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The federal government has instructed local governments to arrange food for the poor people dependent on daily wages. The high-level Covid-19 Prevention and Coordination Committee led by Deputy Prime Minister and Minister of Defense Ishwar Pokhrel urged local governments to identify those people, and provide them with relief packages. 

The streets are empty. Industries are closed. Construction-related works and public transport have been halted. These sectors provide employment to a large number of daily-wage workers. There are also other vulnerable groups such as farmers, senior citizens, widows and those with disabilities who need immediate relief packages.

Earlier, issuing a press statement, Nepali Congress President Sher Bahadur Deuba urged the government to bring immediate relief. “I urge the government to bring relief package to low-income job holders, other workers and students living in rented apartments in Kathmandu,” said Deuba. 

The Kathmandu Metropolitan City has started the process of collection of data of poor people in the city. According to the KMC, all ward committees have been instructed to collect data of daily-wage workers, people living in the street, and those without shelter.  According to Namaraj Dhakal, chief of Administration Department of the KMC, they will provide relief packages to those people after they collect data from all wards. Other some local governments have already started relief packages for the poor. 

Much of the world was unprepared for the Covid-19 pandemic. Nepal wasn’t either. But we could have been better prepared had the federal healthcare system not been botched right from the start. In the old unitary set-up, there was a clear chain of command. As Dr. Sushil Nath Pyakurel, former Director General of the Department of Health District, put it to APEX, under the old set-up, “health offices directly supervised health posts and sub-health posts. Regional health offices supervised and monitored district health offices. The Ministry of Health and Population and its departments in turn monitored the regional health offices.” 
In the federal set-up, there are just 6-7 hospitals under the direct supervision of the federal government and the rest are divided between the federal and local governments.

As there is no clear chain of command, there is a lot of duplication of work. For instance, instead of cooperating to build robust coronavirus quarantine facilities, the provincial and local units have now built their own ramshackle ones. The provincial and local healthcare facilities are understaffed, and short of ideas. Even when they have budget they are incapable of procuring medicines and vaccines without federal-level supervision.  

This is why, argues Dr Pyakurel, all healthcare systems should be centrally commanded. He proposes establishing Centers for Disease Control as well as well-equipped medical labs at the center, and in each of the seven provinces. For this, he emphasizes, there is a need for clear political commitment.

In the view of Nepal’s former Health Minister Gagan Kumar Thapa, a change in mindset is vital. “The 2015 earthquake taught us that we were short on long-term disaster planning and in dealing with health issues in such cases.” Thapa thus proposed a Mass Causality Center under the ministry, which would be operated with the help of security agencies. The proposal was forwarded to the finance ministry. “But nothing happened thereafter,” Thapa laments. “Such a center could have simultaneously treated thousands of patients.” 

Perhaps regional cooperation is a better idea in dealing with this kind of cross-border problems? Indian Prime Minister Modi called a special video-conference of SAARC leaders to chalk out common strategies on the coronavirus. Nepal pledged $1 million to the emergency SAARC fund set up after the conference. Yet the lukewarm response of Pakistan suggests the initiative will struggle to take off. Yet there is also no alternative. If there cannot be wholesale cooperation at the SAARC level, the eight countries can perhaps work together on select issues like climate change and pandemics that impact them all alike. 

More pandemics are likely in the days ahead. The Ebola in West Africa earlier this decade prompted many countries to take steps to fight large-scale epidemics but when the outbreak was controlled, their preparations were shelved too. As a long-term measure, Prime Minister KP Sharma Oli has instructed the Ministry of Health to start the process of building a separate hospital to deal with pandemics. 

But piecemeal solutions won’t do. Modern-day health challenges call for innovative and collaborative ones. There is a desperate need to coordinate the response to infectious diseases both at national and regional levels.  

Even though its government has announced an all-out effort to stop the spread of Covid-19, the Karnali Province is facing an acute shortage of doctors and medicines. People in the province are going back to villages from urban centers, hoping to save themselves from infection. But they get more worried when they get to the villages and find that even basic medical facilities are missing.

