In June 2005, WHO’s Strategic, Technical and Advisory Group on TB approved the new Stop TB Strategy.. The new Strategy was addressed to deal with challenges and obstacles that slow the progress in achieving TB control goals. The major identified challenges are the widespread accessibility to quality TB care, TB/HIV co-infection epidemic, multi drug-resistant TB, weaknesses of the health systems, involvement of all care providers, engagement of the communities, and the development of new diagnostics, drugs and vaccines. The Practical Approach to Lung health (PAL) is one of the strategies intended to overcome the challenge posed by weak health systems. This initiative is addressed to manage respiratory patients in primary health care (PHC) settings while expanding TB detection and quality TB services.
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PAL focuses on the most prevalent respiratory diseases at first level health facilities such as pneumonia, acute bronchitis and other acute respiratory infections, tuberculosis, and chronic respiratory conditions including chronic bronchitis, asthma and chronic obstructive pulmonary disease (COPD). PAL looks for an integrated case management of respiratory patients in PHC on the basis of two main approaches: standardization of diagnosis and treatment of respiratory conditions, and coordination among health workers of different levels. As reflected in A WHO/The Union Monograph on TB and Tobacco Control – “passive or active exposure to tobacco smoke is significantly associated with tuberculosis infection and tuberculosis disease”. The policy document focused that the smokers among those present or being assessed at PHCs for TB or other respiratory diseases or conditions should be identified and offered counseling and other smoking cessation treatments. The documents also proposed that the integration of tobacco control and respiratory care service in Primary Health Care (PHC) settings can reduce smoking and occurrence of TB among respiratory patients. In Nepal, initially Practical Approach to Lung Health (PAL-Nepal) was piloted as a research project to see the feasibility. WHO was responsible for the global PAL and coordinated between Nepalese and international PAL-Nepal partners. In 2001, Practical Approach to Lung Health (PAL) was initiated as pilot study in Nawalparasi district of Nepal. NTC was responsible for pilot implementation of PAL-Nepal. The study concluded that PHC centers and health Posts could manage the respiratory cases with reduced antibiotic prescription and development of referral.But due to lack of funding the PAL could not be expanded further. In May 2007, the team from WHO-HQ and WHO- SEARO visited Nepal and the Govt. of Nepal agreed to launch PAL pilot project in two districts of Nepal (Bhaktapur and Nawalparasi). In order to implement PAL pilot project in Nepal, WHO-Nepal supported financially and technically. The PAL training for all health workers completed in a phase wise manner. The health workers from OPD of Bhaktapur and Nawalparasi hospitals, NTC and all the PHC centers of these two districts trained at the beginning and implementation started accordingly. The implementation of PAL in all the health posts (HP) of Bhaktapur and Nawalparasi started from Dec 2007.