The prevention of - and first response to - injuries in Nepal: a review of policies and legislation.

Background: Injuries, the cause of estimated 4.5 million annual deaths and many more disabilities worldwide, are the predictable outcome of particular circumstances. One of the most effective ways to prevent injuries is through policy and legislation. The aim of this research study was to identify and critically review all policy and legislation in Nepal that had the potential to prevent injuries. Methods: We identified legislation and policy that met inclusion criteria through a stakeholder meeting, networks and contacts, and websites and electronic resources. Each included document was critically reviewed to identify areas of strength and opportunities for improvement. We compared the included documents against the World Health Organisation’s recommendations of known effective interventions. Results: Sixty-two documents met the inclusion criteria for this review. Of these, 24 (38.7%) were exclusively related to road injuries, 11 (17.7%) to occupational injuries, 6 (9.7%) to injuries in the home and 5 (8.1%) to injuries at school; and 30 (48.4%) documents included text related to the first response to injuries. Of 127 strategic recommendations by the WHO that provided an area for policy or legislative focus, 21 (16.5%) were considered adequately met by Nepali policy and legislation, 43 (33.9%) were considered partially met, and 63 (49.6%) were not met. Conclusion: We drew five conclusions from this critical policy review which we have related to recommendations for—widening the scope of legislation and policy for injury prevention to emphasise injuries occurring at home or school; addressing the causes of injuries and promoting proven preventive measures; greater clarity on both individual and institutional roles and responsibilities; trustworthy data and quality evidence to inform decision making; and financial investment and capacity strengthening for injury prevention and first response. The current system of federal governance in Nepal has potential for strengthening injury prevention and first response at central, provincial and local levels.