governmental Organization
NGOCC	NGO Co-ordination Committee
NHA	National Health Account
NHEICC	National Health Education Information and Communication Centre
NHP	National Health Policy
NHRC	Nepal Health Research Council
NHSP-IP	National Health Sector Program- Implementation Plan
NHTC	National Health Training Center
NIP	National Immunization Programme
NPC	National Planning Commission
NPHL	National Public Health Laboratory
NRCS	Nepal Red Cross Society
NSMP	Nepal Safe Motherhood Program
NTAG	Nepal Technical Assistance Group
NTC	National Tuberculosis Center
NTP	National Tuberculosis Programme
NUTEC	Nutrition Technical Committee
OAG	Office of Auditor General
OECD	Organisation for Economic Co-operation and Development
OPD	Out Patient Department
OPV	Oral Polio Vaccine
ORS	Oral Rehydration Solution
ORT	Oral Rehydration Therapy
OTP	Outpatient Therapeutic Programme
OTTM	Operation Theatre Technique and Management
PAC	Post Abortion Care
PCA	Programme Cooperation Agreement
PEFA	Public Expenditure and Financial Accountability
PEM	Protein Energy Malnutrition
PFM	Public Finance Management
PGR	Population Growth Rate
PHC/ORC	Primary Health Care/ Out Reach Clinic
PHCC	Primary Health Care Center
PHCRD	Primary Health Care Revitalization Division
PLA	Participatory Learning Approach
PME	Planning, Monitoring and Evaluation
PMU	Project Management Unit
PNC	Post Natal Care
PNP	Public NGO Partnership
POSDCoRB	Planning, Organizing, Staffing, Directing, Coordinating, Reporting and Budgeting
PPE	Personal Protective Equipment
PPICD	Policy, Planning and International Cooperation Division
PPIUCD	Post Partum Intrauterine Contraceptive Device
PPMO	Public Procurement Monitoring Office
PPP	Public Private Partnership
PPT	Program Preparation Team
PRA	Participatory Rural Approach
PRGF	Poverty Reduction Grant Fund
PRSP	Social Health Insurance
PSI	Population Service International
RBM	Roll Back Malaria
RFT	Released From Treatment
RH	Reproductive Health
RHD	Regional Health Directorate
RHTC	Regional Health Training Centre
RTC	Regional Training Centre
RTI	Respiratory Tract Infection
SARS	Severe acute respiratory syndrome
SBA	Skilled Birth Attendance
SCC	Social Change Communication
SEAR	South-East Asia Region
SHI	Social Health Insurance
SHP	Sub Health Post
SLTHP	Second Long Term Health Plan
SM/FP	Safe Motherhood/ Family Planning
SMNH	Safe Motherhood and Neonatal Health
SODIS	Solar Water Disinfection System
SPR	Slide Positivity Rate
SPSS	Statistical Product and Service Solutions
SRHR	Sexual Reproductive Health Right
STI/STD	Sexually Transmitted Infection/Disease
SWAp	Sector Wide Approach
SWOT	Strength, Weakness, Opportunity and Threat
TADA	Travel Allowance Daily Allowance
TABUCS	Transaction Accounting and Budget Control System
TB	Tuberculosis
TBA	Traditional Birth Attendant
TFR	Total Fertility Rate
TIMS	Training Information Management System
TLB	Total Live Birth
TNA	Training Need Analysis
ToT	Training of Trainers
TRC	Technical Review Committee
TSA	Treasury Single Account
TSFP	Targeted Supplementary Feeding Programme
TT	Tetanus Toxoid
U5	Under Five
UMN	United Mission to Nepal
UNDP	United Nations Development Programme
UNFPA	United Nations Population Fund
UNICEF	United Nation’s International Children’s Emergency Fund
USG	Ultrasonography
UTI	Urinary Tract Infection
VAD	Vitamin A Deficiency
VDC	Village Development Committee
VHW	Village Health Worker
VSC	Voluntary Surgical Contraception
WARUN	Walter Reeds AFRIM Research Unit Nepal
WHO	World Health Organization
WPR	Western Pacific Region