FAMILY PLANNING

Background
The main thrust of the National Family Planning Program is to expand and sustain adequate quality
family planning services to communities through the health service network such as hospitals,
primary health care (PHC) centres, health posts (HP), sub health posts (SHP), primary health care
outreach clinics (PHC/ORC) and mobile voluntary surgical contraception (VSC) camps. The policy also
aims to encourage public private partnership. Female community health volunteers (FCHVs) are
mobilized to promote condom distribution and re‐supply of oral pills. Awareness on FP is to be
increased through various IEC/BCC intervention as well as active involvement of FCHVs and Mothers
Groups as envisaged by the revised National Strategy for FCHV program.
In this regard, family planning services are designed to provide a constellation of contraceptive
methods/services that reduce fertility, enhance maternal and neonatal health, child survival, and
contribute to bringing about a balance in population growth and socio‐economic development,
resulting in an environment that will help the Nepalese people improve their quality of life.

Objectives
Within the context of reproductive health, the main objectives of the Family Planning Program are to
assist individuals and couples to:
• Space and/or limit their children
• Prevent unwanted pregnancies
• Improve their overall reproductive health

Targets
Periodic and long‐term targets for the Family Planning Program have been established as follows:
• To reduce TFR to 2.5 children per woman by 2015
• To increase the Contraceptive Prevalence Rate (CPR) to 67 percent by 2015

Strategies
In order to achieve the CPR and the TFR targets mentioned above, a total of 2,580,000 couples were
expected to be using modern contraception by the end of the FY 2067/68. Recognizing the
importance of spacing of births, the Family Planning Program has been placing greater emphasis on
promoting temporary methods of contraception. More specifically, the long‐term objective is to
reduce the share of permanent sterilization in overall use of family planning methods. However, the
emphasis on VSC services should be continued to address the unmet demand of those who desire to
limit further births.
The Family Planning Program aims to provide a constellation of contraceptive services throughout
thecountry. The strategy to achieve the family planning goals includes the following elements:

• Periodic review of policy through national RH steering committee meetings.

• Co‐ordination of FP program and activities through RH co‐ordination committee networks
including Family Planning Sub‐Committee.
• Institutionalization of policy/operational guidelines and clinical protocols to ensure maximum
coverage and quality of family planning services.
• Increasing the knowledge and understanding of the benefits of delayed marriage, birth spacing,
and a well planned family norm across the country through integrated RH/FP/IEC/BCC activities.
• Increasing accessibility and availability of FP services through a combination of static, outreach
and referral services.
• Establish FP service as a part of hospital service and strengthen Institutionalized Family Planning
Service Centres (IFPSC).
• Expanding regular year‐round and mobile VSC outreach services and expanding IUCD services to
PHC and HP with special emphasis on thorough counselling and follow‐up services.
• Linking FP program with essential Health Care Service.
• Providing non‐clinical methods (condoms, pills, and injectables) through static and outreach
services.
• Training of service providers.
• Improving the quality of care in accordance with the National Medical Standards for contraceptive
services, with special attention on counselling, infection prevention and management of side
effects and complications.
• Providing re‐canalization services in selected hospitals.
• Establishing post‐partum FP services in institutions with a significant caseload of deliveries.
• Integrating family planning services with post abortion care and safe abortion care.
• Identifying national requirements and ensuring adequate procurement of contraceptives and
logistic supplies.
• Promote wider use of Health Management Information Systems (HMIS) and health system
research for better planning and program management.
• Ensuring effective monitoring and supervision of FP programs.
• Increasing free access to condom by having condom boxes at all health institutions and
resupplying pills and distributing condom through FCHVs.

Current status:
SAFE MOTHERHOOD AND NEWBORN HEALTH
Background
The goal of the National Safe Motherhood Program is to reduce maternal and neonatal mortalities
by addressing factors related to various morbidities, death and disability caused by complications of
pregnancy and childbirth. Global evidence shows that all pregnancies are at risk, and complications
during pregnancy, delivery and the postnatal period are difficult to predict. Experience also shows
that three key delays are of critical importance to the outcomes of an obstetric emergency: (i) delay
in seeking care, (ii) delay in reaching care, and (iii) delay in receiving care. To reduce the risks
associated with pregnancy and childbirth and address these delays, three major strategies have been
adopted in Nepal:
• Promoting birth preparedness and complication readiness including awareness raising and
improving the availability of funds, transport and blood supplies.
• Encouraging for institutional delivery.
• Expansion of 24‐hour emergency obstetric care services (basic and comprehensive) at
selected public health facilities in every district
Since its initiation in 1997, the Safe Motherhood Program has made significant progress in terms of
the development of policies and protocols as well as expansion in the role of service providers such
as staff nurses and ANMs in life saving skills. The policy on skilled birth attendants endorsed in 2006
by MoHP specifically identifies the importance of skilled birth attendance at every birth and
embodies the Government’s commitment to training and deploying doctors and nurses/ANMs with
the required skills across the country. Similarly, endorsement of revised National Blood Transfusion
Policy 2006 is also a significant step towards ensuring the availability of safe blood supplies in the
event of an emergency. In order to ensure focused and coordinated efforts among the various
stakeholders involved in safe motherhood and neonatal health programming, government and
non‐government, national and international, the National Safe Motherhood Plan (2002‐2017) has
been revised, with wide partner participation. The revised Safe Motherhood and Neonatal Health
Long Term Plan (SMNHLTP 2006‐ 2017) includes recent developments not adequately covered in the
original plan. These include:
recognition of the importance of addressing neonatal health as an integral part of safe motherhood
programming; the policy for skilled birth attendants; health sector reform initiatives; legalisation of
abortion and the integration of safe abortion services under the safe motherhood umbrella;
addressing the increasing problem of mother to child transmission of HIV/AIDS; and recognition of
the importance of equity and access efforts to ensure that most needy women can access the
services they need. The SMNHLTP identifies the following goal, purposes and outputs.
Goal
Safe‐motherhood and neonatal health aims at improving maternal and neonatal health and survival,
especially of the poor and excluded. The main indicators for this include reduction in maternal
mortality ratio and neonatal mortality rate. The detail indicators are given in Table 3.2.1.
 IMMUNIZATION PROGRAM
The National Immunization Program (NIP) is a high priority program (P1) of Government of Nepal.
Immunization is considered as one of the most cost‐effective health interventions. NIP has helped in
reducing the burden of vaccine preventable diseases (VPDs) and child mortality and has contributed
in achieving the Millennium Development Goal on child mortality reduction (MDG4).
Currently NIP provides vaccination against TB (BCG), diphtheria‐pertussis‐tetanus‐hepatitis B and
haemophilus influenza (DPT‐HepB‐HiB), poliomyelitis (OPV) and measles throughout the country and
JE vaccine in high risk post campaign districts through routine immunization. TT vaccination is
provided to all pregnant women. The routine immunization services are provided through health
facilities (fixed clinic), private, NGO or INGO clinics, urban clinics, outreach session and mobile team
in geographical inaccessible areas. All vaccines under NIP are provided free of cost. Since the past
decades new vaccines are available in the markets, and the Government is keen to provide all
available vaccines to reduce morbidity and mortality. Since last 10 years several new vaccines
(hepatitisB, Hib and JE) were introduced into routine immunization. In addition to routine
immunization services NIP carries out several supplementary immunization activities either to
eradicate, eliminate or control vaccine preventable diseases (VPDs).

