Rajesh Thakur, a barber by profession, has been suffering from high blood pressure for the past several months, but has not yet started the prescribed medication. Instead, he relies on home remedies, which doctors say do not control blood pressure effectively and leave patients at risk of serious complications such as strike, heart attack, or paralysis.

“When I suffer from a severe headache, I take painkillers tablets, bitterguard, and aloe vera to lower the blood pressure,” said Thakur, who is 41 years old. “I am told that once started, medicines for blood pressure cannot be stopped until death, which people like me cannot afford.”

When told that taking painkillers frequently could even risk multiorgan failure, and that medicines for blood pressure are free at state-run health facilities, Thakur said he cannot start medicines, relying on state-run health facilities, as they often run out of free medicines.

This sentiment is common across the country, where many people suffering from non-communicable diseases have not started medications due to multiple reasons, including high costs, fear of side effects, and concerns about creating a financial burden for their families. These delays increase the death rate from non-communicable diseases.

There are thousands of brands and formulations of medicines, and each patient needs a different composition and dose, and not all are on the free essential drug list.

Doctors say that medicine used for one patient with a particular ailment may not necessarily suit another. Sometimes patients need higher-dose medicines that are not included on the free list. Health workers have tried to manage this by providing multiple low-dose tablets and asking patients to take them at once, but many patients find it uncomfortable.

Doctors say the cost of medicines is a major reason that has discouraged many patients with non-communicable diseases—high blood pressure, diabetes, thyroid, cholesterol, asthma, among others—from starting treatment. They warn that health problems worsen if patients delay medication.

Some people are not taking medicines, as symptoms of non-communicable disease do not surface, unless the ailments start seriously affecting health.

“I have to work to feed my children, who are small and are still going to school,” said Sushila Tamang, a local from Makawanpur district who also has been suffering from high blood pressure. “I have to go to work early in the morning. What should I eat early in the morning before taking medicine, since it cannot be taken on an empty stomach?”

Tamang, a mother of three who works as a labourer at a construction site in Tarakeshwar, Kathmandu, complains that she has to take leave due to frequent fluctuations in her blood pressure.

Studies show that around half of the people with non-communicable diseases are unaware of their condition, as Nepali generally do not examine their health unless symptoms appear. Of the remaining 50 percent, around 30 percent admit that they have health issues and visit a doctor. Among them, only 10-15 percent take prescribed medicines, according to doctors.

“Most patients seek treatment only when their health conditions worsen,” said Dr Samir Kumar Adhikari, joint spokesperson at the Ministry of Health and Population, who is also the focal person of non-communicable disease at the ministry. “First of all, our health-seeking behaviour is poor, and it takes time for patients to accept that they are suffering from serious health issues. Multiple other factors are equally responsible for refusal to start the medications.”

Experts say if the problems are identified early, they can be prevented from getting severe with minimal expenditure and behaviour changes.

“We all know that non-communicable diseases are rising alarmingly in our country,” said Dr OM Murti Anil, an interventional cardiologist. “Concerted efforts are needed to address these problems.”

The burden of non-communicable diseases has risen alarmingly in recent years. The Nepal Burden of Disease 2017 report attributed two-thirds (66 percent) of total deaths to non-communicable diseases, while the figure jumped to 71.1 percent in the 2019 report. The Global Burden of Disease 2021 shows 73 percent of deaths are caused by non-communicable diseases.