It has been over four months since the first outbreak of the novel coronavirus was reported in Wuhan of Hubei province, China. On January 24 Nepal recorded its first Covid-19 case. Any way you look at it, Nepal had sufficient time to prepare, including on the purchase of medicines and medical kits. Yet most of this precious time was wasted.   

Medical doctors, nurses, and other frontline health workers say they are desperately short on gloves, medical masks, respirators, goggles, face shields, gowns, and aprons. Other urgent needs are ventilators, testing kits, Personal Protective Equipment (PPE), and medicines. The testing process has been painfully slow due to the lack of sufficient test kits and other supporting equipment.  

Nepal has fallen far short of testing all corona suspects, which is vital to curtailing the spread of the virus. Right now only those who came to Nepal from abroad after the second week of March are being tested. Public health experts say low testing levels could be a reason behind the paucity of detected cases in Nepal, even when compared to other South Asian countries. Similarly, due to the lack of PPE, doctors and other health workers are reluctant to treat those suspected of corona or any other infectious disease. 

A doctor at the Kathmandu Medical College (KMC) says that the hospital staff has been told to prepare for the testing and treatment of possible Covid-19 patients, even as they are short on PPE and other protective gear. “Doctors, nurses and other working staffs worry they will be asked to tend to suspected Covid-19 patients even without these protective gears,” the doctor says, requesting anonymity.  

The situation is worse outside Kathmandu. For example, in the vulnerable Province 2, there are just 11 ventilators and testing level is slow. Various local governments have also complained of insufficient test kits. 

Long and short of it

Dr. Lochan Karki, President of Nepal Medical Association (NMC), acknowledges a slight improvement in the delivery of PPE. “In the initial days, the situation was dire. Things now are better, but we still don’t have sufficient stock if the number of coronavirus cases shoots up,” Karki says. He says still both private and government hospitals are short of vital medical equipment. Some private hospitals are thus trying to get supplies from private companies abroad. 
A rising global demand and severe disruptions in global PPE supply chains maybe a reason for the delay in their import in Nepal. But the federal government’s mishandling of the purchasing process is undoubtedly more responsible. First, the government initiated the process too late. Second, the decision to allow a private company to make these imports without due process invited controversy. The contract was scrapped and another one started, which also took time. 

To fast track the process, a government-to-government (G2G) purchase was initiated. On March 29, the cabinet instructed Nepal Army to do so. The army wrote to China, India, Israel, Singapore and South Korea, requesting for the needed medical supplies. 
The army took nearly three weeks to complete paperwork. Even after this, Foreign Minister Pradeep Gyawali had to talk to high-level Indian and Chinese officials to hurry things up. Of the five countries, there has been some progress on the purchase of test kits and medical equipment from China, while some medicines have also been imported from India.  

Nepal Army completed paperwork to purchase kits and medicine from China on April 20, and the army says it will take another two weeks for the first consignment to arrive. Chinese companies have informed that they are under pressure to deliver to other countries as well. In total, the army will be importing 340 tons of medical supplies worth some Rs 2.24 billion from China—and in multiple stages. The first consignment will be via a charter flight and the subsequent ones will be imported via road. 

Wait and watch, not  

On the purchase of medicines from India, there has been no substantial progress. Nepal Army has dispatched a list of medicines and equipment but is yet to receive specific prices for those items, says army Spokesperson Bigyan Dev Pandey. India is itself purchasing medical supplies, including test kits, from China. Government officials have not shared details about the progress in bringing medical supplies from Israel, Singapore, and South Korea. 
Despite the initial controversy, private companies are also being used for the imports. The Department of Health Services has signed three separate agreements with Om Surgical, Hamro Medi Concern, and Lumbini Health Care for the import of medical goods. These companies are expected to bring medical equipment worth Rs 300 million from China within next two weeks. They could yet take some time to arrive. 

As the World Health Organization puts it, the disruptions in the global supply of PPE and other medical supplies owes to, “…rising demand, panic buying and to some extent misuse of those equipment. Supplies can take months to deliver and market manipulation is widespread, with stocks frequently sold to the highest bidder.” 
To meet rising global demand, says WHO, the medical industry needs to crack up manufacturing by 40 percent. 
Nepal must increase its imports amid all these challenges. Its lethargic health bureaucracy needs to step up its game if Nepal is to tide over the corona crisis with limited damage.