Nepal’s Standard Treatment Protocol (STP) for Basic Health Services (BHS) Package 2078

Introduction

For health professionals, policy makers, and students preparing for the Health Loksewa in Nepal, the Standard Treatment Protocol (STP) for Basic Health Services (BHS) Package 2078 is a foundational document. Published by the Ministry of Health and Population (MoHP), Department of Health Services, this protocol serves as the blueprint for delivering quality, equitable, and standardized healthcare across the country.

Whether you are running a Health Post or preparing for a medical exam, understanding this protocol is essential. This guide breaks down the massive document into actionable insights, covering everything from emergency management to non-communicable diseases.

What is the STP for BHS 2078?

The Government of Nepal is constitutionally obligated to ensure basic health services are accessible to every citizen. The STP for BHS 2078 provides clear guidelines to health care workers on how to provide these services efficiently. It was developed by the Curative Service Division (CSD) with support from the World Health Organization (WHO), GIZ, and NHSSP to ensure uniformity in treatment and rational use of medicines.

The protocol is divided into seven distinct parts, ranging from general prescribing principles to specific curative services.

1. General Principles: People-Centred Care and Rational Prescribing

The protocol shifts the focus from “patient-centred care” to “people-centred care.” This approach views individuals not just as patients with diseases, but as whole persons within the context of their families and communities.

Key Guidelines for Prescribing:

• Rational Use: Antibiotics should only be prescribed for bacterial infections to prevent resistance.
• Generic Names: Prescriptions must use generic names (e.g., Paracetamol) rather than brand names (e.g., Cetamol).
• The “P” Drug Concept: Health workers are encouraged to use the National List of Essential Medicines (NLEM).
• Infection Prevention: Strict adherence to hand hygiene, use of PPE, and proper waste segregation (color-coded buckets: Green, Blue, Red, Yellow, White, Black) is mandated.

2. Managing Common Emergencies

The STP outlines specific protocols for stabilizing patients before referral. This is critical for Basic Health Service Centres (BHSC) often located in rural areas.

• Shock: Identified by fast pulse, low blood pressure (<90 systolic), and cold skin. Treatment involves laying the patient flat, elevating legs, and rapid IV fluids (RL/NS).
• Poisoning: For organophosphorus poisoning (common in Nepal), the protocol details the use of Atropine and Pralidoxime. It explicitly advises against gastric lavage for corrosive poisoning like kerosene or acid.
• Snake Bite: It differentiates between Cobra, Krait, and Viper bites. Anti-snake venom (ASV) is recommended only if signs of neurotoxicity or coagulopathy appear.
• Trauma: The protocol adopts the ABCDE (Airway, Breathing, Circulation, Disability, Exposure) approach for primary trauma care.

3. Preventive and Promotive Health Services

This section is vital for public health management and includes the National Immunization Program and Nutrition protocols.

• Immunization: The document lists the schedule for vaccines like BCG, Rotavirus, Polio (OPV/FIPV), PCV, Pentavalent, and Japanese Encephalitis.
• Child Health (IMNCI): It provides a color-coded triage system (Pink, Yellow, Green) for managing sick children aged 2 months to 5 years, covering pneumonia, diarrhea, and malnutrition.
• Nutrition: It defines Severe Acute Malnutrition (SAM) using Weight-for-Height Z-scores and MUAC (<11.5cm). It outlines the use of Ready-to-Use Therapeutic Food (RUTF) for treatment.

4. Safe Motherhood and Newborn Care

Maternal and neonatal health is a priority. The STP covers the continuum of care from pregnancy to the postnatal period.

• Antenatal Care (ANC): Recommends at least four visits and supplementation with Iron and Folic Acid (IFA) and Calcium.
• Delivery: Active Management of the Third Stage of Labour (AMTSL) is mandatory to prevent Postpartum Haemorrhage (PPH), using Oxytocin (10 IU IM) or Misoprostol if Oxytocin is unavailable.
• PPH Management: If bleeding exceeds 500ml, the protocol details massage, oxytocin drips, and referral strategies.
• Safe Abortion: Guidelines are provided for medical abortion (up to 10 weeks) using Mifepristone and Misoprostol, and Manual Vacuum Aspiration (MVA) for up to 12 weeks.

5. Curative Services: Communicable & Non-Communicable Diseases

With the rise of the “triple burden” of disease, the STP addresses both infections and lifestyle diseases.

Communicable Diseases:

• Tuberculosis (TB): Standard treatment regimens (2HRZE/4HR) are detailed for new cases.
• Malaria: Treatment protocols distinguish between P. vivax (Chloroquine + Primaquine) and P. falciparum (Artemether + Lumefantrine).
• Leprosy: Classifies cases into Paucibacillary (PB) and Multibacillary (MB) for Multi-Drug Therapy (MDT).
• Dengue & Kala-azar: Guidelines for diagnosis via RDT and supportive management.

Non-Communicable Diseases (NCDs):

• Hypertension: Defines hypertensive urgency vs. emergency. It recommends Amlodipine or Losartan for management and emphasizes lifestyle modification.
• Diabetes: Recommends Metformin as the first-line drug and emphasizes diet and foot care.
• COPD & Asthma: Differentiates maintenance therapy (inhalers like Salbutamol/Beclomethasone) from acute exacerbation management (oxygen, nebulization, steroids).
• Mental Health: Covers depression, anxiety, and psychosis, recommending psychosocial counseling alongside medications like Fluoxetine.