Historically, even a simple disease routinely becomes an epidemic in far-flung regions of Nepal. In 2014, almost 200 people died from diarrhea in Jajarkot of western Nepal as its villages lacked even basic medicines and health workers. Last year, flu killed 12 in two weeks in Humla district.

Forget specialist doctors, even general practitioners are not available in the remote mountainous districts of Karnali. While the district headquarters has some medicinal supplies, remote villages are without even basic drugs such as paracetamol. The provincial government has centered its anti-coronavirus efforts in the provincial capital Birendranagar. Although there are plenty of awareness programs, both the provincial and local governments have failed in arranging medicines and doctors. 

Even the district hospitals—the biggest in the districts—don’t have doctors to fill the vacant positions. Dolpa District Hospital has positions for four specialist doctors and five nurses. But only one doctor (under temporary contract) and two nurses are currently serving there. 

Such is also the case of Mugu District Hospital where 10 doctors including four specialists have been provisioned. But all four specialist positions are vacant. “There are some medicines in the drugstore, but we don’t have a single specialist doctor. What little medicines we have will not be enough if the pandemic spreads here,” says Dr. Nirmal Nagarkoti, chief of the District Public Health Office. 

The situation in Kalikot and Jajarkot is no better. People in remote areas of these districts do not get paracetamol if they get a fever. “As many as 200 people come for treatment for seasonal ailments every day. But treating them is a single doctor, instead of the eight provided on paper,” says Dr. Bhisma Pokharel, chief of Kalikot District Hospital. Jajarkot, which has time and again hit by epidemics, also lacks doctors. Most health institutions in the province are run by employees under temporary contracts. 

The Provincial Hospital in Birendranagar is no better. “Of the 50 positions for specialist doctors, only seven have been filled,” says Binod Adhikari, information officer of the hospital. “Of the 25 positions for resident doctors, there is only one.” 

Likewise, Dailekh District Hospital employs one doctor while there are seven positions for specialist doctors. All five resident doctors’ positions lay vacant. 

Although the district hospitals have set aside isolation rooms, they lack basic equipment to identify and treat Covid-19 patients. However, the provincial government keeps promising it will arrange for necessary drugs and doctors. “We are serious about sending medicines and doctors to rural areas. We have asked for medicines from Kathmandu also,” says Rita Bhandari, chief of the Provincial Health Directorate. 

Kathmandu: With the country locked down, people are confused about their freedom of movement. The government has urged them to stay indoors except in ‘emergencies’. 

Social media users are requesting the government to clarify lockdown guidelines. Government sources, however, say the guidelines are clearly established in the Essential Services Operation Act, 2014. The Act covers 19 areas under essential services, including transport and storage of goods, supply and distribution of drinking water, services related to hospital, collection of waste, and printing.

The recent government directive states that people can come out only to purchase essential stuff like food and medicine. 

Police deployed on the streets have been convincing people who have ventured out to return to their homes. In the event of a violation of the lockdown, people would be subjected to six-month jail or Rs 600 in fines, or both. In Chitwan, police have already arrested over a dozen people for violating the lockdown. 

Mentioning Deputy Prime Minister and Minister for Defense Ishwor Pokhrel, Nepali Congress leader Gagan Thapa tweets, “People seem confused about what they can do and what they cannot—please make that clear immediately. Please tell them how this lockdown helps prevent the spread of coronavirus.”

Speaking to APEX, Nepal Police Spokesperson Shailesh Thapa Kshetri says that if people have to travel in a vehicle, they first need to dial 100, the police hotline, and then visit the District Administration Office to get a pass.

“As far as getting vegetables and medicines in nearby shops and stores are concerned, people you can go outside and buy. But you cannot linger there,” Kshetri says. “If someone is seriously ill, we can arrange for an ambulance or even use our own vehicles to take them to a hospital.” Kshetri says the police have also been informing those who are confused about the lockdown.

In other countries, governments have come up with various guidelines on lockdowns. For instance, the United Kingdom has asked people to leave home only for four reasons: to buy medicine and food, to walk (alone), for children below 18 to meet their parents, and for travel to jobs which cannot be done at home. 

Across the world, a lockdown is considered more flexile than a curfew.