Introduction

Background

NCDs have emerged as the biggest health challenge accounting almost two third of global morbidity and mortality most of which occur in low- and middle-income countries including Nepal. Cardiovascular Diseases, Cancer, Diabetes and Chronic Obstructive Pulmonary Disease (COPD) top the list and accounts for 82% NCDs deaths. The burden of NCDs is rising every day and is responsible for over 60% deaths in Nepal. The Government of Nepal, in line with the UN declaration 2011 is committed to reduce the prevalence of NCDs and premature deaths in Nepal.

Nepal is a developing country with a population of 29.9 million in 2021. Along with demographic and epidemiologic transition, and social and economic growth, Nepal is facing a triple burden of disease i.e., communicable diseases, non-communicable diseases and injuries. There has been significant increase in the morbidity and mortality in Nepal due to NCDs and injuries form the past two decades whereas morbidity and mortality due to communicable disease has been declined. The most prevalent NCDs in Nepal are cardiovascular diseases (CVDs), chronic pulmonary diseases, diabetes mellitus, and cancer and mental health disorders and injuries.

The prevalence of NCDs is negatively affecting the Nepal’s economy and making the people especially the poor, vulnerable to catastrophic health expenditure in addition to lifelong morbidity and increased mortality. The health insurance coverage of Nepal is also extremely low, raising the out-of-pocket (OOP) expenditure burden on the country.

NCDs in Nepal

Nepal has experienced a marked epidemiological transition from communicable diseases to NCDs in the past two decades.

1. Cardiovascular Disease

In 2017, CVDs contributed to 26·9% of total deaths and 12·8% of total DALYs in Nepal. CVDs is the seventh most common ailment, accounting for 40% of NCD cases admitted to non-specialty tertiary hospitals. Ischemic heart disease was the most common CVD, accounting for 16·4% of total deaths and 7·5% of total DALYs. National level data on CVDs, including incidence of myocardial infarction and stroke, are not available. High systolic blood pressure, high low density lipoprotein cholesterol, smoking, air pollution, a diet low in whole grains, and a diet low in fruit were identified as the major risk factors for CVDs.

2. Cancer

The Global Cancer Observatory 2018 estimated the age-standardized cancer incidence and mortality rates to be 103.7/100,000 and 77.8/100,000, respectively, in Nepal.The most common cancers were the breast, lung, cervical, stomach and oral cavity cancers. Mortality is high in low- and middle-income countries (LMICs) like Nepal and associated with poor prognosis, which is due to lack of awareness, delayed diagnosis, inequity on health accessibility, and affordability as compared to high-income countries. In Nepal, major risk factors include tobacco (smoking and smokeless), betel quid, areca nut, indoor and outdoor air pollution, alcohol, viral infections like Hepatitis B, Hepatitis C, HIV and Human Papilloma Virus, Helicobacter pylori, and other dietary habits.

3. Chronic Pulmonary Diseases

COPD is also one of the commonest forms of non-communicable diseases (NCDs) among the Nepalese adult population accounting for 43% of NCDs among out-patient visits. In Nepal, the age-standardized prevalence rate of COPD was 4,810 per 100,000 in 2016. A recent study by the Nepal Health Research Council reported 11.7% prevalence of COPD in Nepal.

4. Diabetes

In Nepal, a recent systematic review reported the prevalence of prediabetes and diabetes was 9.2% and 8.5%, respectively. Among the participants with diabetes, only 52.7% were aware of their diabetes status, and 45.3% were taking anti diabetic medications. In 2017, nearly 10,145 deaths were attributed to diabetes, which was also ranked as the 11th most common cause of DALYs.

5. Mental disorders

According to a recent mental health survey, 10% of the adults in Nepal have experienced some form of mental disorder in their lifetime, and 4.3% currently had mental disorder with 6.5% having current suicidal thoughts. Apart from lack of information, the key concerns in Nepal include a dearth of mental health care, with most services centered in urban areas, and a scarcity of dedicated medical and nursing specialists to mental health.