Goal
The goal of National immunization Program is to reduce child morbidity, mortality and disability
associated with vaccine‐preventable diseases.

Objectives
The objectives of the National Immunization Program are as follows:
 Achieve and sustain 90 percent coverage of DPT3 by and of all antigens
 Maintain polio free status
 Sustain MNT elimination status
 Initiate measles elimination
 Expand vaccine preventable disease (VPDs) surveillance
 Accelerate control of other vaccine preventable diseases through introduction of new
vaccines
 Improve and sustain immunization quality
 Expand immunization services beyond infancy
targets
NHSP2 targets to achieve 85 percent of children under 12 months of age immunized against DPT3
and measles.
strategies
The key strategies to achieve the above objectives are:
1. Strengthen routine immunization through RED strategies
• RED micro planning in all districts
• Supportive supervision and monitoring
• Increase and promote public awareness and demand through social mobilisation for
immunisation services and IEC/BCC interventions
• Partnership with private, CBOs, NGOs and others
2. Strengthen municipality immunization services
• Fulfil vacant post of vaccinators
• Ensure availability of vaccine and other logistics
• Supportive supervision and monitoring
3. Conduct supplementary immunization activities and surveillance for eradication of
poliomyelitis and control of measles and JE.
4. Sustain Maternal and Neonatal Tetanus elimination status through expansion of school TT
immunization program and high TT coverage.
5. Strengthen and expand integrated surveillance of VPDs built on AFP Surveillance (AFP, Measles,
Neonatal Tetanus and Japanese Encephalitis) and initiate disease burden study of other vaccine
preventable diseases like Hib and Rubella, Pneumococcal and Rota.
6. Conduct periodic meetings of National Committee for Immunization Practices (NCIP), Adverse
Event Following Immunization (AEFI) and Inter‐agency Coordination Committee (ICC) committee.
7. Conduct capacity building for relevant health staff (MLM, refresher training, cold chain and
vaccine management, maintenance training, in‐country observation tour by EPI staff).
8. Control outbreak of VPDs through appropriate reporting, investigation and response.
9. Improve quality of immunization services practicing injection safety policy.
10. Introduction of new and underused vaccines based on disease burden.

Current status

NUTRITION PROGRAM

The National Nutrition Program under Department of Health Services has laid the vision as “all
Nepali people living with adequate nutrition, food safety and food security for adequate physical,
mental and social growth and equitable human capital development and survival” with the mission
to improve the overall nutritional status of children, women of child bearing age, pregnant women,
and all ages through the control of general malnutrition and the prevention and control of
micronutrient deficiency disorders having a broader inter and intra‐sectoral collaboration and
coordination, partnership among different stakeholders and high level of awareness and
cooperation of population in general.
Malnutrition remains a serious obstacle to child survival, growth and development in Nepal. The
most common form of malnutrition is protein‐energy malnutrition (PEM). The other forms of
malnutrition are iodine, iron and vitamin A deficiency. Each type of malnutrition wrecks its own
particular havoc on the human body, and to make matters worse, they often appear in combination.
Even moderately acute and severely acute malnourished children are more likely to die from
common childhood illness than those adequately nourished. In addition, malnutrition constitutes a
serious threat especially to young child survival and is associated with about one third of child
mortality. Major causes of PEM in Nepal is low birth weight of below 2.5 kg, due to poor maternal
nutrition, inadequate dietary intake, frequent infections, household food insecurity, feeding
behaviour and poor care and practices leading to an intergenerational cycle of malnutrition.

