WHO is supporting the integration of asthma and chronic obstructive pulmonary disease (COPD) services into primary health care (PHC) in Nepal and Sri Lanka, as part of efforts to strengthen frontline respiratory care and improve access to timely diagnosis and treatment. This work, supported by Bloomberg Philanthropies, is part of a wider WHO effort to strengthen the prevention, diagnosis and management of chronic respiratory diseases (CRDs) through PHC, alongside its broader work on technical guidance and global leadership.
Asthma and COPD continue to place a substantial burden on individuals, and families, particularly where diagnosis is delayed, access to inhaled treatment is inconsistent, and continuity of care is weak. Strengthening PHC is central to addressing these gaps, as it provides a platform for early identification, appropriate treatment, inhaler use support, follow-up, referral and patient education closer to communities.
A recent World Health Organization (WHO) report from the South-East Asia Region highlights the scale of CRDs and persistent gaps in primary care service readiness. These include limited availability and use of diagnostics and essential inhaled medicines in many settings. CRDs account for an estimated 12% of all deaths in the Region, with more than 104 million people living with these conditions and around 1.56 million deaths in 2021. These wider regional challenges are also reflected in Nepal and Sri Lanka.
In Nepal and Sri Lanka, technical priorities are being turned into practical action through consultation, service mapping, implementation planning and preparation for frontline health worker training. The current phase is focused on early implementation in selected settings, with the aim of testing practical approaches, generating operational learning and informing future scale-up through national health systems. "The projects closely align with the integrated lung health approach endorsed by the Seventy-eighth World Health Assembly, which emphasizes stronger PHC, effective referral pathways and improved access to essential diagnostics, medicines and technologies," said Dr Sarah Rylance, lead for chronic respiratory diseases at WHO headquarters.
In Nepal, the initiative is supporting national efforts to make asthma and COPD care more accessible by strengthening frontline services, providing practical support for health workers, and integrating care into PHC and existing noncommunicable disease (NCD) service delivery platforms.
"The CRD initiative is being implemented in Kavre District, building on the experience and lessons from the hypertension and diabetes care cascade initiative. The approach integrates asthma and COPD services into existing NCD and PHC structures through short training modules, job aids, locally adapted materials, supportive supervision and community engagement," noted Dr Poma Thapa, NCD and Mental Health Section Chief, Epidemiology and Disease Control Division, Department of Health Services, Nepal.
In Sri Lanka, implementation is being taken forward in Kandy and Kalutara districts through a primary care-focused model that emphasizes systematic screening, improved diagnosis, health worker training, patient education and stronger follow-up through Healthy Lifestyle Centres and other PHC settings. It is supported by practical implementation tools and service delivery approaches designed to improve continuity of care.
"The initiatives in Nepal and Sri Lanka reflect the wider priorities of the South-East Asia Region, where CRDs account for a substantial share of avoidable illness and death. By integrating asthma and COPD care within PHC and focusing on equitable, people-centred service delivery, these initiatives demonstrate practical pathways for closing persistent gaps in respiratory care across the Region," said Dr Suman Rijal, Director, Department of Health Promotion, Disease Prevention and Control, WHO Regional Office for South-East Asia.
The experience from Nepal and Sri Lanka is expected to generate operational learning for the South-East Asia Region, particularly on how existing NCD programmes and service delivery platforms can be leveraged to expand access to asthma and COPD care.
In both countries, the next phase will focus on frontline training and service delivery support, helping health care workers provide more integrated respiratory care closer to where people live.
