Category: Webinar

22^nd Webinar Summary Report on Rural Health Care in Nepal: Nov 1, 2022

Summary:

Brief Background:

The master of the ceremony – Dr. Khima Khatri Thapa- started the webinar proceedings by introducing the speaker, Dr. Bikash Gauchan, and the moderator, Dr. Sakar Khanal.

Dr. Gauchan has been currently working as Executive Director in the Infectious and Communicable Disease Hospital (ICDH) in Gandaki Province. He completed his MBBS and MD (GP & EM) from B.P. Koirala Institute of Health Sciences (Dharan, Nepal). He has also completed his Global Health Fellowship on Health, Equity, Action & Leadership from the University of California San Francisco (UCSF), Global Health Delivery Intensive (GHDI) Course from Harvard University, MPH (online) Specialization (Health System Management) from the University of Liverpool, UK and Effective Writing for Health Care (EWHC) (Specialization: Grant Writing): Post Graduate Medical Education (PGME) from Harvard Medical School (HMS) Harvard University. Dr. Gauchan also worked as a Medical Director and Director of Medical Education at Bayalpata Hospital, Achham, Nepal. He has won Jyoti & Ramnikh Parekh award. He was WONCA’s (World Organization of Family Doctors) featured doctor for the months of February & March 2015. He also received Taiwan Family Medicine Research (TFMR) award in 2016. He was felicitated by Achham JAYCEES & Honorable Former Deputy Prime Minister & Former Minister of Home & Defense. Furthermore, he also received the HEALTHCARE LEADERSHIP AWARD at the 15^th World Rural Health Conference, 26^th-29^th April 2018, in New Delhi, India. He won WONCA Rural South Asia (WoRSA) Leadership award. He has more than 25 peer-reviewed scientific publications.

Dr. Khanal, the moderator of the session, recently graduated in MD Community Medicine from BPKIHS Dharan, Nepal.

Dr. Gauchan started the presentation by briefing about the Infectious and Communicable Disease Hospital (ICDH) in Gandaki Province and Bayalpata Hospital, Achham, Nepal. He highlighted the common challenges that are faced in Rural Health Care in Nepal. Finally, Dr. Gauchan addressed the areas that can be improved and policies that can be formulated to bring a positive change in health facilities in Rural Nepal.

The webinar lasted for 1hr and 44 minutes, and at the end of the webinar session, on behalf of the Nepalese Society of Community Medicine (NESCOM) a certificate of appreciation was presented to Dr. Gauchan. Around 60 participants were present during the webinar. The webinar ended with the concluding remarks by Dr. Khima Khatri Thapa (MC for the program) along with the announcement of the upcoming webinar on “Status of Vaccine-Preventable Disease in South Asia and Feasibility of Elimination of MR” on 15^th November 2022.

Objectives of the Webinar:

1. To understand the status of Rural Health Care in Nepal.

2. To identify the current practices in Rural Health Care in Nepal.

3. To assess the common challenges that are faced in Rural Health Care in Nepal.

4. To discuss the opportunities for Rural Health Care in Nepal.

Key Points Discussed during the webinar:

1. According to World Bank 2021, 79% of people live in rural Nepal and 50% live in rural areas worldwide.
2. Infectious and Communicable Disease Hospital (ICDH): It is situated in Gandaki province near Begnas lake. Formerly it was known as Lekhnath Samudayik Lions Hospital. Later it was established into ICDH (50 bedded) in collaboration with local donations and Gandaki Provincial government in 2077 post-COVID pandemic. During the COVID-19 pandemic, this hospital provided various services like OPD, IPD, lab services, COVID-19 vaccination, Intensive Care Unit (ICU), High Dependency Unit (HDU) services as well as emergency services. The major achievements of the hospital during FY 2078/79 are:

• Large number of COVID – 19 cases managed
• Vaccination Campaign for the control of COVID – 19
• Installation of Transformer (500 KVA) & 3 Phase Line
• Non-COVID-19 Clinical Care
• Established Patient Satisfaction Survey
• Modern Electricity System
• Continuing Medical Education (CME) & Online Database
• Pediatric Beds, Bubble Continuous positive airway machine (CPAP), and Radiant Warmers
• Training Site of IP & Health Care Waste Management (HCWM) Training of Trainers (ToT)
• Electronic Medical Records (EMR), Water Source
• PSC for admitted & discharged COVID – 19 cases
• Stock of PPEs, Masks, Gloves, and Face Shields
• Oxygen Concentrators, Oxygen Cylinders and Oxygen Plant

