Integration of NCD Screening, Management and Care Continuity Through Primary Health Care Using PEN Programme in Nepal: Assessing Practices and Hurdles



Start Data collection started but due to Lockdown, it has been halt for certain period


Jan-Dec 2021


NRs.60,00,000.00


On the collaboration with the WHO and DH-KUMS( Dhulikhel hospital)


The study will be conducted in 31 PEN implemented districts by the fiscal year 2076/77. This includes all the provinces.


In Nepal, the PEN Implementation Plan (2016–2020) was developed in line with the Multisectoral Action Plan for prevention and control of NCDs (2014-2020) .  Epidemiology and Disease Control division (EDCD) under Department of Health Services is responsible for the implementation of PEN starting with the new Institutional structure of MOHP and has endorsed WHO Pen package (Protocol 1, 2, 3 and 4) in Nepalese context for management of CVD, diabetes, COPD and cancer. It has 4 protocols: Prevention of heart attack, stroke and kidney disease through integrated management of diabetes and hypertension; Health education and counseling on healthy behavior; Management of chronic respiratory diseases; and Assessment and referral of women with suspected cancer (breast, cervical).With the aim of increasing accessibility for Universal Health Coverage (UHC), PEN was piloted in two districts in October, 2016 [34]. The program was then extended to 14 other districts in 2017 and 2018 [31].The Government of Nepal aims to expand and scale up PEN throughout the national health system, reaching all 77 districts. However, initial reviews suggested inadequate human resource capacity to implement, monitor, and evaluate it. The current PEN implementation has not been systematically evaluated. Currently, no empirical information is available to rate the status of the program nor the factors affecting its success or failures.

This gap in knowledge is an impediment towards the achievement of NCD targets related to Sustainable Development Goal 3. Taking cognizance of the current scenario, the study will be undertaken to improve the capacity for NCD care using innovative ways. It will be one of the first studies in Nepal to systematically observe and report upon the implementation of Nepal. The study will empower program leaders in systematic monitoring and evaluation of PEN using routine IHMIS data to improve PEN delivery at the point of intervention. In addition, the study will generate vital evidence on facilitators and barriers to PEN implementation from both supply and demand perspective in the process of implementation of PEN in the selected districts. The findings obtained from the study will be very useful for the successful implementation of the PEN package in remaining districts.


  • To examine the preparedness of health facilities in delivering the PEN services in terms of supplies, logistics, information and other administrative functions.
  • To evaluate the integration of PEN protocol in screening, early diagnosis and management of NCD patients.
  • To assess the acceptability, adoption, feasibility, fidelity, penetration, sustainability, and cost of PEN implementation using Proctor’s framework
  • To assess care provision and practice adoptions for patient services. (reminder and recall, responsive referrals, team coordination among health workers)
  • To identify facilitators and barriers to the PEN implementation at the health system and community level.

The study will measure the implementation outcomes of the PEN program and estimate its marginal cost at the primary health care level, to inform the scale up of PEN at the provincial and national levels. The information on facilitators and barriers to implementing the PEN package from the health system and client’s perspective will be instrumental to guide the improvement in the current PEN delivery and strategies to further scale up at national level.