Despite a lack of national data, studies suggest that there is high burden of CHD, which remains the predominant contributor to CVD mortality. The alarming pervasiveness of CHD is driven by risk factors such as smoking, alcohol, poor nutrition and physical inactivity. These are the areas targeted by the GoN through supportive policies, legislation and enforcement. The CHD epidemic has been further accelerated by an expansive ageing population, widened socio-economic inequality and an increase in rural–urban disparities.4 Historically, socially marginalised groups based on the caste system, referred to as ‘untouchables or Dalits’, had higher clustering of risk factors for CVD when compared with the privileged upper caste in rural Nepal, similar to other south Asian regions.
Community-based interventions mobilising female community health volunteers, peer groups, and influential people to advocate health literacy to empower communities and self-care has been advocated, focusing on those at greater risk. Inadequate healthcare coverage, where 80% of the population relies on an expensive out-of-pocket health model, compromises basic healthcare.5 The coverage plan in Nepal is in its infancy, focusing on subsidised treatment through limited government-owned facilities with interventions targeted at disease treatment.
Although prioritised, the target to expand care coverage has been thwarted by low enrollment and increased dropout rates. GoN provides free heart disease treatment to elderly patients over 75 years. But, in fact, over half of CVD-related Nepalese mortality occurs in those under 70 years. GoN has also provided roughly 850 USD as a one-off financial relief package per person for deprived communities to avail of treatment through its eight allocated centres throughout Nepal.6 The financial relief, however, falls short of the actual cost of primary management of acute coronary syndrome, for example, in government-owned hospitals.
Although accepting the adage that prevention is better than cure, the GoN needs to rapidly enact this principle in order to impact the CHD burden.
Conflicts of interest
FCPS Cardiology Trainee
Binay Kumar Rauniyar
Department of Cardiology, Shahid Gangalal National Heart Center, Nepal
Madan Bhandari Academy of Health Sciences, Hetauda, Nepal
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