Health promotion in Nepalese context

Health promotion in Nepalese context
Increasing health awareness and developing positive attitudes and behavior towards healthier living is still a crucial need of the people to cope an alarming health problem like communicable and non-communicable diseases, which are still the leading causes of morbidity and mortality of the people. Emerging diseases such as Japanese Encephalitis, Viral Hepatitis and STD including HIV/AIDS pose increasing threats to the health and well being of the people of the country. Tobacco use, excess use of alcohol, inadequate physical activity, obesity, improper food habit and polluted environment has significant role in increasing burden of communicable and non-communicable diseases in the nation. Similarly, mental health, oral health, hearing impairment, blindness, cardiovascular diseases, diabetes, hypertension, malignancies and problems of elderly are the health issues that need to be addressed effectively by controlling and reducing risk factors and other as necessary.

Nepal is facing several public health problems such as communicable diseases like malaria, kala-azar, tuberculosis, leprosy, encephalitis, meningitis, diarrheas and acute respiratory infections, vaccine preventable diseases, nutritional deficiency problem like malnutrition, Vitamin A deficiency, Iodine deficiency, Anemia, dewormin, poor environmental conditions and high population growth. The health programs related to curative, preventive, promotive and rehabilitative services are regarded to have Health Education, Information and Communication (HEIC) as a core component to bring a desired change in health behavior of the people of Nepal.

The national health education, information and communication centre (NHEICC) is responsible for IEC activities for health promotion. The centre develops and produces various IEC and advocacy materials for the target audience that include people and communities in general, vulnerable population, patients and health system managers and personnel. Messages and materials are disseminated using electronic and print media, health institutions, schools, community groups etc. As a result of the IEC interventions over the years, people’s health awareness has increased, as reflected in higher coverage of immunization and increased demand for health care services. Health education corners have been established in more than 38 districts hospitals and health centre, in which video set including health related VHS cassettes have been provided by the NHEICC. The observance of World Health Day, World No Tobacco Day and other events by the centre has its own impact in terms of sensitization and commitment. However, promotive and preventive health care is yet to be adequately integrated into the mainstream of health services. The people in general, lack of knowledge and awareness about priority health problems, emerging diseases and the importance of their role and healthy practices that contribute significantly to health promotion and protection. Integrated approach involving communities, schools, health facilities and other institutions/organizations is presently lacking.

The organizational wide expectation for this biennium is that capacity for governance, stewardship, planning and implementation of multisectoral health promotion policies and programmes strengthened at country and regional levels, based on gender sensitive approaches to promoting health and well-being throughout and the regional expectation is to National comprehensive health promotion policies and strategies developed and implemented. Office specific result WHO support to integrated health promotion interventions through a network of communities, schools and health institutions. Office specific expected result, product for network mechanism developed, linking selected communities, schools and health facilities for undertaking health promotion activities at individual, family, community and institutional levels. Plan of action mainly focus on health promotion integrated approach and collaborative manner for the set up of the modalities of selected village development committees with coordination sectoral ministries, partners, health institutions, schools, different committees members, communities and family members for effective health massage for preventive , promotive and curative aspect for knowledge, attitude and practices for their areas.

Support for developing integrated approach to health promotion in coordination with other partner through the existing technical committees under the Chairmanship of Director General, Department of Health Services to look the key health issues such as reproductive health, child health, communicable diseases, non-communicable diseases and other main health issues to plan and implement IEC and BCC activities in an integrated and participative manner towards health promotion. Support on baseline survey and advocacy meeting to develop action plan in two VDCs/and schools about knowledge, awareness and practices. It was taken two VDCs (300 household in each VDCs) of Lalitpur districts. Organized advocacy meeting to discuss about the major health issues of the selected community to share the knowledge of IEC/BCC activities and to match need based IEC/BCC activities and to increase awareness among selected community people (300 person) regarding major health issues and the ways to prevent. Support to development, production and dissemination of IEC materials to raise awareness among general public about the causes, ways of prevention and control of major health problems and to ensure positive change in their health behaviors and improve the health status of general public by facilitating them to make right decisions about their health. Organize to celebration of parents’ day conducted in two VDCs of Lalitpur district to highlight the importance of health promotion at the family level .Parents, students and school teachers have major role and responsibility in promoting health at family as well as community level. Celebration of 2006 and 2007, World Health Day is an annual event of WHO through out the country with different programmes. Every year slogan and theme on the aspect of health related message.

Technical back up from the Regional Office, Director, NMH Visited for interaction and implementation status of the programmes. Visit of Director, NMH,SEARO is quite useful for his feedback regarding further planning and implementation of the health promotion and other related areas. Participation with national focal point of Regional Consultation on Regional Strategy for health Promotion for South-East Asia, Chiang Mai, Thailand on 26-29 June 2006. On that workshop sharing experiences by countries and organizations review of the Regional strategy for health promotion. After discussion recommendations on health promotion needs to be managed as well as sustained by involving various partners, allocation of resources and gathering evidence of the effectiveness at all levels.

Main Issues and Challenges:
Lack of knowledge and awareness about priority of health problems on communicable and non communicable diseases, tobacco control activities, disability, injury prevention and role of their healthy practices for health promotion.
Lack of proper approach, using of IEC materials and equipments at all levels.
Inadequate proper trained manpower at all levels to give the proper health promotion message
Inadequate awareness program and active community participation
Inadequate appropriate multi-media campaign and relevant advocacy materials for IEC/BCC.
Security, political instability and restriction movement of relevant staff for the community level activities for the implementation of planned activities in time
Technical input and coordination with other partners but implementation part with concerning programme manager and their staff in the field level for quality of the programme.
Lack of proper coordination among relevant sectoral ministries and partners
Inadequate supervision, monitoring and evaluation of the programmes for further planning and implementation.