Drug-resistant tuberculosis (DR-TB) remains a major public health challenge in Nepal. Each year, the World Health Organization (WHO) estimates around 2400 cases of multidrug-resistant or rifampicin-resistant TB (MDR/RR-TB), placing Nepal among the 30 high DR-TB burden countries globally. In 2024 alone, only 633 of those patients received treatment, leaving many undiagnosed and untreated.
Despite these challenges, Nepal has made notable progress in expanding access to care. DR-TB services are now available through 31 treatment centers, 98 sub-centers and 7 hostels or homes. In 2024, the country introduced WHO-recommended all-oral, shorter regimens for DR-TB patients, designed to improve treatment adherence and outcomes. A year later, the National Tuberculosis Programme assessed DR-TB centers and reviewed how adverse drug reactions were being managed, particularly for patients on the BPaLM and BPaL regimens. The findings pointed to the need for stronger trainings for health-care workers and wider access to these shorter regimens.
To address this, the National Tuberculosis Control Center (NTCC), under the Ministry of Health and Food Safety, with support from WHO, conducted a three-day national training in May 2026. Health-care workers from 24 DR-TB treatment centers across all seven provinces participated to strengthen their skills in TB case management. The sessions combined technical presentations, case study discussions and updates on WHO guidelines. The training was followed by onsite coaching and mentoring visits.
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Presentations by the National Tuberculosis Control Center held during the training held at the National Tuberculosis Control Center. Photo credit: WHO Nepal
Teams from NTCC, the National TB Reference Laboratory and WHO conducted onsite coaching and mentoring visits in four centers from Bagmati and Madhesh provinces. Using a standardized checklist, teams assessed key areas across the TB cascade of care, including DR-TB case identification, diagnosis, treatment initiation, monitoring and follow-up management. The assessment also covered adverse TB drug safety monitoring and management (aDSM) implementation, patient care and support services, infection prevention and control (IPC), as well as recording, reporting, and health information management systems.
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Dr Kenza Bennani, Team Lead of Disease Prevention and Control & AMR Unit at WHO Nepal, presenting recent WHO updates on tuberculosis guidelines during the training. Photo credit: WHO Nepal
Field assessments revealed persistent challenges, including delays in specimen transportation for advanced testing, gaps in treatment initiation and follow‑up monitoring, and the need for stronger patient support systems.
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Health workers practice recording patient details in the National TB Program Management Information System (NTPMIS/DHIS-2) during a mentoring visit at Trishuli Hospital, Nuwakot, Bagmati province. Photo credit: WHO Nepal
Through continued capacity building support and regular supervision, the NTCC aims to improve the quality of care of DR-TB nationwide. These efforts are expected to enhance the knowledge and skills of health-care workers in managing DR-TB patients and monitoring adverse events, alongside improving the quality of recording and reporting, and strengthening coordination and communication between NTCC, the National TB Reference Laboratory and DR-TB treatment centers. Sustaining investment in these areas will be critical to advancing Nepal’s fight against drug-resistant tuberculosis.