6. Injuries including road traffic accidents and disaster

Nepalese people are at risk of avoidable injury at home, at work and on the roads in addition to natural disasters (earthquakes, landslides and monsoon flooding). In 2017, GBD reported 16,831 injuries related deaths in Nepal (age-standardised mortality rate 70.3 per 100,000)l.[18] In addition, transport injuries were responsible for 4.11% of all deaths in Nepal. The main reasons for Nepal’s high injury burden are reported to be rapid urbanization, infrastructure development, an increasing number of vehicles, a lack of road safety and natural catastrophes.

Nepal NCD Alliance (NNCDA)

Various organizations and likeminded individuals working in the field of NCDs in Nepal came together as a loose network in 2013, and henceforth, Nepal NCDA was established in March 12, 2013 (29.11.2069 BS). The founding NNCDA committee included representatives from Nepal Heart Foundation, Nepal Diabetic Society, RECPHEC, Nepal Cancer Relief Society and freelancer health journalists. Later on it was joined by Nepal Hypertension Society, BPK Memorial Cancer hospital, Nepal health Journalist Forum, Yoga and Naturopathy centre and others. Although the NNCDA was in the form of a loose network it participated actively in several NCD related national and international forums. NNCDA represented twice in the Global NCD Forum which was organised in Sarjah, UAE.

NNCDA actively participated in policy advocacy related to control of alcohol, industrial trans-fat, tobacco products, state financing for treatment of major NCDs, Package for intervention of NCD risk factors, Rheumatic heart disease prevention and others.

After 9 years of operation, NNCDA has been officially registered in the Company Registrar office of the Government of Nepal in 22 February 2022 (10.11.2078 BS ) as a not for profit company. It is also affiliated to the Nepal Social Welfare Council. NNCDA is an active member of the SEAR NCD Alliance and a full member of the global NCD Alliance.

NNCDA aims to conduct public health program, training, research activities for NCDs prevention and control, and to support government policies and programs. Its ultimate aim is to reduce the burden of NCDs in Nepal and support the people living with NCDs. NNCDA is directed by its constitution, annual general meetings and an elected board, in order to create synergies and to plan strategies.

Vision

A healthy society empowered and inspired to work towards prevention and control of NCDs.

Mission

To unite and strengthen civil society to collaborate in the prevention and control of NCDs

Goal

To reduce premature deaths due to NCDs and improve the quality of life of people in Nepal

Our goal is aligned with Target 3.4 of SDG 3 which is: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment, and promote mental health and well-being.

Strategic Objectives

To achieve our goal, NNCDA has envisioned the following six strategic objectives for action, all of which are interconnected:

Objective 1: To develop and implement advocacy strategies to drive the government, decision makers and other stakeholders to fulfill their commitment on the prevention and control of NCDs

Objective 2: To ensure accountability for commitments, resources, and results in the prevention and control of NCDs

Objective 3: To strengthen the capacity of members and develop Nepal NCD Alliance as a lead organization

Objective 4: To conduct preventive activities including public awareness and organize trainings for the prevention of NCDs

Objective 5: To generate and promote evidence and best practice in NCD advocacy, policy, and practice, and facilitate knowledge translation and implementation

Objective 6: To provide support to people living with NCDs

Membership

Nepal NCD Alliance welcomes individuals and organizations working in the field of NCDs and also people living with NCDs to join as member and get actively involved in the programs and activities of the NNCDA. The organization offers the following four category of membership:

General member: Entry fee – NRs 500. Membership needs renewal yearly.
Life member: One time entry fee – NRs 2000
Distinguished member: One time entry fee – NRs 10000
Organizational member: One time entry fee – NRs 10000

NB: Membership fee is changeable and is subject to the decision of the executive committee. Membership form can be downloaded from the NNCDA website-www.ncdalliance.org.np