Iodine Deficiency Disorder (IDD) was another endemic problem in Nepal, especially in the western
mountains and mid hills for which Ministry of Health and Population adopted a policy to fortify all
edible common salt with iodine and decided to celebrate February as ‘the month to create general
awareness about the use of adequately iodized salt through mass campaign to contribute in the
prevention of Iodine Deficiency Disorders.
Another problem among school‐aged children and women is the Vitamin A deficiency leading to
night blindness both in children and women. No cases of night blindness are reported so far among
children below 5 years due to a regular semi‐annual supplementation of high dose Vitamin A
supplementation to preschool children (200,000 I.U.). The National Vitamin A Supplementation
Program with community support is considered as the one of the internationally recognized
successful program. Nepal Government also completed the piloting of new‐born Vitamin ‘A’ dosing
program in four district of Nepal (Nawalparasi, Tanahun, Bardiya and Sindhuli). A high dose of
vitamin A supplementation for mother during post‐partum period is also on‐going throughout the
country.
The prevalence of worm infestation in Nepal remaining still high leading to decreased resistance to
infection and contributing to anaemic status, which in turns induces malnutrition, and also, leads to
anaemia impairing cognitive function in children. Therefore, deworming of children one to five years
of age is incorporated into the national biannual Vitamin A supplementation program which has
been implemented in the entire country. Similarly, de‐worming of all pregnant women with single
dose of albendazole tablet after first trimester of pregnancy is being routinely practiced through all
health facilities in Nepal. In addition, under School Health and Nutrition (SHN) Program biannual
school deworming is also launched to the school students studying at government schools
throughout the country. GoN is planning to up‐scale deworming chemotherapy to students from
grade 1 to 10 of all public and private schools of the country.
Anaemia caused by iron deficiency is also a major public health problem in Nepal affecting all
segments of the population. As per findings of NDHS 2011, 46 percent of children ages 6 to 59
months are anaemic. The majority of children who suffer from anemia are classified as having mild
or moderate anemia (27 and 19%, respectively) while less than 1 percent are severely anemic.
Anemia is less common among women; 35 percent show evidence of anemia, and the majority is
mildly anemic (29%). Anemia among both children and women is especially prevalent in rural areas,
where nearly half of the children (46%) and more than one‐third of women (36%) have some degree
of anemia. The NDHS 2011 found more than 70 percent of children aged 6 to 23 months are anaemic
compared with 25 percent of children aged 48 to 59 months. Anaemia is most common among
children less than 5 years in the far‐western terai (60%) compared to central mountain (33%).
Overall, there has been no significant improvement in the anemia status of children and women in
Nepal between 2006 and 2011.
As per the government policy, all pregnant women and postpartum mothers are given iron tablet
starting from second trimester to post‐partum period free of cost. In order to increase coverage and
compliance of iron tablets among pregnant and postnatal mothers ‘Intensification of Maternal and
Neonatal Micronutrient Program (IMNMP)’ is implemented through the existing health facilities and
community‐based outlets like FCHVs with special emphasis on creating awareness. Awareness
raising activities mainly include advocacy, information through public media and training of health
workers/volunteers at all levels. IEC materials such as flip chart and posters are also being
distributed for this purpose. By the end of fiscal year 2067/68, the program has been introduced in
70 districts (Out of total 75 districts).
According to WHO 2011 guideline, micronutrient powder supplementation is required in the areas
where more than 20 percent under five children population is suffering from any form of anaemia.
In
Nepal, irrespective of geographical regions, the anaemia prevalence is higher than 20 percent in the
under five children and the situation is more critical in under two years children where the
prevalence is as high as 70 percent, according to the Nepal Demographic Health Survey, 2011. To
address the problem, MoHP Nepal has endorsed a permissive policy on home fortification of
micronutrient powder (MNP) in the complementary food in order to correct Anaemia Prevalence in
6‐23 month children. Linking the distribution of MNP to 6‐23 months children with Government’s
Infant and Young child Feeding Promotion Program, the MNP distribution program has been
implemented in 6 districts of Nepal viz. Rupandehi, Parsa, Gorkha, Rasuwa, Palpa and Makawanpur.
The plan is to scale up this program all 75 districts by 2015.

Objectives
General Objective
The general objective of the National Nutrition Program is to enhance nutritional well‐being, reduce
child and maternal mortality and is to contribute for equitable human development.
Specific Objectives:
• Reduce general malnutrition among women and children
• Reduce Iron Deficiency Anaemia among children and pregnant mother
• Maintain and sustain Iodine Deficiency Disorder (IDD) and Vitamin A Deficiency Disorder (VAD)
• Improve maternal nutrition
• Align with Multi‐sectoral Nutrition Initiative
• Improve Nutrition related Behaviour change and communication
• Improve Monitoring and Evaluation for Nutrition related Programs/Activities
Targets
In order to improve the overall nutritional status of children and pregnant women, the national
nutrition program has set the following targets:
• To reduce PEM in children under 5 years of age and reproductive aged women to half of the
2000 level by the year 2017.
• To reduce the prevalence of anaemia among women and children to less than 40 percent by
2017.
• To virtually eliminate IDD and sustain the elimination by 2017.
• To virtually eliminate vitamin A deficiency and sustain the elimination by 2017.
• To reduce the infestation of intestinal worms among children and pregnant women to less than
10 percent by 2017.
• To reduce the prevalence of low birth weight to 12 percent by the year 2017.
• To improve household food security to ensure that all people can have adequate access,
availability and utilization of food needed for healthy life in order to reduce the percentage of
people with inadequate energy intake to 25 percent by 2017.
• To improve health and overall nutritional status of school children through the implementation
of School Health and Nutrition Program.
• To reduce the critical risk of malnutrition and life during exceptionally difficult circumstances.
• To strengthen the system for analyzing, monitoring and evaluating the nutrition situation. • To
promote exclusive breastfeeding till the age of six completed months. Thereafter, introduce
complementary foods along with breast milk till the child completes 2 years or more.
• To reduce the Infestation of intestinal worm among Children and Pregnant Women to less than
10 percent by 2017.
Strategies
The following general strategies have been pursued to address the nutritional situation in Nepal:
• To reduce protein‐energy malnutrition (PEM) in children less than five years of age and
Reproductive aged Women to half of the 2000 level by the year 2017 through a multi‐sectoral
approach.
• Promote, facilitate and utilize community participation and involvement for all nutrition
activities.
• Develop understanding and effective co‐ordination between various concerned Sections,
Divisions and Centres within the Department of Health Services.
• Maintain and strengthen co‐ordination among other agencies involved in nutrition activities, i.e.,
the Ministries of Agriculture, Education, Local Development and the National Planning
Commission, as well as with EDPs, NGOs, INGOs and private sector.
• Decentralise authority to the region, district, Health Post, Sub Health Post and community for
needs assessment, planning, implementation, and monitoring.
• Conduct national advocacy and social mobilization campaigns; Integrate/incorporate activities
(such as Expanded Program on Immunization, Integrated Management of Childhood Illness,
Maternal and Family Health and other concern program, etc.) into nutrition plans.
• Develop a systematic approach for Monitoring and Evaluation of all nutrition program activities.
• Celebrate different events related to nutrition program like School Health and Nutrition Week
(Jestha 1 to 7), Breast feeding week (August 1‐7), Iodine month (February) to raise awareness
about the importance of Nutrition.
• Implement School Health and Nutrition Program as per National Strategy.
• Growth monitoring will be used as a screening tool to assess the general malnutrition status of
children under less than five years.
Specific Strategies
1. Control of Protein Energy Malnutrition (PEM)
• Promotion of IYCF through creating awareness regarding the importance of growth monitoring
and exclusive Breast Feeding up to 6 month of age and timely introduction of complementary
foods.
• Provide growth‐monitoring services, ANC checkups, de‐worming during Pregnancy through
outreach clinics, Sub Health Posts, Health Posts/PHC in food insecure districts.
• Protect, Promote & Support Optimal Feeding Practice for Infant & Young Children.
• Increase awareness among medical professionals through advocacy efforts, such as by including
sessions on breastfeeding on seminars/workshops held by various associations.
• BCC for Changing the Dietary Practices.
• Celebrate Breastfeeding Week (August 1‐7) as an advocacy for the protection and promotion of
breastfeeding.
• Strengthen Nutrition Rehabilitation Home and community based management of acute
malnutrition (CMAM).

