"Before this training, I thought telling patients to 'take a puff' was enough," says Bhawani Pokhrel, a frontline health worker from Namobuddha Municipality. "Now, I know how to check every step and help patients receive the full benefit of their medicine."
For many people living with chronic respiratory diseases (CRDs) such as chronic obstructive pulmonary disease (COPD) and asthma, access to diagnosis and treatment alone is not enough. Effective disease management also depends on health workers who having the knowledge and skills to provide quality care, including guiding patients on correct inhaler techniques, supporting treatment adherence and empowering patients to manage their condition.
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A WHO personnel demonstrates the correct use of a metered-dose inhaler during a training in Dhulikhel, Nepal, in July 2026. Photo credit: WHO Nepal/Sujan Govinda Amatya
Recognizing this need, the Epidemiology and Disease Control Division (EDCD) of the Department of Health Services under the Ministry of Health and Food Safety has recently launched a capacity-building initiative in Kavrepalanchok District, Bagmati Province. Supported by the Bloomberg Foundation through WHO, the initiative is currently being implemented in four municipalities to strengthen people-centered CRD care at the primary health care level.
Addressing a major public health challenge
Chronic respiratory diseases are a leading cause of illness and death in Nepal. In 2019, they accounted for approximately 16% of all deaths, making them the country's second leading cause of mortality after cardiovascular diseases. COPD is also the leading cause of hospital admissions among noncommunicable diseases (NCDs).
Despite the availability of effective interventions, many people living with CRDs continue to face significant barriers to care. Delayed diagnosis, limited access to essential medicines and inhalers, and shortages of primary care providers trained in respiratory management often result in avoidable complications, repeated hospitalizations, and increased out-of-pocket health spending. Strengthening the capacity of frontline health workers is therefore a critical step toward closing these gaps.
Building skills for better respiratory care
To enable integration of CRD services into primary health care, EDCD, in collaboration with provincial, district and local governments, conducted an intensive two-week training programme in Kavrepalanchok from June to July. Nearly 200 frontline health workers from 63 health facilities across four municipalities participated, including medical officers, auxiliary health workers, auxiliary nurse midwives, staff nurses and municipal health managers.
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Facilitators from WHO and Dhulikhel Hospital supervise practical sessions during a capacity-building training in Dhulikhel, Nepal, in July 2026. Photo credit: WHO Nepal/Sujan Govinda Amatya
Rather than treating respiratory illness in isolation, the training integrated CRD care into existing services for hypertension and diabetes, reflecting Nepal’s broader approach to integrated NCD management. Participants received practical instruction on early detection, standardized clinical management and the correct use of inhalers, nebulizers and pulse oximeters. They also enhanced their counselling skills to improve treatment adherence, support smoking cessation and reduce exposure to household air pollution.
"Earlier, I assumed patients already knew how to use inhalers," says Santosh Sah, a health worker from Roshi Municipality. "Now I will always make sure to check their technique and correct any mistakes."
Extending care beyond the health facility
Beyond strengthening clinical skills, the training provided an opportunity for participants to share the challenges they face in delivering respiratory care within their communities. Participants highlighted the needs of patients with severe respiratory disease who require regular follow-up or home-based care, particularly in remote and hard-to-reach areas.
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Practical sessions held during a capacity-building training programme in Dhulikhel, Nepal, in July 2026. Photo credit: WHO Nepal/Sujan Govinda Amatya
Drawing on these real-life experiences, participants explored practical strategies to extend respiratory care beyond health facilities through home visits, stronger community engagement and more consistent follow-up support. Municipal health officials also emphasized the importance of maintaining a reliable supply of essential respiratory medicines and inhalers to reduce financial barriers for patients and ensure continuity of treatment.
Improving referrals and continuity of care
Alongside building clinical capacity, the initiative is strengthening systems that support continuity of care. Efforts are underway to strengthen case registration, reporting and referral mechanisms so that patients can transfer seamlessly between different levels of the health system. As part of this effort, Dhulikhel Hospital and Methinkot Hospital have committed to establishing clear referral pathways, ensuring patients referred from primary health care facilities can access appropriate secondary and tertiary care when needed.
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Dr Pomawati Thapa, Chief of Noncommunicable Diseases and Mental Health Section at EDCD under Department of Health Services, providing her remarks at a capacity-building programme in Dhulikhel, Bagmati province. Photo credit: WHO Nepal
"Our goal is to make Kavrepalanchok a national demonstration district for comprehensive NCD service delivery through primary health care," says Dr Pomawati Thapa, Chief of the Noncommunicable Diseases and Mental Health Section at EDCD.
To sustain implementation, the District Health Office will coordinate regular progress reviews with municipal health sections.
"We will establish regular coordination with municipal health sections and monitor progress through our monthly meetings," says Ragishree Kakshapati Shrestha, Chief of the Kavrepalanchok District Health Office.
Additionally, officials from the MoHFS, Provincial Health Directorates, Dhulikhel Hospital and WHO Nepal will conduct joint supportive supervision and mentorship visits to strengthen clinical practice and support the delivery of quality respiratory care.
The initiative is part of ongoing efforts to integrate chronic respiratory disease services into primary health care and expand access to quality NCD services across all municipalities in Kavrepalanchok.