The major challenges of the hospital were the contract system of the employee, lack of consultant doctors and infrastructures, and long-term management system. The major areas for improvement include the availability of adequate medical staff, Biomedical technicians, IT & Computer Experts, and adequate Space for the Radiology Department to provide CT scan & MRI services. The hospital should be expanded and become the referral Provincial Hospital for Gandaki province. Clinical Skills Course training like ICU, HDU, Infection Prevention & Control, IP & HCWM ToT, and CTS should be conducted. Health Insurance should be effectively implemented to ensure Universal Health Coverage (UHC) and Special Professional Growth of Health Administration and Health Accounting systems.

1. Bayalpata Hospital: It was Established in 2066 BS. The main motto of this hospital is ‘Affordable & Accessible High-Quality Community Based Healthcare for All’. It follows Integrated Health Care Model. Electronic Health Record (EHR) is available in this hospital (Patient care, follow-up, government reporting, impact evaluation, and research and quality improvement). Services provided by the hospital include major and minor surgeries, ANC Deliveries, and Health Insurance Reimbursements.
2. Current Practices in Rural Health Care in Nepal: There is significant progress in the last 2 decades but still there are many challenges. There is a lack of competency (skill) based training, a lack of connection with communities, lack of monitoring and evaluation systems. Furthermore, there is incomplete organization and management and a broken referral network.
3. The common challenges are as follows:

• Retention of HRH
• CPD of Health Care Professionals
• Lack of Research and related activities
• Isolation
• Lack of Mentoring & Professional Support
• Budget Limitations
• Public Procurement Act & Regulation (Quality)

1. The Opportunities for Rural Health Care in Nepal are:

• Reformation of the Health System which needs to include the Astana Declaration 2018
• Implementation Research
• Comprehensive Collaboration of Diversified Health Care Workers in Nepal
• Reduction of Health Care Costs
• Strengthen Primary Health Care in Nepal
• Focus on Building Blocks
• Integration with Communities & Strengthen Referral Networks
• New Course on Rural Medicine in Nepal

Points for the Policy Brief:

The government of Nepal should implement the health insurance program more effectively and reach the rural populations as well. The government should also work on the health system strengthening such as budget allocation, adequate infrastructure, equipment, and human resources.

Points to be Discussed in Executive Committee:

Role of the Nepalese society of Community Medicine (NESCOM) in organizing interactive sessions for a better understanding of rural health in Nepal and how it can be improved.

Conclusion:

The health system should be reformed according to Astana Declaration 2018. There should be a comprehensive collaboration of diversified healthcare workers in Nepal. Strengthen Primary Health Care as well as referral networks should be strengthened. The concept of Rural Medicine should be made clear. Furthermore, health insurance program should be effectively implemented and reach rural areas. Implementation Research (IR) and Hospital and community -based research should be conducted. Continuous Quality Improvement Projects (CQI) should be carried out by the government.

 

 

Brief Background:

The master of ceremony Dr. Animesh Kunwar started the proceedings of the webinar by introducing the speaker Dr. Sudhir Khanal and the moderator Dr. Bedana Pokhrel.

Dr. Sudhir Khanal is a public health physician with more than twenty years of work experience at global level. At present he is positioned as Technical Officer for Measles at the WHO Regional Office for South East Asia. He is coordinating and collaborating with Global and Regional partners and Ministries of health of eleven countries in WHO SEARO to develop national strategy and action plan for elimination of Measles and Rubella through health system strengthening.

Dr. Bedana Pokhrel, the moderator of the program is a recent graduate of Community Medicine from BPKIHS. She completed Master Training of Trainers (MTOT) for international classification of diseases 11^th revision, the global standard for diagnostic health information held at BPKIHS. She has actively participated as a resource person in the training course in service provider training on PACKAGE OF ESSENTIAL NON-COMMUNICABLE DISEASE (PEN) conducted at BPKIHS, Dharan, and also on-site training at Gaighat, Udaypur.