• Improve Maternal and Adolescent Nutrition & Low Birth Weight Baby Through improved
Maternal Nutrition Practices.
2. Control of IDD
• Strengthen the implementation of Iodized Salt Act, 2055 for regulation and monitoring of
iodized salt trade to ensure that all edible salt is iodized.
• Increase the accessibility and market share of iodized packet salt with ‘two‐child’ logo.
• Create awareness about the importance of use of iodized salt for the control of IDD; through
Social Marketing Campaign.
• Celebrate month of February as an iodine month.
3. Control of Vitamin A Deficiency (VAD)
• Distribute high‐dose vitamin A capsules to children between 6 and 59 months biannually
through FCHVs.
• Advocate for increased home production, consumption and preservation of Vitamin A rich foods
at the community level.
• Explore the fortification of suitable foods (such as sugar and cooking oil) with Vitamin A.
• Strengthen the usage of Vitamin A Treatment protocol.
• Supplementation of Vitamin A capsule (200,000 IU) to postpartum mothers through healthcare
facilities and community volunteers.
4. Control of Anaemia
• Increase coverage and compliance of iron/folate supplementation for pregnant women.
• Reduce the burden of parasitic infestations (helminths, malaria and Kalazar).
• Identify and implement food fortification to increase the dietary iron intake focusing on
commercial as well as small‐scale community based fortification initiatives.
• Promote dietary diversification to improve the quality of food consumed with an emphasis on
bio‐available iron.
• Promote maternal care practices and services to improve health and nutritional status of mother
and babies.
• Identify and implement the effective modalities to address iron deficiency in adolescents and
non‐pregnant women of reproductive age.
5. De‐worming
• De‐worming of pregnant women through health facilities with single dose tablet (Albendazole
400 mg) starting from 2nd trimester (4 months) of the pregnancy.
• Distribute Bi‐annual de‐worming tablet to Primary School Children in 75 districts (Government
schools).
• Follow up the comprehensive de‐worming work plan.

Current status:

IMCI PROGRAM
Community Based Integrated Management of Childhood Illness (CB‐IMCI) Program is an integrated
package of child‐survival interventions and addresses major childhood killer diseases like
Pneumonia, Diarrhoea, Malaria, Measles, and Malnutrition in 2 months to 5 year children in a
holistic way. CBIMCI also includes management of infection, Jaundice, Hyperthermia and counselling
on breastfeeding for young infants less than 2 months of age. With the implementation of this
package children are diagnosed early and treated appropriately for major childhood diseases at the
health facility and community level. At the community level FCHVs are the main vehicle of service
delivery and also plays key role to increase community participation.
In 1997, the program was initiated in Mahottari as a piloting district for IMCI. Based on the
recommendations it was decided to include a community component, enabling mobilisation of
community health workers (VHWs and MCHWs) and FCHVs to provide CDD, ARI, Nutrition and
Immunisation services to the community. As a result the Community based ARI and CDD (CBAC)
program was merged into IMCI in 1999 and is now called the Community Based IMCI (CB‐IMCI). At
the end of fiscal year 2066/67 (2009/2010) CB‐IMCI Program has covered 75 districts. In 2004,
Newborn component was added to CB‐IMCI.
Vision
•• Contribute to survival, healthy growth and development of under five children of Nepal.
• Achieve MDG Goal 4 by 2015.
Goal
To reduce morbidity and mortality among children under‐five due to pneumonia, diarrhoea,
malnutrition, measles and malaria.
Targets
• To reduce neonatal mortality from the current rate of 33/1,000 live births to 17/1,000 live births
by 2015.
• To reduce neonatal morbidity among infants less than 2 months of age.
Objectives
• Reduce frequency and severity of illness and death related to ARI, Diarrhoea, Malnutrition,
Measles and Malaria.
• Contribute to improved growth and development.
Strategy
The following strategies have been adopted by CB‐IMCI program: 1. Improving knowledge and
case management skills of health‐care staff
CB‐IMCI aims to improve the skills of healthcare staff through
• training to all health workers on CB‐IMCI including zinc treatment for diarrhoea;
• regular integrated review and refresher trainings to health service providers;
• inclusion of CB‐IMCI in the curriculum of pre‐service medical and paramedical schools;
• technical support visits should include visits from the central and regional level to districts,
DHO to all HFs; HFs to FCHVs; and
• capacity building training to the CB‐IMCI focal persons of the districts.
2. Improving overall health systems
• Carry out CB‐IMCI Program maintenance activities as per the recommendations made by IMCI
working group and global context.
• Improve logistic supply.
• Regularize mother’s group meeting.
• Strengthen reporting system at all levels.
• Strengthen supervision and monitoring.
3. Improving family and community practices
• Disseminating key behavioural message through FCHVs to families and communities using
relevant IEC materials.
• Reaching the disadvantaged and hard‐to‐reach communities through reactivated mother’s
group meeting.
• Dissemination of key family practice messages through interpersonal communication.
Current status:

