Medicosnext
Dr. Lekh Jung Thapa
He is a distinguished neurologist and a pivotal figure in Nepal’s medical and political landscape. Currently serving as a Member of Parliament, he bridges the gap between clinical practice and national policy. He is the Founder President of the Nepal Stroke Association (NSA) and represents Nepal as a Commissioner for the Lancet Commission on Stroke in LMICs, advocating for systemic healthcare reforms on both a national and global scale. In the clinical and academic sectors, Dr. Thapa serves as an Associate Professor of Neurology and is a graduate of the SQIL program at Harvard Medical School. He is the Director of the National Neuro Center (NNC) in Kathmandu and leads the Neuro and Allied Clinic in Bhairahawa. As a member of the American Academy of Neurology (AAN), he is dedicated to integrating international standards of safety, quality, and informatics into the Nepalese healthcare system.
His work is defined by a commitment to evidence-based neurology and health equity. By combining his roles as a senior consultant, academician, and statesman, Dr. Thapa continues to lead efforts in establishing standardized stroke care pathways and improving specialized medical access across the country.
Neurological disorders represent a major and growing public health challenge in Nepal, contributing significantly to mortality, disability, and economic burden. Globally, neurological conditions account for approximately 443 million disability-adjusted life years (DALYs) and nearly 11 million deaths annually, making them the leading cause of disability worldwide1. In Nepal, the burden is increasing due to demographic aging, rapid urbanization, and the rising prevalence of non-communicable disease (NCD) risk factors such as hypertension, diabetes, and unhealthy lifestyles. Currently, NCDs account for approximately 70% of total deaths in the country, and neurological disorders constitute a substantial but under-recognized component of this burden 2.
Among the major neurological conditions in Nepal, stroke has emerged as a leading cause of adult mortality and long-term disability, with increasing incidence linked to vascular risk factors 3. Epilepsy remains highly prevalent, affecting an estimated 7-10 per 1,000 population, with treatment gaps exceeding 50%, particularly in rural and underserved areas [4]. Neuroinfectious diseases, including Japanese encephalitis and neurocysticercosis, continue to contribute to neurological morbidity, especially in endemic regions 5. Additionally, the burden of neurodegenerative disorders such as dementia and Parkinson’s disease is rising due to population aging, although these conditions are frequently underdiagnosed due to limited awareness and a lack of specialized services.
Nepal’s Health Policy
Nepal’s policy environment provides a strong normative foundation for addressing these challenges. The Constitution of Nepal (2015) explicitly recognizes health as a fundamental right, guaranteeing citizens access to free basic health services and emphasizing equity and non-discrimination (Article 35) [6]. This rights-based framework obligates the state to ensure the availability, accessibility, affordability, and quality of healthcare services, including those required for chronic and disabling neurological conditions. However, despite this constitutional commitment, neurological disorders have not been explicitly prioritized in national health policies. Existing frameworks, such as the Multisectoral Action Plan for the Prevention and Control of Non-Communicable Diseases (2014-2020) and the National Health Policy (2019), include neurological conditions within broader NCD strategies but lack disease-specific plans, dedicated funding, and implementation mechanisms tailored to neurological care.
The health system in Nepal faces multiple structural constraints in responding effectively to neurological disorders. Specialized neurological services are heavily concentrated in urban tertiary centers, particularly in Kathmandu and a few major cities, resulting in significant geographic inequities in access. Rural populations, which constitute the majority of the population, often face delays in diagnosis and treatment due to the limited availability of neurologists, neurosurgeons, and allied health professionals. Diagnostic capacity is also restricted, with advanced imaging modalities such as CT and MRI, as well as electrophysiological investigations like EEG and EMG, largely confined to higher-level facilities. Furthermore, rehabilitation services, critical for conditions such as stroke and traumatic brain injury, remain underdeveloped and inaccessible for many patients. Weak referral systems and limited integration of neurological care into primary healthcare further exacerbate these challenges.