6. Ayurveda and Homeopathy

Unique to this protocol is the inclusion of traditional medicine.

• Ayurveda: Discusses Abhyanga (oil massage) and Swedana (steaming) as therapeutic procedures. It also mentions the use of Shatavari powder for lactating mothers.
• Homeopathy: Provides treatment options for common conditions like warts (Thuja), tonsillitis (Belladonna), and acidity.

Frequently Asked Questions (FAQ)

Q: Who is the STP BHS 2078 designed for?

A: It is a guide for health workers (HA, AHW, ANM, Staff Nurse) providing services at Basic Health Service Centres, Health Posts, and Primary Health Care Centres in Nepal.

Q: Does the STP cover mental health?

A: Yes, Chapter X includes protocols for managing depression, anxiety, psychosis, and epilepsy.

Q: What is the protocol for dog bites?

A: Immediate wound washing for 15 minutes with soap and water is crucial. Post-Exposure Prophylaxis (PEP) with the Rabies vaccine is administered intradermally on days 0, 3, and 7.

Q: How does the protocol address antibiotic resistance?

A: It emphasizes the rational use of antibiotics, prescribing them only for bacterial infections and not for conditions like the common cold or simple diarrhea.

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Quick Reference: Nepal’s STP for Basic Health Services (BHS) 2078 at a Glance

Here is a catchy breakdown of the vital components of the protocol. This will help your readers digest the information quickly.

Service Area	Key Components & Protocols	The “Golden Rule” / Clinical Pearl
General Prescribing	• Rational Use: Prescribe by generic name, not brand name (e.g., Paracetamol, not Cetamol).• Infection Control: Use color-coded buckets (Green, Blue, Red, Yellow, White, Black) for waste segregation.	“Treat the person, not just the disease.” Focus on People-Centred Care, viewing the patient within the context of their family and community.
Emergency Care	• Trauma: Follow the ABCDE approach (Airway, Breathing, Circulation, Disability, Exposure).• Snake Bite: Distinguish between Cobra/Krait (Neurotoxic) and Viper (Haematotoxic). Do NOT cut or suck the wound.• Poisoning: Use Atropine for Organophosphorus poisoning; avoid gastric lavage for corrosive poisons,.	For Shock: Elevate legs, keep warm, and rapid IV fluids (RL/NS). If Anaphylactic, give Adrenaline IM immediately,.
Child Health (IMNCI)	• Dehydration: Classify into Plan A (Home treatment), Plan B (ORS at center), or Plan C (IV fluids for severe dehydration),.• Pneumonia: Treat fast breathing with Amoxicillin; refer if chest indrawing or stridor is present.	For diarrhea, Zinc is the best friend of ORS. Give Zinc for 10 days to prevent recurrence.
Maternal Health	• Delivery: Active Management of Third Stage of Labor (AMTSL) is mandatory. Give Oxytocin 10 IU IM within 1 minute of birth.• PPH: If bleeding >500ml, massage uterus, start IV Oxytocin, and refer if unstable.	Pre-eclampsia alert: If BP >140/90 with protein in urine, manage with Magnesium Sulphate to prevent seizures before referral.
Communicable Diseases	• Tuberculosis: New cases get 2HRZE + 4HR regimen (Isoniazid, Rifampicin, Pyrazinamide, Ethambutol).• Malaria: Test first! P. vivax gets Chloroquine + Primaquine; P. falciparum gets Artemether + Lumefantrine (AL),.• Dengue: Supportive care only (Paracetamol + Fluids). Avoid NSAIDs/Steroids.	For Dog Bites: Wash the wound with soap and water for 15 minutes immediately. This is the first line of defense against Rabies.
Non-Communicable Diseases (NCDs)	• Hypertension: Start with Amlodipine 5mg or Losartan 25mg if lifestyle changes fail.• Diabetes: Metformin 500mg is the first-line drug after diet/exercise advice.• COPD/Asthma: Use Salbutamol for acute relief; Beclomethasone for maintenance,.	Screening is key: Measure BMI and Blood Pressure at every visit for adults to catch NCDs early.
Mental Health	• Depression: Look for persistent low mood and loss of interest. Treat with psychosocial counseling and Fluoxetine.• Psychosis: Manage with Risperidone and refer for diagnosis.	For Alcohol Withdrawal: Use Diazepam and Thiamine to manage shakes and prevent seizures.
Traditional Medicine	• Ayurveda: Recommends Shatavari powder for lactating mothers to increase milk production.• Homeopathy: Uses specific remedies like Thuja for warts and Belladonna for tonsillitis,.	Integrate holistic care: Yoga and breathing exercises (Pranayama) are recommended for stress and NCD management.

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In Fact,

The STP for BHS 2078 is more than just a document; it is the backbone of Nepal’s rural healthcare system. It standardizes treatments to protect patients from malpractice. This ensures that a patient in a remote Health Post receives care based on the same principles as one in an urban center.

Disclaimer: This blog summarizes the STP 2078 for educational purposes. Health professionals should consult the full official document for specific dosages and clinical decision-making.