Dr. Sudhir Khanal started his presentation with describing the vaccine preventable diseases and the need for vaccination. He highlighted the status of vaccine preventable disease in South Asia, the set backs that the region suffered from the pandemic, the graphical representations of eleven countries positioning from their target and the feasibility of elimination of MR and the key challenges that we need to overcome.

The webinar lasted for 1 hour and 32 mins. On behalf of the Nepalese Society of Community Medicine (NESCOM), a certificate of appreciation was presented following the insightful presentation by Dr. Sudhir Khanal. The webinar ended with the concluding remarks by Dr. Prajjwal Pyakurel along with the announcement that the upcoming NESCOM webinar series which will now be supervised by Dr. Surya Parajuli.

Objectives of the webinar:

1. To understand the status of vaccine preventable disease in South Asia
2. To impart knowledge of the plans implemented by SEAR countries in meeting the target
3. To know the feasibility of elimination of Measles and Rubella
4. To address the key challenges that we face in thus context.

Key points discussed during the webinar:

1. Vaccination is the most cost-effective public health intervention after hand-washing. For every 1 USD invested in measles vaccination there is a return of 76.5 USD. It is estimated that vaccines will help keep an estimated 24 million people from falling into poverty by 2030. Immunization will have positive impact to 14 of 17 SDGs. The Global Immunization Program guided by Immunization Agenda 2030 envisions a world where everyone, everywhere, at every age fully benefits from vaccines for good health and well-being.
2. Immunization Agenda 2030 has been adapted to the region as regional vaccine action plan 2030 with three impact goals. Goals include pursuing vaccine preventable disease elimination and control goals (achieving measles and rubella elimination, sustaining polio-free status, maintaining MNT elimination, achieving hepatitis B control in 11 South East Asia countries namely Bangladesh, Bhutan, DPR Korea, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand and Timor-Leste), reducing overall mortality and morbidity from vaccine preventable diseases for all across the life course and leaving no one behind by increasing equitable access and use of new and existing vaccines. There are 7 strategic priorities and 33 key areas of focus.
3. DTP3 coverage is the precursor of the immunization program and the strength of past immunization program was measured with DTP3 coverage which is given at first year of infancy. We are gradually moving to MCV2 which is given at second year. All time high DTP3 coverage was achieved in 2019 by SEA region which surpassed the Global coverage.
4. Surveillance for priority Vaccine Preventable Diseases in SEAR includes Polio, Measles, Congenital Rubella Syndrome, Neonatal tetanus, Diptheria, Pertusis, Japanese Encephalitis, Rotavirus, Invasive Bacterial Disease and Typhoid. Non-measles and non-rubella discarded rates is viewed as an indicator of sensitivity of surveillance.
5. Measles and rubella elimination is a regional flagship priority in the SEA Region.
6. Region certified polio-free status on 27 March 2014 is maintained despite the COVID-19 pandemic.
7. Bangladesh, Bhutan, Nepal, Thailand verified for control of hepatitis B through immunization
8. Maternal and neonatal tetanus elimination has been sustained in the South-East Asia Region since 2016. Countries will need to do post-validation assessment exercise every 3-5 years.
9. Ten out of eleven countries in SEA Region are providing COVID vaccination. DPR Korea is the only country not on the list. Out of 15 emergency use authorized vaccine, 12 vaccines are available in the region. 3.2 billion doses of COVID vaccines have been administered throughout the region where 73.3% received one dose, 66.3% completed primary series and 19.2% received one booster dose. 10 countries achieved 40% completed primary series.
10. Globally regional verification commissions have established measles elimination to be 39% and rubella elimination to be 46%. There has been backsliding like in Mongolia where reestablished transmission of measles happened during the covid pandemic.
11. As of June 2022, an estimated 91% reduction in mortality due to measles has occurred in 2020 in the Region compared with 2003. Two essential criteria and five lines of evidences are needed for verification of measles and rubella elimination in the Region.

