Table 2 Eleven strategic government policies for NCD management, adapted from Multisectoral Action Plan on the Prevention and Control of NCDs in Nepal 2014-2020 [78]

High level political commitment

Action area 1: Leadership, advocacy and partnership

1. 25 % relative reduction in overall mortality from cardiovascular diseases, cancers, diabetes, or chronic respiratory diseases

To have high level of political commitment in line with country international commitment, NCD multisectoral action plan will be linked to the head of state/his representative Chief Secretary Government of Nepal

• Establishment of National Steering Committee for NCD Prevention And Control chaired by Chief Secretary,

2. 10 % relative reduction in the harmful use of alcohol

Multisectoral response

• Creation of functional NCD Unit at the MoHP to coordinate NCD activities

3. 30 % relative reduction in prevalence of current tobacco use in persons over 15 years

Accelerating and scaling up national response to NCD epidemic by setting functional mechanism for multisectoral partnerships and effective coordination, effective leadership and sustained political commitment and resources for implementation of NCD action plan

• Encouraging formation of regional and district NCD committees to oversee activities at each level, numerous inter-sectoral planning and

4. 50 % relative reduction in the proportion of households using solid fuels as the primary source of cooking

Tobacco

• Encouraging review of work plans and sharing lessons of implementation.

5. 30 % relative reduction in mean population intake of salt/sodium

Strengthening enforcement and compliance to Tobacco Product (control and regulatory) Act, 2011 and improving public awareness to hazards of tobacco use

Action area 2: Health promotion and risk reduction.

6. 25 % reduction in prevalence of raised blood pressure

Alcohol

• Enforcement of the existing tobacco regulations, encourage implementation of alcohol policies in line with the Global policy

7. Halt the rise in obesity and diabetes

Reducing commercial and public availability of alcohol and implementing social mobilisation programmes to reduce harmful use of alcohol

• Strategy to reduce harmful use of alcohol

8. 10 % relative reduction in prevalence of insufficient physical activity

Unhealthy diet

• Encourage increased consumption of fruits and vegetables and legislate ban of food products with high unsaturated fat and reduce salt consumption

9. 50 % of eligible people receive drug therapy and counseling (including glycemic control) to prevent heart attacks and strokes

Encouraging increased consumption of fruits and vegetables, reducing consumption of salt, saturated fat and unsaturated fat

• Community-based projects to reduce indoor air pollution will be scaled up in rural communities.

10. 80 % availability of affordable basic technologies and essential medicines, including generics, required to treat major NCDs in both public and private facilities

Physical inactivity

Action area 3: Health systems strengthening for Early detection and management of NCDs and their risk factors.

Improving environment and promoting health beneficial physical activity through supportive policies in key settings

• Strengthening the existing primary health care system through a Package of Essential NCDs (PENs) will be piloted in primary health care settings. Essential drug lists will be updated with psychotropic drugs, diagnostic services for NCDs will be added, primary health care workers will be trained in NCD management and referral system will be developed.

Indoor air pollution

Action area 4: Surveillance, monitoring and evaluation, and research.

Reaching communities and areas with poor indoor air quality as a result of use of biomass fuels for cooking and heating, and providing support with alternative means of energy to reduce adverse health impacts

• Surveys in mental health, oral diseases, sodium urinary excretion level, national psychiatric morbidity survey, assessment of fluoride content in water and assessment of physical infrastructure for walk-ability in urban settings will be conducted.

Essential NCDs (CVDs, COPDs, diabetes and cancer)

Strengthening health system competence, particularly the primary health care system to address common NCDs particularly CVDs, COPDs, diabetes and cancer, along with the additional NCDs and empowering communities and individuals to perform self-care

Oral health

Improving access to essential oral health services through community oriented oral health focusing on preventable oral diseases and oral care

Mental health

Improving basic minimum care of mental health services in the community and improving competency for case identification and initiating referral at primary care level

Surveillance, research, monitoring and evaluation

Strengthening systematic data collection on NCDs and their risk factors, programme implementation and use of this information for evidence-based policy and programme development