MALARIA

Malaria control project was first initiated in Nepal in 1954 with the suppot from USAID (then USOM).
The objective of the project was to control malaria mainly in southern Terai belt of central Nepal. In
1958, national malaria eradication program, the first national public health program in the country
was launched with the objective of eradicating malaria from the country within a limited time
period. Due to various reasons the eradication concept was reverted to control program in 1978.
Following the call of WHO to revamp the malaria control programs in 1998, Roll Back Malaria (RBM)
initiative was launched to address the perennial problem of malaria in hard‐core forested, foot hills,
inner Terai and valley areas of the hills, where more than 70 percent of the total malaria cases of the
country prevail. The high risk of getting the disease is attributed to the abundance of vector
mosquitoes, mobile and vulnerable population, relative inaccessibility of the area, suitable
temperature, environmental and socio‐economic factors. Currently malaria control activities are
carried out in 65 districts at risk of malaria. The districts are divided into four different categories as
follows:
• High risk districts (13): Ilam, Jhapa, Morang, Sindhuli, Dhanusa, Mahottari, Kavre, Nawalparasi,
Banke, Bardiya, Kailali, Kanchanpur, Dadeldhura
• Moderate risk districts (18): Panchthar, Dhankuta, Sunsari, Saptari, Siraha, Udayapur, Sarlahi,
Rautahat, Bara, Parsa, Makawanpur, Chitwan, Sindhupalchowk, Rupandehi, Kapilvastu, Dang,
Surkhet, Doti
• Low risk 34 Districts (Minimal transmission) (34)
• No risk Districts (10)
The Global Fund is supporting malaria control program in the high risk 13 endemic districts and
moderate risk 18 endemic districts.
Objective
• Overall incidence of (probable and confirmed) malaria in ‘population at risk’ brought below 2
cases per 1,000 by 2011. (2005 baseline: 4.1 cases per 1,000)
• Hospital‐based severe malaria case fatality rate reduced to below 15% by 2010.
• By 2010, weekly incidence of malaria (probable and confirmed) in all outbreak wards brought
below outbreak threshold level within 6 weeks of detection.
• Community mobilization and community partnership in malaria control.
Targets
• 80 percent of people in high risk areas (stratum 1 VDCs) sleeping under LLIN (last night) by 2011. •
80 percent of malaria cases reported by public sector health facilities in high risk areas (stratum 1)
confirmed by microscopy or RDT by 2011.
• 80 percent of care providers at rural public sector health facilities providing appropriate treatment
for malaria by 2011.
Strategies
Vector Control and Personal Protection
• Two rounds of routine indoor residual spraying (IRS) will be carried out annually in each high risk
VDCs unless LLIN population coverage in that VDC exceeds 80%
• In the event of limited insecticide stocks round 2 of the IRS campaign may be withheld and target
VDCs will be prioritized according to malaria burden.
• Insecticides for IRS will be WHOPES approved and will be selected by the insecticide Technical
Working Group (TWG) on the basis of likely cost effectiveness (insecticide resistance profiles for
primary vectors will be taken into consideration).
• IRS operations will aim to cover at least 80 percent of households in target VDCs.
• WHOPES approved long‐lasting insecticide treated bed nets (LLINs) will be provided free of charge
to all people living in high risk VDCs (1 LLIN per 2 people every three years ‐ assuming a three year
life for the LLIN).
• LLIN delivery campaigns will take place in one third of targeted VDCs in each district each year so
that total coverage of the target population is achieved by year 3 and maintained thereafter.
Additional WHOPES approved LLINs will be provided to all pregnant women attending ANC checkups
in high risk VDCs (one LLIN per pregnancy).
Early Diagnosis and Appropriate Treatment
• Diagnostic services for malaria will be provided free of charge at all public sector health facilities.
• Microscopy will form the diagnostic method of choice at hospital and primary health care centre
level and some selected health posts and sub‐health posts.
• Below primary health care centre level falciparum specific and RDTs will form the diagnostic
method of choice in high and moderate risk areas. To minimize wastage, use of RDTs will be
strictly limited to diagnosing clinically suspected cases only.
• EDCD will implement a comprehensive quality assurance system for malaria microscopy and RDTs
through the referral laboratory network (District, Regional and Central). This will be linked to
needs‐based refresher training.
• Anti‐malarial drugs will be provided free of charge from all public sector health facilities.
• Anti‐malarial drugs will be provided free of charge through the Female Community Health
Volunteer (FCHV) network in high risk area according to national treatment guidelines.
• Artemisinin‐based combination therapy (ACT) will be provided for confirmed falciparum malaria
cases throughout the country as per national treatment guidelines.
• Chloroquine will be provided for confirmed vivax cases and suspected malaria cases as per
national treatment guidelines.
• Primaquine will be provided for the radical cure of confirmed vivax cases as per national
treatment guidelines.
• National malaria treatment guidelines will be reviewed regularly and revised as appropriate based
on the findings of drug resistance surveillance.
• National malaria treatment guidelines (and any revisions to them) will be implemented at all
public sector health facilities throughout the country within one year of ratification by the
Regional Technical Advisory Group on Malaria (RTAG‐M). Recommended anti‐malarials,
includingACT, will be incorporated into the essential drug list. Malaria Surveillance and
Epidemic Preparedness
• A simple malaria outbreak early warning system will be established in selected public health
facilities (one sentinel site/endemic district). This will be complimentary to existing surveillance
networks.
• Technical and operational linkages between EDCD and epidemic prone districts will be
strengthened for an effective coordinated action in response to outbreaks.
• In the event of an outbreak, focal IRS will be carried out in the ward(s) where the outbreak was
detected and in all adjacent wards.
• In the event of an outbreak, district‐level teams will carry out RDT‐based active case detection in
the outbreak ward(s) and in all adjacent wards. Confirmed cases will be treated according to
national treatment guidelines.
Behaviour Change Communication (BCC)
• Carefully tailored locally appropriate malaria related IEC/BCC will be delivered through 5
methodologies: interpersonal communication (health workers, religious and community
members); primary and secondary education (malaria incorporated into vector borne disease
control module); mass media (electronic and print); special events (malaria day); and, high level
advocacy.
• Final development and production of BCC materials will be outsourced to private/INGO/NGO
sector specialists.
• Maximum use will be made of free promotional opportunities such as articles in newspapers, and
news bulletins, and dramas on television and radio.
Program Management
• Capacity building: A holistic package of carefully tailored technical and management training will
be developed and will be implemented through central and district level staff in order to
strengthen the functionality of service provision in the periphery.
• Planning: Technical Working Groups (TWGs) will be established and maintained for all key
technical areas including: diagnostics; case management; vector control; IEC/BCC; monitoring &
evaluation; and operational research.
• Existing technical guidelines, including guidelines on case management, vector control, epidemic
preparedness and control, monitoring drug and insecticide resistance will be updated by the
TWGs/TA and disseminated.
• Policies, strategies and guidelines will be reviewed regularly by TWGs in light of findings from
periodic evaluations and in view of recommendations resulting from surveillance and operational
research activities.
• To ensure equitable and evidence‐based distribution of services, allocation of all program
commodities will be carried out by the relevant TWG.
• A National Technical Advisory Group for Malaria (NTAG‐M) will be established. The group will have
representation from MoHP, EDCD, NPHL, NHEIC, VBDRTC, DHOs, the INGO/NGO sector and WHO
(and other key agencies as appropriate). This committee will meet annually in order to review
programmatic progress and to ratify any policy/strategy changes.
Operational Research
• The program will implement a modest needs‐based package of operational research in association
with implementing partners and national and international research institutes.
• Research priorities will be reviewed annually by a TWG and the resulting research agenda will be
ratified by the NTAG Malaria.
Community Participation
• Enhance community participation and partnership building in malaria control through the
progressive expansion of Roll Back Malaria (RBM) initiative.