The essential criteria includes:

1. Documentation of interruption of endemic measles or rubella transmission, for a period of at least 36 months from the last known endemic case
2. Presence of high-quality, laboratory-supported surveillance system

The Five lines of evidence required for verification of measles/rubella elimination includes:

1. Detailed description of the current and past epidemiology of measles, rubella, CRS
2. Analysis of molecular epidemiology to document viral transmission patterns and the duration of the circulation of viruses of specific lineages
3. Quality of surveillance and monitoring systems for measles, rubella & CRS
4. Population immunity presented as birth cohort analysis, including evidence on adults and underserved, migrant and refugee groups
5. Accountability framework of the programme
6. Seventy second session of the WHO Regional Committee for South-East Asia endorsed SEA/RC72/R3 on “measles and rubella elimination by 2023”. A Regional costed strategic plan covering the period 2020-2024 has been developed which has five key strategic objective areas: Immunization, Surveillance, Laboratory, Outbreak preparedness and response and Linkages
7. Age distribution of confirmed measles and rubella cases shows approximately 90% of cases in children under 15 years of age. Reported cases of measles despite 2 doses of MCV were investigated. It was found that most of them were due to recording errors and other times it was due to vaccine failure.

Policy brief:

1. There is little data on circulating measles genotypes (target is to have genotype information for more than 80% chains of transmissions). Strengthening of virus genetic data need joint efforts of field surveillance and laboratory testing
2. The under-five susceptibility population has reached closer to one full birth cohort in the Region making it vulnerable to imminent outbreak and the utmost need to prepare for that.
3. Outbreak response readiness status in SEAR using ten indicators showed that countries in the region are far away from preparedness and there lies the call for action.

Points to be discussed in the Executive committee:

1. Policy regarding vaccination for older age groups (beyond 2 years) during routine sessions must be implemented
2. Accountability mechanism at subnational level and re prioritization of MR activities post pandemic recovery period
3. Inclusion of non-government sectors
4. MR lab network need to penetrate private sector
5. Molecular epidemiology needed more than ever as of open border that Nepal shares with India

Conclusion:

Measles and Rubella elimination is feasible using the existing tools however the efforts need to be supplemented with sufficient resources and political commitment. Both immunization and surveillance activities have been impacted by the COVID-19 pandemic and has pushed back the progress by at least 5-8 years. There is a need to have in depth review of MR activities and develop tailored mitigation plans at national and subnational level to accelerate progress.

Summary:

Brief Background:

Master of ceremony Dr. Simran Shrestha started the proceedings of the webinar by introducing the speaker Dr. Shambhu Acharya and the moderator Dr. Suman Lohani.

Dr. Acharya is currently working as a director, strategic division, in WHO, Geneva, Switzerland. He has completed Masters of Arts in Sociology, Master of Business Administration in Public Finances and PhD in Public Health. He has more than twenty-five years of experiences in policy and strategy development and analysis, policy dialogue, technical advice and program management support to countries and WHO country offices. He has published several articles on policy analysis, management and health and development in regional and international journals.

Dr. Lohani is a recent MD graduate in Community Medicine and Tropical Diseases from BPKIHS, Dharan. She has actively participated as a resource person to the training course on service provider on PEN. She has completed Master Training of Trainers for International Classification of Diseases.

Dr. Acharya started the presentation by explaining what public health actually deals with. He shared an idea to focus on grabbing the opportunities to build our skills and competencies on the area that are in demand. He stated various opportunities for Public Health professionals both Nationally and Internationally such as NGO’s, INGO’s, bilateral and multilateral agencies.

He also mentioned that on the basis of our skills we can indulge our self on various fields like Maternal and Child Health, Healthy Behavior and Health Promotion, Water and Sanitation, Population and Democracy.

The webinar lasted for one hour and fifteen minutes. On behalf of the NESCOM, a certificate of appreciation was presented following the insightful presentation by Dr. Acharya. Around 100 participants were presented during the webinar. The webinar ended with the concluding remarks by Dr. Surya Bahadur Parajuli along with the announcement of the upcoming NESCOM webinar on “Rural health care in Nepal”.

