Monsoon, dengue and weakness in public health infrastructure

The ongoing monsoon season and subsequent flooding in many regions of Nepal are likely to cause severe outbreaks of various water- and vector-borne diseases, including dengue. According to the latest WHO statistics, Nepal recorded over 39,360 dengue cases and 20 dengue-related deaths between January and October 2023.

In Sunsari district of Koshi province, there were 16,096 dengue cases, accounting for 40.9% of the total cases. Tanahun district in Gandaki province reported 5,050 cases, which is 12.8% of the total. As of 9 June 2024, government statistics show that approximately 1,130 dengue cases were reported in 71 districts, with Kathmandu reporting the highest number of cases (114), followed by Jhapa (111). This rapid increase has overloaded the already fragile health systems in the country, highlighting the importance of enhancing Nepal’s public health preparedness and mitigation abilities.

Challenges in Nepal’s health system

The introduction of federalism in Nepal has brought both benefits and drawbacks to the country’s health systems. While there have been improvements at the local level, several shortcomings have exposed system failures. A cross-sectional study published in the Health Research Policy and Systems journal identified major issues such as a disorganized organizational structure, delays in fund releases, uneven distribution of healthcare personnel, and inadequate monitoring and supervisory capacity. The system is not fully stabilized, and it will take time to capture the full impact of federalization. Current difficulties include a lack of coordination within and between governments, program and fund duplication, untimely fund releases, underutilized funds, staffing deficits, skill mismatches, and constant problems with medicine supplies.

Lessons from the 2022 outbreak

By the end of 2022, Nepal had 55,000 people affected by dengue, with 88 fatalities, highlighting the challenges within the healthcare system. The response was inadequate, as most hospitals were overwhelmed, and community-level measures were insufficient. The WHO report noted that the timeliness of the response was not optimal, leading to a significant increase in morbidity and mortality rates. This emphasizes the crucial need for Nepal to improve its disease surveillance, outbreak preparedness, and community engagement efforts.

Addressing the challenges

Given the current situation in Nepal and the threat of a dengue outbreak, the government and relevant health agencies must work closely to strengthen the healthcare framework. This involves improving coordination between central and local governments, ensuring timely distribution of funds, and addressing the irregular distribution of health workers. Enhancing outbreak surveillance systems, vector control efforts, and implementing widespread community awareness initiatives will help prevent the impending dengue fever outbreak.

The WHO report also noted that dengue disproportionately affects different population groups within communities. Pregnant and lactating women, children, and elderly citizens are at higher risk, while young adults engaged in outdoor work face higher exposure risks. Targeted interventions to protect these vulnerable groups are crucial. The recent incidence of dengue fever in 2023 indicates that Nepal requires a long-term and progressive commitment to reform its public health system. With the monsoon rains now affecting the nation, the challenge is to prevent an outbreak that could overwhelm the already fragile public health system.