# Lessons Learned from the Design and Implementation of the Tuberculosis Free Nepal Initiative

## TL;DR

Nepal's Tuberculosis Free Initiative improved TB control through local committees, community engagement, and innovative case-finding methods.

## Contribution

The paper presents a novel approach to tuberculosis control through decentralized ownership, real-time monitoring, and community-led initiatives in Nepal.

## Key findings

- 112 END TUBERCULOSIS Committees and over 1,000 ward-level committees were formed to support tuberculosis microplanning.
- Innovative case-finding methods identified over 2,500 tuberculosis cases in 2023 through sputum courier systems and community screening.
- Community participation was strengthened through mobilizing patient support groups, youth groups, and civil society organizations.

## Abstract

Nepal has a persistently high burden of tuberculosis. Despite implementation of multiple interventions by the National tuberculosis Program, Nepal is not on track to achieve many of WHO's End tuberculosis Strategy targets.

The National tuberculosis Control Centre developed a Google Sheet with key indicators to monitor the tuberculosis -Free Initiative across municipalities. Focal points recorded real-time data, ensuring transparency. National tuberculosis Control Centre compiled, analyzed, and interpreted the data to track progress, evaluate program outcomes, and support future planning.

The tuberculosis-Free Initiative achieved significant results in implementing municipalities. A total of 112 END TUBERCULOSIS Committees were formed at the municipal level, with over 1,000 ward-level committees engaged in tuberculosis microplanning. More than 56% of municipalities mobilized community-led monitoring groups, and 16 municipalities conducted annual social audits. tuberculosis-Free Volunteers facilitated screening in 53 municipalities. In 2023, innovative case-finding methods contributed significantly. The sputum courier system identified 1,790 Pulmonary bacteriologically confirmed tuberculosis cases, 554 cases were diagnosed via screening camps and door-to-door visits, and 222 cases through Primary healthcare centre Outreach Clinics. Additionally, 23 patient support groups, 32 youth groups, and 32 civil society organizations were mobilized, strengthening community participation. These efforts highlight the tuberculosis-Free Initiative's impact on enhancing case detection, community engagement, and tuberculosis control strategies.

Developing local level ownership and accountability in the national tuberculosis response, ensuring high quality implementation through robust monitoring and evaluation, and generating and sustaining local resources, requires strong government leadership, advocacy, and capacity building. Within the implementing teams by the stakeholders, frequent initiative reviews, coaching, and mentoring support.