Objectives:

1. To know opportunities for a public health professional nationally and internationally
2. To know the skills required to become a potential candidate for recognizable position

Key points that came up during discussion:

1. We should focus on how we can build our skills and competencies on the areas of demand
2. Years of experiences in the national level is required to get opportunities at the international level
3. Documentation of the work and building networks for the dissemination of the work is very important. Annual awareness program held globally are another hub for networking and opportunities
4. Hard work with no disappointment after rejection is the key to success
5. Communication skills also plays a significant role specially speaking which should be clear, convincible and understandable

Policy brief:

• Coordination with various national and international agencies to strengthen the network is needed to recognize public health professionals at the global level. Development of the education system focusing in building the practical knowledge and skills is need of an hour and should be focused

Point to be discussed in Executive Committee:

• Role of Nepalese Society of Community Medicine (NESCOM) in providing the opportunities for public health professionals

Conclusion:

There are various opportunities for public health professionals around the world but the only thing is we need to recognize those opportunities, grab it and keep on exploring on the areas of focus to build our skills and competency. There is land of opportunities if we explore socially and through mass media especially updating our knowledge through recent updates from internet rather than sticking only to our books.

 

Summary:

Brief Background:

The webinar proceedings was started by the Master of ceremony Dr. Anjwani Rimal who introduced the speaker Dr. Surya B Parajuli and the moderator Dr. Alisha Manandhar.

Dr. Surya is an Associate Professor of Community Medicine at Birat Medical College Teaching Hospital and also the Vice President of Nepalese Society of Community Medicine (NESCOM). He has contributed to Dengue Research, Prevention, and Control in Eastern Nepal through Dengue Education Campaign (DEC) since last 10 years. He also completed his MD thesis on Dengue during an outbreak in Eastern Nepal in 2013/14 AD.

Dr. Alisha Manandhar, the moderator of the program is a lecturer in the Department of Community Medicine and Public Health at KIST Medical College and teaching hospital. She is an organizing member of the NESCOM webinar and certified in leadership and management in health profession development from the University of Washington.

Dr. Surya started the presentation with a beautiful poem about dengue’s current upsurge. He then talked about the DEC and gave some statistics about the number of infected cases and deaths, and mentioned the high-risk areas of Nepal for Dengue infections. He described the Dengue virus, its vector, and the high-risk patients for Dengue infections. He then described the clinical features of Dengue infection and then elaborately discussed the Dengue prevention strategies and highlighted the reasons for the surge in current Dengue cases. He pointed out the methods of diagnosing Dengue cases, their treatment and ended his presentation by laying importance on the need for Integrated Vector Management and enhanced disease surveillance to control the current upsurge.

At the end of the presentation, interesting zoom poll questions were welcomed focusing on the understanding of the topic which the speaker answered with excellent, clarity and precision.

The webinar lasted for 1 hr. and 20 minutes, and at the end of the webinar session, on behalf NESCOM a certificate of appreciation was presented to Dr. Parajuli. Around 80 participants were present during the webinar. The webinar ended with the concluding remarks by Dr. Anjwani Rimal (MC for the program) along with the announcement of the upcoming webinar on “Opportunities for public health professionals in global health career” on 30^th September 2022.

Objectives:

1. To address the current upsurge of Dengue in Nepal
2. To understand the reasons for rising Dengue cases
3. To know the diagnostic methods for Dengue
4. To understand the management of cases of Dengue

Key points that came up during the discussion:

1. Dengue Education Campaign from 2012 to 2022 is ongoing
2. Number of Dengue-infected cases and deaths in Nepal:
   11 deaths and 11000 infections (2004 – 2022)
3. High-risk areas of Nepal:

Kathmandu, Lalitpur, Makwanpur, Bhaktapur, Rupandehi, Dang, Dhading, Tehrathum, Kavrepalanchok and Chitwan

1. History of Global Scenario, South East Asian Region, and Nepal
2. Introduction to Dengue Virus
3. Information about the vector Aedes including its appearance, life cycle, modes of transmission
4. High-risk patients for Dengue infection:

• Less than 1 year of infants
• More than 60 years of elderly
• Obese, Pregnant, Peptic Ulcer patients
• Thalassemia, Congenital Heart diseases
• Diabetes Mellitus, Hypertension, Cirrhosis of the liver, Chronic Kidney Disease
• Under medications such as Steroids or NSAIDs

