Publication: Lessons Learned from the Design and Implementation of the Tuberculosis Free Nepal Initiative
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Nepal Medical Association
Abstract
Abstract
Introduction: Nepal has a persistently high burden of tuberculosis. Despite implementation of multiple interventions by the National tuberculosis Program, Nepal is not on track to achieve many of WHO’s End tuberculosis Strategy targets.
Method: The National tuberculosis Control Centre developed a Google Sheet with key indicators to monitor the tuberculosis -Free Initiative across municipalities. Focal points recorded real-time data, ensuring transparency. National tuberculosis Control Centre compiled, analyzed, and interpreted the data to track progress, evaluate program outcomes, and support future planning.
Results: The tuberculosis-Free Initiative achieved significant results in implementing municipalities. A total of 112 END TUBERCULOSIS Committees were formed at the municipal level, with over 1,000 ward-level committees engaged in tuberculosis microplanning. More than 56% of municipalities mobilized community-led monitoring
groups, and 16 municipalities conducted annual social audits. tuberculosis-Free Volunteers facilitated screening in 53 municipalities. In 2023, innovative case-finding methods contributed significantly. The sputum courier system identified 1,790 Pulmonary bacteriologically confirmed tuberculosis cases, 554 cases were diagnosed via screening
camps and door-to-door visits, and 222 cases through Primary healthcare centre Outreach Clinics. Additionally, 23 patient support groups, 32 youth groups, and 32 civil society organizations were mobilized, strengthening community participation. These efforts highlight the tuberculosis-Free Initiative’s impact on enhancing case detection, community engagement, and tuberculosis control strategies.
Conclusion: Developing local level ownership and accountability in the national tuberculosis response, ensuring high quality implementation through robust monitoring and evaluation, and generating and sustaining local resources, requires strong government leadership, advocacy, and capacity building. Within the implementing teams by the stakeholders, frequent initiative reviews, coaching, and mentoring support.
Description
Prajowl Shrestha
National Tuberculosis Control Centre, Naya Thimi, Bhaktapur, Nepal
Gokul Mishra
Freelancer- Nayathimi, Bhaktapur, Nepal
Mukti Nath Khanal
National Tuberculosis Control Centre, Naya Thimi, Bhaktapur, Nepal
Naveen Prakash Shah
National Tuberculosis Control Centre, Naya Thimi, Bhaktapur, Nepal
Deepak Dahal
Freelancer- Kausaltar, Bhaktapur, Nepal
Barsha Thapa
World Health Organization, Pulchowk, Lalitpur, Nepal
Lok Raj Joshi
Save the Children International, Nepal
Namita Ghimire
Nepal Health Research Council, Ramshahpath, Kathmandu
Tom Wingfield
Departments of Clinical Sciences and International Public Health, Liverpool School of Tropical Medicine, Pembroke Place Liverpool L3 5QA UK; WHO Collaborating Centre in TB and Social Medicine, Karolinksa Institutet, Sweden, Norrbackagatan 4, 171 76; Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L7 8YE, UK