Current status:
TUBERCULOSIS

Tuberculosis (TB) is a major public health problem in Nepal. About 45 percent of the total population
is infected with TB, of which 60 percent are adult. Every year, 40,000 people develop active TB, of
whom 20,000 have infectious pulmonary disease. These 20,000 are able to spread the disease to
others. Treatment by Directly Observed Treatment Short course (DOTS) has reduced the number of
deaths; however 5,000‐7,000 people still die per year from TB. Expansion of this cost effective and
highly successful treatment strategy has proven its efficacy in reducing the mortality and morbidity
in Nepal. By achieving the global targets of diagnosing 70 percent of new infectious cases and curing
85 percent of these patients will prevent 30,000 deaths over the next five years. High cure rates and
Sputum conversion rate will reduce the transmission of TB and lead to a decline in the incidence of
this disease, which will ultimately help to achieve the goal and objectives of TB control.
DOTS have been successfully implemented throughout the country since April 2001. The NTP has
coordinated with the public sectors, private sectors, local government bodies, I/NGOs, social
workers, educational sectors and other sectors of society in order to expand DOTS and sustain the
present significant results achieved by NTP. By 16th July 2011 NTP has 1,118 DOTS treatment centres
with 3,103 sub centres. The treatment success rate stands at 90 percent and case finding rate of 73
percent. At the national level 36,951 TB patients have been registered of whom 15,000 infectious
(sputum smear positive new cases) and are being treated under the DOTS strategy in NTP during the
FY 2067/68 (2010/2011).
Vision
The NTP’s vision is TB free Nepal.
Mission
• To ensure that every TB patient has access to effective diagnosis, treatment and cure
• To stop transmission of TB
• To prevent development of multi drug resistant TB
• To reduce the social and economic toll of TB
Goal
• To reduce the mortality, morbidity and transmission of tuberculosis until it is no longer a public
health problem in Nepal.
Objectives
• Achieve universal access to high‐quality diagnosis and patient‐centred treatment
• Reduce the human suffering and socioeconomic burden associated with TB
• Protect poor and vulnerable populations from TB, TB/HIV and multi‐drug‐resistant TB
• Support development of new tools and enable their timely and effective use
Targets
Targets linked to the MDGs and endorsed by the Stop TB Partnership:
• by 2005: detect at least 70 percent of new sputum smear‐positive TB cases and cure at least 85
percent of these cases
• by 2015: reduce prevalence of and death due to TB by 50 percent relative to 1990
• by 2050: eliminate TB as a public health problem (<1 case per million population)

Strategies

Stop TB strategy

1. Pursue high-quality DOTS expansion and enhancement

• Political commitment with increased and sustained financing
• Case detection through quality-assured bacteriology
• Standardized treatment with supervision and patient support
• An effective drug supply and management system
• Monitoring and evaluation system, and impact measurement
2. Address TB/HIV, MDR-TB and other challenges
• Implement collaborative TB/HIV activities
• Prevent and control multi-drug-resistant TB
• Address prisoners, refugees and other high-risk groups and special situations
3. Contribute to health system strengthening
• Actively participate in efforts to improve system-wide policy, human resources, financing,
management, service delivery, and information systems
• Share innovations that strengthen systems, including the Practical Approach to Lung Health
(PAL)
• Adapt innovations from other fields
DoHS, Annual Report 2066/67 (2009/2010) (page 161)
4. Engage all care providers
• Public-Public, and Public-Private Mix (PPM) approaches
• International Standards for Tuberculosis Care (ISTC)
5. Empower people with TB, and communities
• Advocacy, communication and social mobilization
• Community participation in TB care
• Patients' Charter for Tuberculosis Care
6. Enable and promote research
• Programme-based operational research
The National Tuberculosis Programme
The National Tuberculosis Programme (NTP) is an approach within the national health system for
control of tuberculosis (TB). NTP has specific policies, plans and activities to achieve its goals,
objectives and targets. NTP is countrywide, continuous, and permanent and fully integrated within the
general health services. NTP policies are in accordance with the national health plan, WHO Stop TB
Strategy and the Global Plan to Stop TB (2006-2015).
Current status

