Tuberculosis (TB) poses a significant public health challenge in Nepal, ranking among the top 10 causes of death and imposing a substantial social and economic burden. The disease claims approximately 17,000 lives each year.
Nepal has set the goal to end TB epidemic by 2035. To assess the progress of the national TB program, the National Tuberculosis Control Center (NTCC), under the Ministry of Health and Population (MoHP), with support from WHO, has conducted the latest TB Programme Review Mission in 2023.
Review conducted in Kalimati Chest Hospital, Bagmati Province. Photo credit: WHO Nepal
The review team, comprising both national and international experts NTCC, WHO, provincial and local health authorities, and all key stakeholders conducted field visits to all 7 provinces from 9 to 21 April.
Reviewers conducting an interview with a cured drug-resistant tuberculosis patient in Sudurpashchim Province. Photo Credit: NTCC
The main objective of the joint review mission was to evaluate and make an in-depth analysis of the program progress in relation to the current TB-NSP; identify the programmatic gaps, challenges, and constraints; and gain insights into the drivers of the programmatic achievements to define clear, feasible, and contextual strategic recommendations.
The review team conducting an interview with a healthcare worker at Mahakali Provincial Hospital, Kanchanpur, Sudurpashchim Province. Photo Credit: NTCC
During the mission, several key areas were examined, including the implementation of the TB Free Initiative at the local level, public-private mixed approaches for TB interventions, community engagement strategies, active case finding activities, TB laboratory network and capacity, existing interventions for drug-resistant (DR) TB, childhood TB diagnosis, TB preventive treatment, multisectoral engagement and social protection, procurement supply chain management, TB information system, program governance, leadership, management, and financing.
Recognizing the importance of a multisectoral approach in combating TB and to attain a more comprehensive understanding on the issues, consultations were held with other high-level stakeholders beyond the health sector, such as the Ministry of Labour, Employment and Social Security; Ministry of Industry, Commerce and Supplies; Ministry of Education, Science and Technology; National Planning Commission; Health Insurance Board; and International Organization for Migration.
Reviewers at a tuberculosis treatment center in Pokhara, Gandaki Province. Photo Credit: RIT/JATA
Following the field visits and a thorough review, the team presented their findings, highlighting achievements, gaps, and significant recommendations at a debriefing meeting held on 21 April in Kathmandu. Officials from the MoHP, WHO, Save The Children, TB implementing partners, and representatives from other ministries attended the meeting.
The key recommendations emphasized the need for better and sustained leadership, enhanced efforts to find all TB patients and finding them early, increased financial investment, patient-centered approaches to treatment and care, engagement of sectors beyond health in TB efforts, and collaboration with provincial and local government to identify and address human resource needs. The findings will also aid in developing a proposal for a new funding grant to be submitted to the Global Fund.
The experts now have developed a detailed report with recommendations for the national TB program.
“Considering Nepal's inclusion among the 30 countries with a high burden of DR TB globally, the timing of the review was particularly fitting. I urge all stakeholders to keep collaborating and commit to implementing the shared recommendations to strengthen the TB program and to improve the quality of care for TB patients,” said Dr Naveen Prakash Shah, Acting Director, NTCC.
Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal, providing his opening remarks at the debriefing program. Photo credit: WHO Nepal
“I am confident this comprehensive report will serve as a roadmap for Nepal's efforts and contribute to setting priorities to strengthen the public health responses to end TB epidemic in the country,” said Dr. Rajesh Sambhajirao Pandav, WHO Representative to Nepal. “Together, we can make a significant impact and work towards a Nepal free from the burden of TB.”