1. Clinical features of Dengue infection
2. WHO Dengue case classification
3. Dengue Prevention methods:

• Preventing small and clean water accumulation in containers such as tires, empty cans, flower pots, coolers, and empty drums
• Preventing the entry of mosquitoes into water tanks
• Wearing full sleeves to cover arms
• Mosquito-repellent creams
• Sleeping inside mosquito nets especially for children and chronic disease sufferers
• Nets in windows and doors
• Cleaning the surroundings

1. Is there a vaccine for Dengue?
2. Mosquito breeding places and their association with the risk of Dengue: Highest risk with flower vases with holding plate
3. Reasons for the increase in Dengue cases:

• Unorganized city planning
• Improper waste management
• Human migration to distant places
• Increasing use of plastic products, tires,
• Weather: summer and monsoon, global warming
• Increasing population

1. Methods to identify Dengue cases
2. Treatment of Dengue
3. COMBI (Communication for Behavioral Change Initiative) for Dengue prevention and control in 2009 in 12 high-risk districts in Srilanka
4. Integrated Vector Management
5. Actions to be taken for Dengue Prevention and Control at household, community, and institutional levels
6. Enhanced disease surveillance
7. Types of indices used for larval and pupal sampling

Points for the Policy brief:

Actions for Dengue prevention and control are required more at the household, community, and institutional levels rather than at the policy level because individual measures would help curb the rise in Dengue cases. There is a need for launching a “Dengue search and destroy drive campaign” across the country to prevent future outbreaks

Point to be discussed in the executive committee:

Role of Nepalese society of Community Medicine (NESCOM) in organizing interactive sessions for better understanding of steps for Dengue transmission. prevention and control.

Conclusion:

Dengue infections are currently rising at an alarming rate in Nepal and are becoming a serious Public Health issue, adding a burden to both the healthcare system and individual patients. Without effective preventive strategies, the infection rates can soar by leaps and bounds in the near future such that the healthcare system of Nepal can become overwhelmed with Dengue cases.

 

Brief Background:

The master of the ceremony Dr Poba Zobegow started the proceedings of the webinar by introducing the speaker Dr Prerna Bansal and the moderator, Dr Pallavi Koirala.

Dr Bansal is currently working as an Assistant Professor in the Department of Community Medicine at the College of Medical Science, Bharatpur, Chitwan. After her MD in Community Medicine, she completed a fellowship in diabetes from Medaversity and Apollo Hospital, Educational and Research Foundation, Hyderabad, India. She was a member of the Rapid Response team for COVID-19, Chitwan District, of the Government of Nepal (2020-22), and is a focal person for the GoN, representing COMS since the beginning of the COVID-19 pandemic for implementing prevention and control measures.

Dr Pallavi Koirala, the moderator of the programme is a recent graduate of Community Medicine. She has been actively involved in case investigation and contact tracing (CICT) in COVID-19 from the College of Medical Sciences, Bharatpur. She has had more than 15 health-related articles published in national news media like Republica and Swasthya Khabar Patrika.

Dr Bansal started the presentation by introducing the problem of diabetes both globally and locally. Diabetes has a high disease burden, with diverse social determinants, and is associated with various co-morbidities, requiring a multidisciplinary team for management. Consequently, there can be diverse barriers and challenges associated with the prevention and treatment of diabetes. Beyond the health care system, diabetes care requires contribution from different sectors including the food industry for a holistic care approach to this disease.

Dr Bansal described the need for the prevention of metabolic diseases like diabetes in Nepal, and what those would include. She stated that both high-risk group and population-based approaches are required to tackle this issue in a country like Nepal, using a multi- tired, risk stratification approach, with short and long-term plans. Thus setting the scene, Dr Bansal went on to describe the range of potential community-based interventions to tackle diabetes. Setting goals of integrated team-based care and a population-wide intervention in the pre-pathogenic stage, the incidence of diabetes could be potentially decreased, by utilizing a community-based approach. This was backed by evidence as well, stating so, Dr Prerna then introduced the Community based interventional program on “Diabetes Prevention and Control”, which was ongoing in Bharatpur, Chitwan since Shrawan 2079.

