The burden of Non-Communicable Diseases (NCDs) has been burgeoning, particularly in Low- and Middle-Income Countries (LMICs), yet policy responses remain inadequate. There is limited evidence about how NCD policies were formulated and evaluated in Nepal. This study used Kingdon’s Multiple Streams Framework (MSF) to explore how the NCD policy was formulated in Nepal and used the Package of Essential Non-communicable (PEN) diseases intervention framework to evaluate the implementation process of the PEN programme. A qualitative approach was applied, using semi-structured interviews with key stakeholders (n=44) from all government levels and three districts (Jumla, Bardiya, Kapilvastu), alongside policy documents, reports, and peer-reviewed literature. Data was analysed using a framework analysis approach. The rising burden of NCDs was gradually recognised and put on the policy agenda through key indicators and advocacy from national and international stakeholders. Adoption of PEN was informed by evidence synthesis, World Health Organisation (WHO) recommendations, global trends, and experiences from other countries. During the decision-making process, policymakers encountered various challenges, such as unfinished existing health agendas, commitments mainly focused on communicable diseases, the chronic nature of NCD donor influence, and financial constraints. Coordinated efforts made by a wide range of stakeholders, particularly the WHO, brought the problem, policy, and politics streams together, leading to the formulation of NCD policies in Nepal. Despite successful policy formulation, the implementation of PEN was inconsistent. Variations were observed across the three districts- partial implementation was found in Jumla and Bardiya, while no implementation occurred in Kapilvastu. Despite positive perception and motivation, PEN delivery was severely constrained by weak health infrastructure, inadequate training opportunities, and financial constraints. These findings underscore that successful policy formulation alone is not sufficient. For NCD policies to achieve intended health outcomes, providing an enabling environment, including a strengthened health system, capacity building of human resources, and sustainable financial support mechanisms, is essential.
| Date of Award | 5 Feb 2026 |
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| Original language | English |
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| Supervisor | Padam Simkhada (Main Supervisor) & Susan Jones (Co-Supervisor) |
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