Noncommunicable Diseases

Bikram Adhikari, Achyut Raj Pandey, Bipul Lamichhane et al. · 2023 · BMJ Open

Nepal's NCD burden is severe — NCDs cause 71.1% of deaths (GBD 2019) and hypertension affects 24.5% of adults (STEPS 2019) — yet the health system remains structured around a three-tier federal split where local governments (Constitution Schedule 8) hold responsibility for 'basic health and sanitation,' including the roughly 3,778 health posts and 187 PHCCs that serve as most Nepalis' first point of contact. This study's finding that facilities managed by local government were 96% less likely to be ready for CRD services (AOR 0.04) than federal/provincial hospitals exposes a critical devolution gap just as MoHP's WHO PEN package and the NCD Multi-Sectoral Action Plan (2021-2025) depend on exactly these peripheral facilities for screening, diagnosis and referral.

Bihungum Bista, Meghnath Dhimal, Saroj Bhattarai et al. · 2021 · PLOS ONE

This STEPS 2019 survey was designed to monitor Nepal's 2014 Multisectoral Action Plan for the Prevention and Control of NCDs, and its province-level data exposes a critical mismatch between risk and capacity: Sudurpashchim (26% current smoking) and Karnali (22%) carry the country's highest tobacco burden, yet Karnali has 0% of its sanctioned physician and consultant posts filled, leaving the province least able to screen for or treat the NCDs this survey documents. With NCDs already responsible for 66% of Nepal's deaths and WHO's Package of Essential NCD Interventions (PEN) being rolled out at primary-care level, these disaggregated findings should directly inform where PEN services and the ~98-item Free Essential Drug List are prioritised, rather than NCD care remaining concentrated in urban tertiary hospitals.

Rajshree Thapa, Ayse Zengin, Dinesh Neupane et al. · 2023 · Lancet Global Health

Nepal's NCD burden is large and rising -- hypertension affects 24.5% of adults (STEPS 2019) and NCDs account for 66-71% of all deaths (WHO 2022; Nepal Burden of Disease 2019) -- and the government's current reform priority is expanding WHO PEN-based NCD services at primary care using the same ~50,396-strong FCHV cadre this trial deployed. COBIN is a Nepal-based cluster RCT that directly tested the FCHV-delivered lifestyle-counselling model MoHP/DoHS are now trying to scale, and its finding that benefits reverse once FCHVs' active monitoring stops is a first-order caution for any FCHV-based NCD scale-up plan, not a generic 'intervention effectiveness' result.

Kavita Singh, Ambalam M Chandrasekaran, Soumyadeep Bhaumik et al. · 2018 · BMJ Open

Nepal's NCD burden is severe -- cardiovascular disease and diabetes together drive an estimated 66-71% of all deaths, with adult hypertension at 24.5% and raised blood glucose at 5.8% (STEPS 2019) -- yet government health spending remains only about 4.9% of the national budget (FY2025/26) and out-of-pocket spending covers 54.2% of health costs. This systematic review compiles South Asian cost-effectiveness evidence directly relevant to Nepal's current reform priorities of expanding the WHO Package of Essential Non-communicable Disease interventions (PEN) at primary care and stocking essential NCD medicines in the Basic Health Service Package (BHSP), including a Bhutan modelling study that found the PEN-based diabetes and hypertension screening programme to be cost-saving compared with no screening at all. Critically, however, none of the review's 42 included studies were conducted in Nepal (37 were from India alone) -- an evidence gap that the Ministry of Health and Population (MoHP) and Department of Health Services (DoHS) should address as WHO PEN scale-up proceeds.

Jorge César Correia, Hafsa Meraj, Soo Huat Teoh et al. · 2021 · Bulletin of the World Health Organization

Nepal's NCD burden is severe -- noncommunicable diseases cause an estimated 66-71% of deaths and diabetes/raised blood glucose affects roughly 5.8-8.5% of adults (STEPS 2019; population estimates) -- yet NCD care remains concentrated in urban tertiary hospitals while Karnali province has 0% of its sanctioned physician and consultant posts filled (DoHS AHR 2080/81). With 'telemedicine for remote access' and DHIS2 strengthening named as 2026 digital-health reform priorities, this review's finding that low-tech telephone- and SMS-based interventions outperformed smartphone apps and telemetry across nearly every outcome offers directly relevant guidance for a health system where physician density collapses from roughly 1:850 in Kathmandu Valley to 1:150,000 in remote districts.