LEPROSY
Leprosy has existed in Nepal since time immemorial and was recognized as a major Public Health
problem as early as 1950. Khokana Leprosarium near Kathmandu was established more than 160
years ago to provide services to the leprosy patients.
For ages, leprosy has been a disease causing public health problem and has been a priority of the
government of Nepal. Thousands of people have been affected by this disease and many of them
had to live with physical deformities and disabilities.
Activities to control leprosy in an organized and planned manner were initiated only from 1960.
According to a survey conducted in 1966, an estimated 100,000 leprosy cases were present in Nepal.
Dapsone monotherapy treatment was introduced as a Pilot Project in the Leprosy Control Program.
Nepal Leprosy Control Program was started in the country in 1966. Multi Drug Therapy (MDT) was
introduced in 1982 in few selected areas and hospitals of the country. By this time, the number of
registered leprosy cases had reached 21,537 with a Prevalence Rate (PR) of 21 per 10,000
population. Sixty‐two districts of the country had PR of over 5, while only three districts had PR less
than 1 per 10,000 inhabitants.
The program was integrated into the general health services in 1987. By 1996 MDT was expanded to
all 75 districts. The country conducted Leprosy Elimination Campaign in 1999 (LEC‐1) and again in
2001 (LEC‐2) which was an active case detection activity. In high endemic pockets special
interventions were undertaken for case finding. Community mobilization and participation during
LEC contributed to voluntary case reporting due to reduction of stigma and discrimination against
leprosy affected persons. High cure rates through flexible and patient‐friendly drug delivery systems
were ensured. Monitoring and supervision of the activities were undertaken to keep track of
progress towards elimination.
All initiatives were coordinated amongstthe national, international and local
non‐governmental organizations.
Specialized care for leprosy affected Evolution of Leprosy Control Program
persons was provided in Leprosy 1960 Leprosy survey in collaboration with WHO
hospitals and referral clinics run by 1966 Pilot Project launched with Dapsone therapy
1982 Introduction of Multi Drug Therapy
NGOs and the government. WHO and 1987 Integration of vertical program into general basic
health services
other major partners supporting the 1991 National leprosy elimination goal was set
program are Sasakawa Memorial 1995 Focal persons (TLAs) appointed for districts & regions
Health Foundation, The Nippon
Foundation, Netherlands Leprosy
Relief, The Leprosy Mission,
International Nepal Fellowship and
Nepal Leprosy Trust.
Leprosy Control Division, the guiding body for leprosy control activity in Nepal, functions in close
coordination with the Regional Health Directorate, District Health System, donor agencies and all the
supporting partners. Regional Health Directorate (RHD) supervises and monitors the program in all
districts within the region. Disease control activities including leprosy control activities are headedby
respective officer as appointed by Regional Director in RHD. Regional Tuberculosis and Leprosy
Officer/Assistant (RTLO) is the focal person of leprosy in RHD. In addition, District TB & Leprosy
Officer/Assistant (DTLO), implement the program in respective district.
MDT service is being delivered through all the public health facilities (Primary Health Centres, Health
Posts and Sub Health Posts) in Nepal. Majority of health care providers serving at community based
health facilities have undergone Comprehensive Leprosy Training (CLT) and are effectively providing
MDT service. In addition more than 90 percent Female Community Health Volunteers (FCHVs) have
received orientation on leprosy and are suspecting and referring cases to the nearest HF for
confirmation of diagnosis and treatment. Capacity building is a key intervention area and is
conducted with support from the WHO and INGOs mentioned above. In addition to capacity building
INGO supported referral centres also provide primary, secondary and tertiary level care to leprosy
patients.
Vision
To usher in a leprosy free society where there are no new leprosy cases and all the needs of existing
leprosy affected persons having been fully met.
Mission
To provide accessible and acceptable cost effective quality leprosy services including rehabilitation
and continue to provide such services as long as and wherever needed.
Goal
Reduce further the burden of leprosy and to break channel of transmission of leprosy from person to
persons by providing quality service to all affected community.
Objectives
• To eliminate leprosy (Prevalence Rate below 1 per 10,000 population) and further reduce
disease burden at district level;
• To reduce disability due to leprosy;
• To reduce stigma in the community against leprosy; and
• Provide high quality service for all persons affected by leprosy.
Strategies
• Early case detection and prompt treatment of cases.
• Enable all general health facilities to diagnose and treat leprosy.
• Ensure high MDT treatment completion rate.
• Prevent and limit disability by early diagnosis and correct treatment.
• Reducing stigma through information, education, and advocacy by achieving community
empowerment through partnership with media and community.
• Sustain quality of leprosy service in the integrated set up.
Targets
• Reduce NCDR by 25 percent at national level by the end of 2015 in comparison to 2010.
• Reduce PR by 35 percent at national level by the end of 2015 in comparison to 2010.
• Reduce by 35 percent GII disability amongst newly detected cases per 100,000 population by
the end of 2015 in comparison to 2010.
• Additional deformity during treatment <5 percent by EHF score.
• 80 percent health workers are able to recognize and manage /refer reaction/complications.
• Promote POD and Self care.

Current status:

HIV/AIDS AND STI

History of Nepal’s response against HIV/AIDS begun with the launching of first National AIDS
Prevention and Control Program in 1988. In 1995, a National HIV/AIDS Policy with 12 key policy
statements and supportive structures like National AIDS Coordination Committee (NACC) and
District AIDS coordination Committee to guide and coordinate the response at central and district
level was endorsed. As directed by the
National HIV/AIDS Policy, a multi‐sector Box 4.7.1: Milestones in Response to HIV/AIDS
National AIDS Coordinating Committee 1988 Launched the first National AIDS Prevention
(NACC) chaired by the Minister of Health, and Control Program (short term)
1990‐1992 First Medium Term Plan
with representation from different 1993‐1997 Second Medium Term Plan
ministries, civil society, and private 1993 National Policy on Blood safety
sector was established at centre to build 1995 National Policy on HIV/AIDS
the coordination mechanism to support 1997‐2001 Strategic Plan for HIV/AIDS Prevention
and monitor the activities implemented 2000 Situation Analysis of HIV/AIDS‐Nepal
through NCASC. Similarly, DACC was 2002‐2006 National HIV/AIDS Strategic Plan
established to coordinate and monitor 2003‐2007 National HIV/AIDS Operational Plan
the activities at district level. 2006‐2011 National HIV/AIDS Strategic Plan
In 2002 a National AIDS Council (NAC) 2008‐2011 National HIV/AIDS Action Plan
was established, chaired by the Prime 2007 National HIV/AIDS and STD Control Board
Minister, to raise the profile of HIV/AIDS. established
The NAC was intended to set overall 2008 National HIV/AIDS Action Plan
policy, lead high level advocacy, and 2010 New National Policy on HIV/AIDS
provide overall guidance and direction to 2011‐2016 New National HIV/AIDS Strategic Plan
the national response to AIDS in Nepal.
The latest national policy on HIV and AIDS (2010) have envisioned a more concrete policy framework
for making AIDS free society with the overall policy aim of reducing impact of HIV among people by
reducing new HIV infections.
Recently Nepal has expressed its high level political commitment to Political Declaration on
HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS June 2011. The 2011 declaration builds on
two previous political declarations: the 2001 Declaration of Commitment on HIV/AIDS and the 2006
Political Declaration on HIV/AIDS. At UNGASS, in 2001, Member States unanimously adopted the
Declaration of Commitment on HIV/AIDS. This declaration reflected global consensus on a
comprehensive framework to achieve Millennium Development Goal Six‐: halting and beginning to
reverse the HIV epidemic by 2015.
Thus, to ensure the effective response to the HIV epidemic in Nepal and so to fulfil the accountability
of the response, Nepal has already implemented three rounds national HIV/AIDS strategic plan. The
recent National HIV/AIDS Strategy 2011‐2016 has laid a concrete road map in planning,
programming and reviewing of the national response to the epidemic.

