Overview of Health Promotion and Non-Communicable Diseases in Nepal

Dr BR MarasiniSenior Health Administrator

Ministry of Health and PopulationKathmandu, 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

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

Prevalence of NCD Risk Factors-2Risk factors Prevalence rate Remarks Thyrotoxic foods Unknown Hypothyroid

Consanguineous marriage 400 persons Thalassemia

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

- -

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

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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

Contribution of Public Sector Agencies in NCD Health Promotion

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• 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

Contribution of Public Sector Agencies in NCD and Health Promotion

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• Outdoor air pollution-Ministry of Environment• Education - Department of Education

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

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• 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

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

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