This document discusses current policies, strategies and programs for the prevention, protection and control of chronic obstructive pulmonary disease (COPD) in Nepal. It finds that COPD is a major cause of death and hospitalization. Key risk factors include tobacco use, indoor air pollution from solid fuels, and outdoor air pollution. National policies aim to control tobacco, promote smokeless stoves, and reduce vehicular emissions. The WHO's MPOWER strategies and PEN package are implemented. Opportunities exist in multisectoral coordination, but stronger tobacco control and monitoring of air pollution are still needed.

1. Current Policies, Strategies and
Programs of Preventive
Protective and Control Measures
of COPD
Prepared by:-
Deepak Pandey
MPH(PHSM) 2nd Semester
Nobel college
Sinamangal Kathmandu

2. Introduction
 Non-communicable diseases (NCDs) are emerging as the
leading cause of death globally and also in the South East Asia
region due to many social determinants like unhealthy
lifestyles, globalization, trade and marketing, demographic
and economic transitions, leading to behavioral and metabolic
risk factors.
 Cardiovascular diseases (CVD), Chronic non-infectious
respiratory diseases (like COPD), Cancers and Diabetes
Mellitus are referred as essential non-communicable disease
with well established common modifiable risk factors.
 Chronic obstructive pulmonary disease (COPD) is a lung
disease characterized by chronic obstruction of lung airflow
that interferes with normal breathing and is not fully
reversible.

3. Background
 Respiratory diseases (including COPD and asthma)
accounted for about 7 % of a country NCD burden.
 COPD in Kathmandu valley has increased by more
than 70%. COPD was the eighth common cause for
OPD visits and the seventh common cause for
hospitalization.
 The highest mortality and morbidity among the
hospitalized patient in Bir hospital was from COPD in
FY 2062/2063, and is still the leading cause of
mortality in Bir hospital but in morbidity head injury
has exceeded it .

4. Death due to NCD at SEAR in 2008
Source WHO multisectoral action plan 2014-2020

5. NCD morbidity in Nepal
38.7
21.9
7.1 7
2
All NCD CVD COPD Cancer Diabeties
Source Nepal NCD burden WHO/WB

6. Mortality due to NCD in Nepal
43.7
22.4
7
4.9
1.7
All NCDs CVD Cancer COPD Diabetes
Source Nepal NCD burden WHO/WB

7. Risk factor for COPD
Tobacco use
Unhealthy diet
Alcohol consumption
Adverse environmental condition
- Indoor air pollution
- Outdoor air pollution

8. Risk factors of COPD contd….
Tobacco use
The STEPS survey 2013, show that 18.5% of
the Nepalese population are current smokers
and 15.8% people smoke daily
Smoking is more prevalent among males while
still 10.3% of the females are smokers
STEPS survey 2013 also reveal that 36.1% of
population is exposed to second smoke either
at home or at work place.

9. Air pollution
According to Census 2011 Report, 74% of
households depend upon solid biofuels for
domestic uses.
An analysis of the records of 369 Chronic
Obstructive Pulmonary Disease (COPD) patients
and 315 control patients admitted to Patan
Hospital from April 1992 to April 1994 showed
that the odds of having COPD are 1.96 times
higher for Kathmandu Valley residents compared
to outside valley residents.
Risk factors of COPD contd….

10. Air pollution contd….
Besides indoor air pollution, affect of air pollution
from the vehicular and industrial emissions are
also a concern as air pollution are increasing in
fast urbanizing cities such as Kathmandu.
The STEPS survey 2013 revealed that 15.1 % of
the population was exposed to combined 3-5 risk
factors.
This indicates that the burden of NCD will worsen
as risk factors take root in the society as people
live in urban environment and ageing starts.

11. Policies related to COPD
• National health policy 2071
• National health policy 2075 (first draft)
• Sustainable development goal 2017-2030
• Multisectoral action plan for the prevention
and control of NCD (2014-2020)

12. National health policy 2071
Rule 7.3 :- Create healthy lifestyle and healthy
environment for healthy lives
Strategies
• Control of tobacco and alcohol production and
supply
• Promotion of smokeless stoves, focus in
alternate energy with the coordination of local
level

14. National health policy 2075 (draft)
 develop integrated health services and make
responsible individual, family and society for
prevention and control of non communicable disease
Strategies
 Implementation of health promotion activities from all
level of health facility
 Multisectoral approach for control of alcohol and
tobacco abuse
 All measures adopt to minimize the environmental
pollution by coordination between different
stakeholders ( Development of cycle lane, Develop
park)

16. Sustainable Development Goal
By 2030, reduce by one third premature
mortality from non-communicable diseases
through prevention, treatment and promote
mental health and well-being
Strengthen the prevention and treatment of
substance abuse, including narcotic drug
abuse and harmful use of alcohol
Strengthen the implementation of the World
Health Organization Framework Convention
on Tobacco Control in all countries, as
appropriate