National HIV/AIDS Strategy (2011‐2016)

Vision
Nepal will become a place where new HIV
infection are rare and when they do occur, every
person will have access to high quality, life
extending care without any form of
discrimination.
Goal
To achieve universal access to HIV prevention,
treatment, care and support.
Objectives
• Reduce new HIV infections by 50 percent by 2016, compared to 2010;
• Reduce HIV‐related deaths by 25 percent by 2016 (compared with a 2010 baseline) through
universal access on treatment and care services; and
• Reduce new HIV infections in children by 90 percent by 2016 (compared with a 2010 baseline)
The National HIV/AIDS Strategy is a national guiding document and a road map for the next five
years for all sectors, institutions and partners involved in the response to HIV and AIDS in Nepal to
meet the national goal; to achieve universal access to HIV prevention, treatment, care and support
with two major programmatic objectives (i) reduce new HIV infections by 50 percent, and (ii) reduce
HIV related deaths by 25 percent, by 2016. The strategy delineates the central role of the health
sector and the essential roles the other sectors play, in response to the HIV epidemic.
The current national HIV/AIDS Strategy,
therefore, builds on two critical program
strategies: (i) HIV prevention, and (ii) treatment
care and support of infected and affected. To
ensure the achievements of program outcomes,
cross‐cutting strategies are devised to supports (i)
creating enabling environment: health system
strengthening, legal reform and human rights and
community system strengthening (ii) strategic
information (HIV and STI surveillance, program
monitoring and evaluation and research).

Building on the achievements, lessons and experiences of the past five years, the strategy (2011‐
2016) will focus on the following key points:
• Addressing the all dimensions of continuum of care from prevention to treatment care and
support
• Effective coverage of quality interventions based on the epidemic situation and geographical
prioritization
• Health system and community system strengthening
• Integration of HIV services into public health system in a balanced way to meet the specific
needs of target populations
• Strong accountability framework with robust HIV surveillance, program monitoring and
evaluation to reflect the results into NHSP‐II and National Plan.

Strategy components
1: Prevention
2: Treatment, Care & Support
3: Advocacy, Policy & Legal reform
4: Leadership & Management
5: Strategic Information
6: Finance & Resource mobilization
expansion and scaling up of the programs for safe migration and mobility; STIs, VCT, PMTCT
services, prevention among health care delivery settings, workplace programs etc.

Six key programs areas and strategic outcomes have been identified within the strategy as follows:
1.2.1 Prevention
improved knowledge and safe behavioral practices of all target groups (safer sex and injecting
practices),
increased availability and access to appropriate and differentiated prevention services,
increased acceptance of HIV/AIDS and enhance non-discriminatory practices affecting
marginalized and most at risk populations,
Reduced risk and vulnerability to HIV infection of all target populations.
1.2.2 Treatment care and support
increased national capacity to provide quality diagnostic, treatment and care services,
increased availability of appropriate and differentiated care and support services to infected,
affected and vulnerable populations,
increased involvement of private sectors, civil societies, communities and family for treatment,
care and support to infected, affected and vulnerable groups,
increased importance of the role of support groups of infected, affected and vulnerable people
in treatment, care and support,
established and monitored continuum of prevention to treatment, care and support,
standardized clinical care, ART, Oise and PEP services both in the public and the private
sectors,
Impact mitigation strategies and programs in place, adequately resourced and accessed equitably
by the infected, affected and vulnerable groups.
1.2.3 Advocacy, policy and legal reform
HIV/AIDS prioritized as national development agenda and included in 11th Five Year Plan as
program under the social sector,
rights of infected, affected and vulnerable groups insured through an effective legislative
framework,
networks of PLHA and most at risk populations operational,
HIV/AIDS response decentralized and coordinated,
Multi-sectoral response to HIV/AIDS strengthened and expanded.
1.2.4 Leadership and management
operationalized national strategy through the National Action Plan,
active champions and leaders at the societal, institutional and individual levels for the
HIV/AIDS response,
mainstreamed HIV/AIDS programs in all development sectors,
enhanced social inclusion, equitable access and gender equality to AIDS services,
co-ordinated and decentralized response to HIV/AIDS.
1.2.5 Strategic information
trends and changes in HIV prevalence and HIV and STI related risk behaviours among different
risk groups tracked over time and across regions in Nepal;
effectiveness of HIV prevention and care interventions and activities monitored and evaluated;
all aspects of key programme service delivery areas effectively monitored and evaluated;
programme coverage and service delivery assessed by target group;
DoHS, Annual Report 2066/67 (2009/2010) (page 191)
resources inputs and outputs contributing to the programme monitored.
1.2.6 Finance and resource mobilisation
100% of funding mobilized for the implementation of the multi-year National Action Plan from
the Government, development partners, NGOs and private sector organizations,
by 2009, government investment in AIDS activities be at least 5% of the total HIV/AIDS
program budget, and by 2011, at least 10%,
appropriate multi-sectoral resource allocation under the relevant line ministries,
an efficient and coordinated financial management system,
timely and improved resource flow,
improved accountability at all levels.