Strengthening policy and governance to address the growing burden of diabetes in Nepal.

Diabetes poses a major challenge to Nepal's health-care system. Deaths due to noncommunicable diseases (NCDs) have increased from 51% of all deaths in the country in 2010 to 60% in 2014. In 2014, diabetes and other essential NCDs accounted for 46% of the total deaths and 22% of premature deaths in the country. As diabetes is common in adults of working age, the impact will further impoverish individuals and families in Nepal, where out-of-pocket expenditure for health remains high. To halt the rise in diabetes and obesity, the government of Nepal will have to adopt a public health approach that balances individual and population-level interventions. Awareness, early diagnosis and prevention are key to management and control of diabetes. To date, there has been no nationwide robust programme for diabetes prevention in the country and services are inaccessible to much of the Nepalese population. However, under the NCD Multisectoral Action Plan (2014-2020), there will be phase-wise implementation of the World Health Organization Package of Essential Noncommunicable (PEN) disease interventions for primary health care in low-resource settings. The NCD PEN brings opportunities to strengthen the health workforce, diagnostics, medicines and supplies, the health information system, and research and surveillance and to reduce inequity in diabetes care in Nepal.