17. Multisectoral action plan of NCD
Targets
1. 25% relative reduction in overall mortality from
cardiovascular diseases, cancers, diabetes, or chronic
respiratory diseases
2. 10% relative reduction in the harmful use of alcohol
3. 30% relative reduction in prevalence of current
tobacco use in persons aged over 15 years
4. 50% relative reduction in the proportion of
households using solid fuels as the primary source of
cooking
5. 80% availability of affordable basic technologies and
essential medicines, including generics, required to
treat major NCDs in both public and private facilities

18. Multisectoral action plan of NCD
Strategic policies
1. High political commitment: 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
2. Multisectoral response: 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

19. Strategic policies contd….
3. Tobacco: Strengthening enforcement and
compliance to Tobacco product (control and
regulatory) Act, 2011 and improving public
awareness to hazards of tobacco use
4. Alcohol: Reducing commercial and public
availability of alcohol and implementing social
mobilizing programs to reduce harmful use of
alcohol
5. Unhealthy diet: Encouraging increased
consumption of fruits and vegetables, reducing
consumption of salt, saturated fat and trans fat
6. Physical inactivity: Improving built environment
and promoting health beneficial physical activity
through supportive policies in key setting

20. Strategic policies contd….
7. Indoor air pollution: 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
8. Essential NCDs (CVDs, COPDs, diabetes and cancer):
Strengthening health system competence, particularly the
primary health care system to address common essential NCDs
particularly CVDs, COPDs, diabetes and cancer, along with the
additional NCDs and empowering communities and individuals
for self-care
9. Oral health: Improving access to essential oral health services
through community oriented oral health focusing on
preventable oral diseases and oral care

21. Strategic policies contd….
10.Mental health: Improving basic minimum
care of mental health services at the
community and improving competency for
case identification and initiating referral at
primary care level
11.Surveillance, research, monitoring and
evaluation: Strengthening systematic data
collection on NCDs and their risk factors’
situation, program implementation and using
this information for evidence-based policy
and programme development

22. WHO strategies for the prevention and control
of COPD
Raise awareness about the global epidemic of
chronic diseases;
Create more healthy environments, especially for
poor and disadvantaged populations;
Decrease common chronic disease risk factors,
such as tobacco use, unhealthy diet and physical
inactivity;
Prevent premature deaths and avoidable
disabilities from major chronic diseases.

23. NHEICC activities for COPD
Standardize, regulate and update non-
communicable disease risk factors related health
promotion, education, and communication
initiatives.
Develop, produce and disseminate messages,
materials and tools.
Collaborate with state and non-state partners to
maximize and expand programme outreach.
Implement MPOWER and health promotion
interventions including the Package of Essential
Non-communicable diseases (PEN)

24. MPOWER program
MPOWER is a policy package intended to assist in
the country-level implementation of effective
interventions to reduce the demand for tobacco, as
ratified by WHO framework convention on tobacco
control The six evidence-based components of
MPOWER are:
• Monitor tobacco use and prevention policies
• Protect people from tobacco smoke
• Offer help to quit tobacco use
• Warn about the dangers of tobacco
• Enforce bans on tobacco advertising, promotion
and sponsorship
• Raise taxes on tobacco

25. PEN package programme
 The WHO Package of Essential Non communicable
Disease Interventions (WHO PEN) for primary care in
low- resource settings is an innovative and action-
oriented response
 It is a prioritized set of cost-effective interventions that
can be delivered to an acceptable quality of care, even
in resource- poor settings.
 It will reinforce health system strengthening by
contributing to the building blocks of the health
system.
 Cost effectiveness of the selected interventions will
help to make limited resources go further and the user-
friendly nature of the tools that are been developed,
will empower primary care physicians as well as allied
health workers to contribute to NCD care.

26. PEN package programme contd….
It should not be considered as yet another
package of basic services but, rather, an
important first step for integration of NCD into
PHC and for reforms that need to cut across the
established boundaries of the building blocks of
national health systems.
WHO PEN is the minimum standard for NCDs to
strengthen national capacity to integrate and
scale up care of heart disease, stroke,
cardiovascular risk, diabetes, cancer, asthma and
chronic obstructive pulmonary disease in primary
health care and health post in low-resource
settings.

27. SWOT analysis
Strength
Prohibition of smoking in public places eg
buses, film hall etc.
Promotion of smokeless stoves to minimize
indoor air pollution
Promotion of electrical vehicle to reduce air
pollution

28. Weakness
No sufficient programme for prevention and
control of COPD
PEN package programme is not expanded to
all districts
No provision of smoking zone people freely
smoking at small hotels and other public
places

29. Opportunity
Multisectoral coordination for control of
indoor and outdoor air pollution
Strong government channel to implement the
health programme
Donors are interested to provide help for the
implementation of prevention and control of
COPD programme
Promotion of electrical vehicle by government

30. Threats
Tobacco control policy is not implemented
effectively
Prevalence of smoking habit is high in
adolescent group
Too much dust particles due to construction of
roads and buildings
Government cannot monitor effectively to
tobacco production industries

31. Thank you