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.
