Dissemination of Findings and Recommendations of Joint External Monitoring Mission(JEMM) of Nepal National Tuberculosis Program
Joint External Monitoring Mission (JEMM) is conducted every five years to assess the impact of the National Tuberculosis (TB) Control Programme on the TB epidemic in the country; evaluate progress of the national strategic plans; and provide clear, strategic, prioritized recommendations. The last JEMM for Nepal was conducted in 2013.
To meet the milestones of End TB Strategy and address issues of TB control in Nepal, it will require implementing bold policies that guarantee access to high-quality TB care and prevention to all who need it. This is also part of Universal Health Care agenda which Nepal is pursuing with dedication.
Nepal has successfully established a nationwide National TB Programme (NTP) headed by the National Tuberculosis Centre (NTC) and has notified and treated more than 32,000 cases annually for the last 10 years. The NTP has delivered nation-wide comprehensive services for management of drug sensitive TB patients and recently has rolled out a life-saving care system for multi-drug resistant TB (MDR-TB) cases. Effective collaboration with the National Centre for AIDS and STD Control (NCASC) has ensured that most TB patients receive HIV screening, and now, 94% of HIV-infected TB patients receive anti-retroviral treatment (ART).
NTP has introduced modern rapid diagnostic technology (GeneXpert), new TB drugs and new regimens for treatment of MDR-TB, an electronic reporting system now in 46 districts, started a collaboration with the private sector to ensure proper management of patients attending there, and begun a programme to find and treat children with TB. Treatment success had been maintained over 90% over last many years which is excellent.
As Nepal is transitioning towards federalization, there are opportunities that can be addressed and harnessed to ensure that quality TB services are essential part of border health service delivery agenda. Nepal will need to address persistent health system issues and significantly increase investments in TB from both the domestic and external funding sources to meet the End TB Targets.
Despite consistent programme efforts, the case notification is static around 32,000 for past the 5 years, and 13,000 cases are missed each year.
Sustainability of essential TB functions in the federal context is a huge challenge if stakeholders fail to invest in human and financial resources on time.
There is a need to hugely expand the newer diagnostic tools of TB. People who are diagnosed are not always reported and followed up until end of the treatment. Patients spend huge amount of money in diagnosis and treatment, and lose wages while they are sick. Hence, this disease can drive families to poverty.
Together with all the other UN member states, Nepal has committed to end TB by 2035 at the regional and global high-level forum, and undertook to follow the WHO End TB Strategy.
Nepal will accelerate TB response and increase investment in TB and reach the End TB targets by 2035.
Major high level Recommendations
- Stop the collapse of the NTP by addressing the impact of health system weakness and federalization.
- The MoHP and partners must significantly increase it’s investment in TB control and fully fund the NSP, 2016-2021.
- To fill the training gap, the MoHP and partners must develop a fully-funded training plan, to be implemented with the aid of the staff.
- The NTP should ensure that all presumptive cases are tested with GeneXpert. Sputum smear diagnostic should be phased out.
- The NTP should be open to collaboration with essential stakeholders.
Improving TB services will not only cure people from TB but will be able to generate economy for the country and reduce poverty. TB has one of the highest return on investments, and as per economists, every dollar invested in TB has USD 43 in return. Hence, it is very much worth investing in TB.
TB is the 7th leading cause of death in Nepal, and causes nearly 5,000 – 9,000 deaths every year.
Males are reported nearly 1.6 times more than female of developing TB and children accounts for 6% of the cases.
- 123 new TB cases are reported. Additionally, 27 % (i.e 34 TB cases) which also develops TB, is missed to be reported into the program. They are either not diagnosed, or not reported even if diagnosed.
- 18 deaths are attributed to TB.
- 34 new cases develop.
Despite the challenges, once diagnosed, the success rates of TB treatment through the program is more than 90%.
Most of the cases being reported are from Terai region (around 57%) among eco terrain, and from Province 3 (nearly 1/4 of cases) among all provinces.
For more information, please contact: National Tuberculosis Centre