Surveillance, Prevention and Management of Chronic Disease (NCD)



The increasing burden of Non Communicable Diseases (NCD), particularly in developing countries, threatens to overwhelm already-stretched health services. The factors underlying the major NCDs (heart disease, stroke, diabetes, cancer and chronic respiratory conditions) are well documented. Primary prevention based on comprehensive population-based programme is the most cost-effective approach to contain this emerging epidemic.

Recognizing the unique opportunity that exists to formulate and implement an effective strategy for substantially reduce deaths and disease burden worldwide by improving diet and promoting physical activity, WHO has adopted, in May 2004, the "Global Strategy on Diet, Physical Activity and Health". The overall goal of the strategy is to promote and protect health through healthy eating and physical activity.

In 2007, progress report to the Assembly describes non communicable disease activities in advocacy, surveillance and population-based prevention since the year 2000. A resolution urges Member States to strengthen national efforts in non communicable disease (NCD) prevention and control and also calls for an action plan for the prevention and control of NCDs to be presented to the 61st WHA in 2008. The Assembly held lengthy discussions on public-health problems caused by the harmful use of alcohol.

An NCD policy and strategies has been drafted and NCD RF survey conducted in 2004-2005, in 2006-2007 with a good coordination of WCO Nepal, SEARO and support from HQ Nepal has been able to follow up with interventions at district level, launching of the global report, improving country’s capacity on NCD RF data analysis and planning for the nationally representative data of the NCD risk factors.



Objective of the evaluation

Present the results and future options of GON - WHO collaborative program

Specific objective Identify investments to improve

v      Health System

v      Equitable access to health

v      Global health security

v      Determinants of health and accountability


Implementation and Outputs of 2006-07


As part of supporting implementation of the national policies and strategic plans for NCDs following exercises were conducted to meet the following expected results.


NCD surveillance system initiated and linked to the HMIS, in keeping with the National NCD surveillance strategic plan


v      Utilizing the NCD RF data of 2004-05 NCD intervention plan in 3 districts have been developed. A dissemination meeting of NCD RF 2005 was carried out, a district plan of action for NCD awareness program agreed upon, and a screening camp for early detection of breast and cervical cancer, hypertension and Diabetes mellitus was carried out.

v      Two officials were trained in planning and implementation of NCD InfoBase to develop NCD InfoBase network in three hospitals. Beginning by developing guidelines and instrument for data collection at hospital level, a training guideline was developed.

v      An Inter country workshop on NCD RF data management analysis and reporting was carried out in Kathmandu from 18-22 July 2006 supported by experts from SEARO and trainers from HQ. At the event there were also a launching program of World NCD report by Ministry of Health and Population.

v      A screening camp was carried out in Lalitpur, Ilam and Tanahun. About 1000 local people were screened for major NCDs, early detected cases were referred for further follow up at the district hospital.

v      7 hospitals have been supported for National cancer registry. A new reporting tools has been updated.


Human resource for integrated NCD prevention and control strengthened


v      Policy makers and NCD program managers have been briefed on evidence based prevention and control of NCD’s during which the policy draft was reviewed and proposed for revision.

v      Oral health issues was advocated and disseminated among health stakeholders, government as well as external development partners. Oral health training materials were reviewed and necessary changes have been recommended. ToT in Oral health management conducted and refresher training for 24 health workers on basic oral health package was carried out for health worker in line with the second long term health plan 1997-2017.


Technical inputs

Dr Praveen Mishra, Oral Health Focal Point and Mr Gyan Bdr Basnet participated in the international conference in China. Technical input provided by participating in Diet Physical activity and health,  Yangoon Myanmar  2006, Cervical cancer prevention, Bangkok, Thailand 2007, Monitoring and supervision of NCD RF survey result dissemination, screening camp for major NCD, and awareness program  follow up.



Community and hospital based interventions on major NCDs operational in selected demonstration area


v      Awareness program for diet and physical activity was conducted in three districts. Support has been provided to create awareness program on NCD at community level by local NGO.

v      Regional Statistical Support Group provided support in finalizing the proposal for the national NCD RF survey 2007. The NCD Regional Adviser was supporting the whole process not only technically but also helping Nepal to get funds for NCD survey implementation. At present Nepal NCD Risk Factor Survey 2007 is being initiated.

v      District hospital teams together with central NCD team carried out the screening for major NCD at the three districts (Lalitpur, Ilam and Tanahun). An NGO, teachers’ association developed a training manual for school age youth in and out of school, to increase awareness of primary prevention for NCD. At present the draft is in field trial.




v      NCD policy and strategies reviewed and waiting for government endorsement. The regional and HQ support   for NCD was profound, and there is significant awareness improvement about primary prevention for NCD. After the NCD RF survey 2007 Nepal can refine the policy and strategies draft, design an intervention policy to reduce risk and promoting healthy life.

v      Nepal NCD intervention is the country responsibility as a follow of member countries’ commitment in the WHA. The global strategy has four main objectives: Reduce risk factors for chronic diseases, increase awareness and understanding of DPAS, develop strengthen and implement global, regional, national policies and action plans and monitor science and promote research on diet and physical activity. Bringing about changes in the dietary habits and patterns of physical activity will require the combined efforts of many stakeholders, public and private, over several decades. A combination of sound and effective actions is needed at global, regional, national and local levels, with close monitoring and evaluation of their impact.

v      A link to the health education program could be developed and supported by the government budget






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