Summary

The project aims to support the Government of Nepal (GoN) in strengthening the country’s health system resilience and response, contributing towards a world free from the burden of HIV/AIDS, Tuberculosis (TB), and malaria, while promoting equitable access to quality health care for all. Considering the 2015 Constitution, the Project seeks to strengthen the capacity of relevant stakeholders at the sub-national level, thereby improving the resilience of health systems to effectively respond to HIV, TB, and malaria in the country.

The TB component of the project focuses on addressing the significant gaps in TB case notification by intensifying efforts to identify and reach missing cases, with particular emphasis on screening among key and vulnerable populations and engaging private service providers. The programme also seeks to enhance the capacity of laboratory network, especially by optimizing sample transportation, improving diagnosis services, expanding the utilization of GeneXpert technology, and ensuring quality assurance across the diagnostic laboratory system. Additionally, the project prioritizes expanding the treatment coverage for drug-resistant TB (DR-TB) cases and ensuring that individuals initially loss to follow up are brought back into care and treatment pathways. 

The HIV component focuses on achieving the 95-95-95 targets by reducing new infections, improving treatment adherence, and addressing inequalities in HIV prevention and care. Additionally, it prioritizes interventions targeting key populations, including people who inject drugs and their partners, migrants and their spouses and People Living with HIV to enhance life skills and ensure access to testing, treatment, care and support services.  Further, the Global Fund project also supports the government in procuring the health products supporting the essential services to the affected populations.  

Background

Nepal faces significant challenges in combating HIV, TB, and malaria, despite noteworthy progress and achievements in public health and the country’s response to health issues. According to the National Center for AIDS and STD Control (NCASC), approximately 30,300 people are living with HIV, with concentrated prevalence among key populations such as sex workers, people who inject drugs, men who have sex with men, and migrants—groups that face higher risks due to unsafe practices and limited access to targeted interventions. In 2023, 457 new HIV infections were reported, representing a 91% reduction in the annual infection rate compared to 2000.

TB remains a major public health concern, with an estimated 69,000 new cases annually, yet only 69% of cases are notified . Mortality among HIV-negative individuals stands at 17,000 per year. DRTB is an emerging issue, further complicating prevention and treatment efforts. Nepal has launched a TB-Free Initiative with the potential to shift the trajectory of TB in the country; however, the initiative currently covers only 150 out of 753 local governments. Limited or overburdened human resource capacity has significantly hampered the coordination of TB program implementation at the provincial level, and substantial capacity development needs persist. Moreover, weak maintenance systems for equipment including delayed calibration, outdated software, and untimely repair of diagnostics pose additional challenges to effective treatment.

Over the past decade, malaria cases have declined significantly, yet the disease remains endemic in 25 districts, with over 1.2 million people still at risk particularly in remote areas with limited access to healthcare. Socioeconomic factors, stigma, and inadequate health infrastructure continue to impede timely treatment and service delivery. Low awareness, risk behaviors, and persistent funding gaps further undermine Nepal’s ability to effectively prevent, diagnose, and treat these diseases. Strengthening community health systems and integrating response efforts are critical to sustaining progress and achieving national health goals.

Therefore, to address these challenges, Nepal’s health programs are focused on achieving universal access to prevention, care, and treatment services, supported by community-based interventions. For HIV, the target is to adopt and implement the 95-95-95 strategy, ensuring that 95% of people living with HIV are aware of their status, 95% of those diagnosed receive antiretroviral therapy, and 95% of those on treatment achieve viral suppression. For tuberculosis, the National Tuberculosis Control Center (NTCC) has developed the National TB Strategic Plan (TB-NSP) for the period 2021/2022–2025/2026. The plan aims to achieve a 90% reduction in TB-related deaths and eliminate catastrophic health costs for affected households by 2035. Malaria elimination efforts aim to achieve elimination in selected districts by 2026, reducing disease burden and mitigating associated economic losses. Achieving these outcomes will require scaled-up investments, strengthened health infrastructure, and enhanced community partnerships to ensure equitable and sustainable progress.