Objectives of the Webinar:

1. To reiterate the need for diabetes because of its increasing incidence and prevalence.

2. To gather evidence-based information about the community-based approach to tackling diabetes at the local level.

3. To know about the ongoing action taken at the local level in terms of prevention and control of diabetes.

4. To generate more areas with such a community-based program available for population-based intervention for metabolic diseases in other parts of the country, as a way of moving forward to managing non-communicable diseases.

Key Points Discussed during the webinar:

1. About 422 million people worldwide have diabetes majority living in low and middle-income countries. (2014).
2. The cases of diabetes are estimated to increase to about 642 million by 2035, with an increasing burden in low and middle-income countries.
3. In 2019, diabetes is the 9^th leading cause of death, with an estimated 1.5 million death attributed to diabetes.
4. In Nepal, the prevalence of Diabetes is about 8.4%, with 50% of people with known diabetes, not under any medication.
5. Prevalence of diabetes steadily rising.
6. Need for multiple avenues of public health action, including the health system, better provisions for health promotion and population-wide policies.
7. Prevention strategies should include both high-risk and population approaches.
8. Considerations to be taken in designing of prevention strategy include:
   1. Prevalence/ burden of diabetes
   2. Prevalence/ burden of undiagnosed diabetes
   3. Current status/ trajectory of environment/ cultural risk
   4. The capacity of the health system to manage diabetes
   5. Potential of communities and insures to support high-risk individuals
   6. Political context/ will for population-wide intervention
   7. A time horizon of public health goals
9. Actions at the Local level, at Bharatpur, Chitwan:
   1. 2015-16 established a diabetes centre
   2. Helping screening and treatment at the community level with the organization of health cams
   3. Raising awareness about diabetes through the diabetes centre.
   4. Since Shrawan, 2079 running a community-based interventional program on Diabetes Prevention and Control in the central part of Nepal, which is a long-term project, under the Department of Community Health Services, a wing of the Department of Community Medicine, College of Medical Sciences, Bharatpur, Chitwan
10. The activities under the community-based intervention program mainly focus on interventions at all levels of prevention within the community.

Its activities include:

• Health promotion, through the use of motivational and educational slogans.
• Health education
• Lifestyle modification
• Behavioural change advocacy
• Community participation: Ties were set up with the Diabetes Society of Chitwan (an independent society), with 800 people around that area and more than 4000 diabetes patients registered in this society. To conduct community programmes and facilitate them.
• Functions as a diabetes screening clinic: At the entrance of the College of Medical Science there is a small clinic (started on 1 Shrawan 2079) which is open from 6 am to 8 am all days of the week and is focused to bring awareness, screening also provides treatment to diabetics.
• Functioning as a Diabetes Care Call Centre: For diabetic patients to communicate and contact if they require any information regarding their disease.

Points for the Policy Brief:

• Similar to the guidelines for diagnosis, screening and treatment set by the American Diabetes Association and the Centers for Disease Control, a guideline should be developed which is feasible for the local context of Nepal.
• A specific diagnostic algorithm should be developed for the management of diabetes in Nepal so that all people can get treatment based on uniform guidelines.
• Adequate budget and resources (manpower and infrastructure) allocation should be present for non-communicable diseases like diabetes.
• Regular capacity-building activities should be organized for health care workers.
• The Local Government should help facilitate community-based health interventions so that the people benefit.

Points to be Discussed in Executive Committee:

The following points should be considered in the forthcoming Executive Committee:

• The capacity building of the residents for providing awareness about Non-communicable diseases like diabetes
• Provision of regular health camps to be organized to screen for non-communicable disesase or heath awareness generating activities by residents
• Regular training regarding health-related policies and regulations should be shared through webinars. This could help the residents to remain updated regarding the policies

Conclusion:

Diabetes demands a multi-tiered strategy to reduce complications, and progression of disease in high-risk individuals, and poses a population-wide risk. The incidence and prevalence of diabetes are steadily on the rise, so effective strategies have to be made. A community-based approach is one strategy which has ample benefits and is sustainable long term, and this approach could benefit to tackle the problem in low and middle-income countries like Nepal.