The first phase was executed as a single-day intensive health camp on 21 December 2025 at Triveni-5, Nerpa, Rolpa District, Province No. 5, funded entirely by GAAPP. Rolpa was selected as the pilot site because its conditions — near-universal biomass fuel dependence, high tobacco use, poor indoor ventilation, rugged terrain, and severely limited access to healthcare — mirror those of hundreds of rural districts across Nepal. A total of 308 patients were served with a comprehensive six-service clinical package including general health screening (BP, RBS, BMI), portable spirometry, digital chest X-ray, specialist medical consultation, hands-on inhaler technique training, essential medicine distribution, health education sessions in Nepali, individual counselling, and referral linkages to local health posts. Spirometry confirmed a 70% obstructive lung disease burden in patients tested. Pre-training inhaler technique error rate stood at 65%, which was reduced to 92% accuracy following hands-on individual demonstration — an absolute improvement of 27 percentage points. 85% of patients expressed an intention to seek early care following their consultation. 95% of diagnosed patients received free essential medicines. As a landmark commitment to continuity of care beyond the camp, two qualified Medical Officers have been formally deployed in Rolpa District for a continuous period of eight months, spanning all three project phases, to monitor the 308 camp patients, supervise Phase 2 outreach, and contribute field evidence for Phase 3 advocacy.

Phase 3 represents the apex of the Swastha Saans Nepal model — the translation of clinical evidence from Phase 1 and community voices from Phase 2 into lasting national systems change. The advocacy strategy is structured around six pillars: (1) Awareness — integrating COPD and lung health screening into the existing FCHV training curriculum for Nepal's approximately 35,000 frontline community health volunteers, with a projected impact of identifying 100,000 or more undiagnosed COPD cases per year; (2) Prevention — scaling up improved cookstove distribution through the Alternative Energy Promotion Centre (AEPC) and embedding lung health messaging in clean cooking campaigns, targeting a 40% reduction in indoor air pollution exposure over five years; (3) Diagnosis — deploying portable spirometers to all 753 local governments (Palikas) and developing a Nepal-specific clinical algorithm for COPD diagnosis, with a target of 80% of health posts being capable of diagnosing COPD within two years; (4) Treatment — including essential COPD medicines (salbutamol, ipratropium bromide, inhaled corticosteroids) in the National Free Drugs List and training all health workers in proper inhaler technique, enabling 500,000 or more COPD patients to access affordable treatment; (5) Data — incorporating spirometry and standardized respiratory questionnaires into the next Nepal Demographic and Health Survey or commissioning a dedicated national COPD prevalence study to establish a robust national evidence base; and (6) Policy — developing and officially adopting Nepal's first National COPD Strategy integrating health, environment, women's empowerment, and agriculture sectors under multi-ministerial ownership. Phase 3 will engage the Ministry of Health and Population, Ministry of Energy, Ministry of Women Children and Social Welfare, development partners, and all 753 Palikas with a consolidated evidence package drawn from Phases 1 and 2.