Economic burden of Neurological disorders
The economic burden of neurological disorders in Nepal is substantial and multifaceted, encompassing direct medical costs, indirect productivity losses, and broader social impacts. Direct costs include expenditures on hospitalization, diagnostic investigations, medications, surgical interventions, and rehabilitation services. Indirect costs, which are often more significant, include loss of productivity due to disability, caregiver burden, long-term dependency, and premature mortality. In Nepal, where out-of-pocket expenditure accounts for about 55% of total health spending, households affected by neurological disorders are at high risk of catastrophic health expenditure [7]. Chronic conditions such as stroke, epilepsy, and dementia require long-term care and continuous medication, placing sustained financial pressure on families and contributing to impoverishment. From a macroeconomic perspective, the cumulative impact of reduced workforce participation and increased dependency represents a significant constraint on national economic productivity.
Despite these challenges, there is strong evidence that investment in neurological health is both feasible and cost-effective. Preventive interventions, such as the control of hypertension and diabetes, can significantly reduce the incidence of stroke. Treatment of epilepsy with low-cost antiepileptic medications is highly effective and can dramatically reduce seizure frequency and associated disability. Similarly, expanding rehabilitation services can improve functional outcomes and reduce long-term care costs. These interventions align with global evidence demonstrating that investments in NCD prevention and management yield substantial economic returns through improved productivity and reduced healthcare costs [8].
Social determinants and cultural factors also play a critical role in shaping the burden and outcomes of neurological disorders in Nepal. Stigma associated with conditions such as epilepsy and dementia remains widespread, often leading to delayed care-seeking, social exclusion, and reduced quality of life [9]. Limited public awareness and misconceptions about neurological diseases further contribute to underdiagnosis and inadequate treatment. Geographic disparities, poverty, and limited educational access exacerbate inequities in service utilization and health outcomes. Addressing these factors requires a comprehensive approach that integrates health system strengthening with community engagement, education, and social support mechanisms.
In light of these findings, a strategic and coordinated policy response is essential. Nepal should prioritize the development of a national strategy for neurological disorders, aligned with the WHO Intersectoral Global Action Plan on Epilepsy and Neurological Disorders. Integration of neurological care into primary healthcare systems, supported by task-sharing approaches such as the WHO Mental Health Gap Action Programme (mhGAP), can significantly reduce treatment gaps. Strengthening provincial and district-level health services, expanding access to diagnostic and rehabilitation infrastructure, and increasing the training and distribution of specialized health workforce are critical steps. Financial protection mechanisms must be enhanced through the expansion of the National Health Insurance Program to include essential neurological services, thereby reducing out-of-pocket expenditure. Additionally, investments in prevention, data systems, and research are necessary to support evidence-based policy and planning.
Monitoring and evaluation frameworks should be established to track progress, with indicators such as reduction in epilepsy treatment gap, decreased stroke mortality, increased insurance coverage, and improved workforce density. Community-based interventions, including public awareness campaigns and stigma reduction initiatives, should complement health system reforms to ensure early detection and improved care-seeking behavior.
Conclusion
In conclusion, neurological disorders constitute a significant and growing challenge for Nepal’s health system, with far-reaching implications for population health, social equity, and economic development. While the constitutional recognition of health as a fundamental right provides a strong foundation, translating this commitment into effective and equitable neurological care requires targeted policy action, sustained investment, and system-wide reforms. Addressing neurological disorders is essential not only for improving health outcomes but also for advancing universal health coverage and achieving sustainable development goals in Nepal.
References
1.GBD Neurological Disorders Collaborators. Global burden of neurological disorders. Lancet Neurology. 2021.
2.World Health Organization. Noncommunicable diseases country profile: Nepal. 2022.
3.Paudel R et al. Stroke epidemiology and outcomes of stroke patients in Nepal: a systematic review and meta-analysis. BMC Neurol. 2023
4.Rajbhandari KC. Epilepsy in Nepal. Canadian Journal of Neurological Sciences. 2004
5.WHO South-East Asia Regional Office. Neuroinfectious disease report. 2021.
6.Government of Nepal. Constitution of Nepal. 2015.
7.World Bank. Nepal Health Financing Profile. 2023.
8.Intersectoral global action plan on epilepsy and other neurological disorders. Geneva: World Health Organization. 2023.
9.Devkota K, et al. Epilepsy treatment gap in Nepal. 2019.
