PAL in Nepal

In Nepal, initially Practical Approach to Lung Health (PAL-Nepal) was a multi-organization collaborative research project. Funding of research activities is secured through a grant by the Netherlands Foundation for the Advancement of Tropical Research (WOTRO), applied for on behalf of all partners by Erasmus University of Rotterdam (EUR).

WHO was responsible for the global PAL and co-ordinated between Nepalese and international PAL-Nepal partners.

In 2001, Practical Approach to Lung Health (PAL) was initiated as pilot study in Nawalparasi district of Nepal. NTC was responsible for pilot implementation of PAL-Nepal.

In 2004, WHO Tobacco Free Initiative (TFI) and WHO Stop TB (STB) have initiated a collaboration to integrate tuberculosis (TB) and tobacco control activities within the district health system. 

WHO (TFI & STB) has developed a document on the integration of TB and tobacco control activities into PHC services using the PAL.

In May 2007, WHO-HQ, WHO- SEARO visited Nepal and the Govt. of Nepal agreed to launch PAL pilot projects in two districts of Nepal (Bhaktapur and Nawalparasi).

WHO STP recruited and started working in Nepal since mid July 2007.

      Work-plan was prepared (Annex-1) and the National Working Group (Annex-2) for PAL implementation was formed by NTP (National Tuberculosis Program), Nepal.

      The sensitization meeting held on 24 Aug as per work plan and a total of 62 participants attended.

Activities completed so far:

The activities are as follows:

      Formation of the National Working Group (NWG)

      Finalization, adaptation of PAL guidelines and training materials including smoking cessation materials and registers

      TOT and Training of Health Workers of the Out Patient’s Department of NTC, Bhaktapur and Nawalparasi hospitals and all PHC centers of these two districts

      Training of Health Workers of all Health posts of Bhaktapur and Nawalparasi districts

      Implementation of PAL and smoking cessation activities

      Supervision and monitoring

      TOT on PAL was conducted from 20-22 Sep 2007 (17 participants trained). Most of the participants attended were involved during PAL guide discussion and training materials adaptation.

      The District training for health workers of OPD of NTC, Bhaktapur and Nawalparasi hospitals and  that of all the PHC centers (Bhaktapur and Nawalparasi districts) was conducted in two phases from 23-27 Sept (21 participants) and 11-15 Oct (34 participants).

      Training of health post workers – Bhaktapur 16-20 Nov and Nawalparasi 28 Nov -2 Dec 2007.

      Peak Flow meter for OPD, PHC center and health posts purchased and distributed.

      PAL reporting form (Annex-3), OPD register (Annex-4) and Anti-smoking register (Annex-5) distributed to health facilities.

      Implementation started at OPD and PHC centers from 3rd week of November.

      Training for HP staff of Bhaktapur (16-20 Nov 2007, 18 participants and 12-16 Dec 2007, 21 participants) and Nawalparasi (28 Nov-2 Dec 2007, 17 participants) completed.

      Peak flow meter and registers also distributed to all health posts in 2nd week of Dec.

      Health posts started implementation of PAL from 1st week of Dec 2007.

Supervision and Monitoring

      Monitoring and supportive supervision started from the 3rd  week of Dec (It was proposed to keep smoking cessation registers in DOTS center separately only to record smoking cessation practice for TB patients.

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