Anusha Ban has aptly summarized the status of non-communicable diseases (NCDs) in Nepal (THT, May 23, Page 8). However, unlike what she writes, there have been some recent efforts for prevention and control of NCDs at the primary health care level in Nepal through the implementation of PEN (Package of essential non-communicable disease interventions). PEN consists of cost-effective interventions that enable early detection and management of cardiovascular diseases, diabetes, chronic respiratory diseases and cancer to prevent life threatening complications. Started first in two districts last year, the package has been recently rolled out to ten more districts, and the government intends to implement it in all the 75 districts within a couple of years to come. However, the focus of the PEN package is on primary prevention and early detection of the major NCDs at the level of primary health care outlets. The missing link, therefore, is the health promotion at the community level through proven cost-effective interventions, which would empower the general population to make healthy choices and improve their health seeking behaviour. The government must give emphasis to scientific health promotional interventions to reduce the burden of NCDs.

Dr. Abhinav Vaidya, KMC

Regulations

Apropos of the editorial “Commuters’ ordeal” (THT, May 23, Page 8), you have piously suggested ‘more bigger vehicles, better management and sound regulation’ to redress commuters’ woes. Unfortunately, while bigger vehicles could come in easy, better management will not. As for sound regulations, we better not even think about

it. If there were better management and sound regulations the existing number of tempos and buses should take care of commuters at peak office hours, especially in the evening. Buses vanish in the morning office hours to transport school and college kids, tempos vanish in the mid-day for meals and charging battery, and retire (most of them) for the day at around 5 and 6 p.m. Most buses vanish from the streets again around 2 to 4 p.m. for school duty and start thinning out from 5 p.m. before disappearing completely by 6/6.30p.m., leaving commuters headed home to jostle and fight for space in the limited buses that will cram the people like sacks of potatoes. If we had strict regulations requiring all buses to be on the road till 8 p.m., commuters would be served well. So will the government take note of this and serve people well. The best way to serve the commuters on a regular basis – day and night - is to introduce mono or metro rails that are cost effective and environment friendly as they are operated by electricity which produces no pollution. May be, the new leadership in the Kathmandu Valley will come up with plans of mono and metro rails to connect the entire Valley where buses and micro-buses will be phased out in a couple of years.

Manohar Shrestha, Kathmandu