| Autor: |
Koirala B; Tribhuvan University, Institute of Medicine, Department of Cardiothoracic and Vascular Surgery,Maharajgunj, Kathmandu. and Kathmandu Institute of Child Health, Budhanilkantha, Kathmandu., Adhikari SR; Tribhuvan University Faculty of Humanities and Social Sciences, Central Department of Economics, Kritipur, Kathmandu., Shrestha A; Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre., Vaidya A; Kathmandu Medical College and Teaching Hospital, Department of Community Medicine, Sinamangal, Kathmandu., Aryal KK; Bergen Center for Ethics and Priority Setting in Health, Department of Global Public Health and Primary Care, University of Bergen., Kalaunee SP; Nyaya Health Nepal, Tripureshwor, Kathmandu., Shrestha A; Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre., Mishra SR; Nepal Development Society, Chitwan, Nepal., Sharma SK; B.P. Koirala Institute of Health Sciences, Dharan., Karki A; School of Health, Medical and Applied Sciences, Central Queensland University., Maharjan B; Kathmandu Institute of Child Health, Budhanilkantha, Kathmandu., Singh S; Kathmandu Institute of Child Health, Budhanilkantha, Kathmandu., Schwarz D; Brigham and Women's Hospital, Division of Global Health Equity; Harvard Medical School, Department of Medicine., Gupta N; Center for Integration Science, Brigham and Women's Hospital; Program in Global NCDs and Social Change, Harvard Medical School; NCD Synergies Project, Partners In Health; NCDI Poverty Network, Boston, USA., Bukhman G; Center for Integration Science, Brigham and Women's Hospital; Program in Global NCDs and Social Change, Harvard Medical School; NCD Synergies Project, Partners In Health; NCDI Poverty Network, Boston, USA., Karmacharya BM; Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre. |
| Abstrakt: |
We aimed to assess the burden of NCDIs across socioeconomic groups, their economic impact, existing health service readiness and availability, current policy frameworks and national investment, and planned programmatic initiatives in Nepal through a comprehensive literature review. Secondary data from Global Burden of Disease estimates from GBD 2015 and National Living Standard Survey 2011 were used to estimate the burden of NCDI and present the relationship of NCDI burden with socioeconomic status. The Commission used these data to define priority NCDI conditions and recommend potential cost-effective, poverty-averting, and equity-promoting health system interventions. NCDIs disproportionately affect the health and well-being of poorer populations in Nepal and cause significant impoverishment. The Commission found a high diversity of NCDIs in Nepal, with approximately 60% of the morbidity and mortality caused by NCDIs without primary quantified behavioral or metabolic risk factors, and nearly half of all NCDI-related DALYs occurring in Nepalese younger than 40 years. The Commission prioritized an expanded set of twenty-five NCDI conditions and recommended introduction or scale-up of twenty-three evidence-based health sector interventions. Implementation of these interventions would avert an estimated 9680 premature deaths per annum by 2030 and would cost approximately $8.76 per capita. The Commission modelled potential financing mechanisms, including increased excise taxation on tobacco, alcohol, and sugar-sweetened beverages, which would provide significant revenue for NCDI-related expenditures. Overall, the Commission's conclusions are expected to be a valuable contribution to equitable NCDI planning in Nepal and similar resource-constrained settings globally. |
