RESPONDING TO COVID-19 Health sector preparedness, response and lessons learnt GOVERNMENT OF NEPAL MINISTRY OF HEALTH AND POPULATION KATHMANDU, NEPAL RESPONDING TO A NOVEL CORONAVIRUS 2 RESPONDING TO COVID-19 Health sector preparedness, response and lessons learnt GOVERNMENT OF NEPAL MINISTRY OF HEALTH AND POPULATION KATHMANDU 2021 I Responding to COVID-19 (Health sector preparedness, response and lessons learnt) A technical committee led by Secretary Mr Laxman Aryal and co-led by Prof. Dr Jageshwor Gautam and other officials from MoHP guided the production of the report. Design, drafting and publication of this report was supported by WHO Country Office for Nepal led by Dr Rajesh Sambhajirao Pandav, WHO representative. Similarly, the production of provincial profiles was facilitated by the WHO Country Office for Nepal led by Dr Reuben Samuel, Team Lead, WHO Health Emergencies Programme. Dr Sujan Marahatta and Mr. Manish Gautam prepared the report. Additional information about this report may be obtained from the Ministry of Health and Population, Ramshahpath, Kathmandu. Cover photos: Anweshan, PMO Anweshan: Page xxvi, 1, 2, 3, 4, 6, 7, 9, 10, 11, 13, 16, 45, 57, 61, 63, 68, 73 CCMC: 22, 26 MoHP/DoHS: Page viii, 31, 34, 38, 41, 42, 43, 56, 76, 79, 80, NHSSP: Page 17 Rajan Kafle, PMO: Page ix, xiv, 5, 19, 28, 70, 86 Unicef: Page x, 59, WHO Nepal: Page 32, 36, 40, 46, 48, 54, 55, 66, 81, 82, 90 Suggested citation: MoHP. (2021). Responding to COVID-19: Health sector preparedness, response and lessons learnt. Kathmandu: Ministry of Health and Population. KATHMANDU NEPAL THE PRIME MINISTER Message from the PM When the first COVID-19 case in Nepal was washing and sanitizing. The government also made detected on January 23, 2020, the government of COVID-19 treatment free in government hospitals Nepal—much like the rest of the world—was in and established quarantine and isolation facilities. a state of confusion. The novel coronavirus was like a strange, unwelcome guest humankind knew The months-long lockdowns bought the government nothing about. The best the government could do the time it needed to build the capacity of the was put together its best doctors who specialised country’s health system for surge response. The in infectious diseases, isolate the patient who lockdowns also assisted the government in capacity had contracted the virus and protect the rest of building of the Ministry of Health and Population, the nation while it prepared a robust plan to tackle including molecular laboratory capacity to increase the virus. testing. On March 1, the government formed the High- Till date, the MoHP, under the government of level Coordination Committee for the Prevention Nepal, has carried out more than 21,000,000 PCR and Control of COVID-19, which later became the tests and it promises to continue conducting such COVID-19 Crisis Management Centre, to curb the tests. The government has successfully built 83 spread of the virus across the country. It imposed a PCR testing laboratories. nationwide lockdown and a ban on international flights and Point of Entries to stop the inflow of Despite these efforts, there was no stopping the people into the nation. virus. Soon, cases grew. And the effect of the lockdowns was soon felt in multiple sectors—from Despite having limited resources at hand, the the hospitality sector to the construction field. The Government of Nepal was able to tackle the crisis very fabric of society was paralyzed. effectively and was able to avoid it turning into a catastrophe. This was only possible because of But the timely measures the government adopted smooth multi-sectoral engagement, with assistance very early on in the pandemic, although distressing from the World Health Organization, UNICEF, to those lowest in the economic strata, helped among other partners. contain the spread of the virus to a great extent. The government also implemented effective Education, health, drinking water and sanitation information disseminating measures, through SMS and employment were among the sectors hurt and caller tunes services, educating the masses about most by the pandemic, according to the Human the importance of social distancing, mask use, hand Development Report 2020, published by United III Nations Development Program. However, This year alone, the foundation of 309 hospitals at according to the report, Nepal’s growth for the the local level have been laid. Once these hospitals next three-year period is projected to be at 5.3 are fully constructed, by the end of the next two percent—a positive statistics. years, an additional 8,000 beds will be available in hospitals. When the government eased the lockdowns, to not hamper the economy of the country further, the Additionally, next year, 204 new hospitals will be government did not stop the national pride projects constructed. In total, there will be a total of 300 and started working to secure vaccines. ventilator beds, 400 ICU beds and 2,000 high- dependency beds. The government is also in As the number of COVID-19 cases dwindles, the process of constructing new 300-bed infectious country strives to get back up again. With the aid of diseases hospital in Kathmandu and a similar 50- India, the Government of Nepal was successful in bed hospital in each of the provinces. procuring two million doses of vaccine in February. The government is currently also committed to Nepal is the second country in the South Asian reducing deaths and increasing hospital capacity. region to start mass vaccination campaigns. And while the new variants of the virus might Until March 20, over 1,650,000 people have pose deeper challenges, the government is hopeful been administered with the first dose of the two- that strengthening the health system will overcome dose virus. this issue. The coronavirus pandemic brought with it much I am glad that MoHP has come up with this useful difficulty and pain, but it also taught governments resource that will serve as institutional memory for across the world how important it is to be vigilant the whole nation. I would like to congratulate the and prepared to handle such a crisis—as there team for making this happen. will certainly be in the future. That is why, the Government of Nepal is now working on making Like countries across the world, Nepal too was at the country’s healthcare system stronger and a loss of how to handle this unprecedented crisis. resilient: already, in hospitals and health posts Economies around the world collapsed, and the across the country, from 2492 (or 38. 4 percent) of stress was felt here too. But the Government of hospital beds have been added, making the total of Nepal persevered and with preparedness, resilience hospital beds in the country increased from 6,490 and clear communication with the public, it was to 8,982. able to meet the crisis head-on. Hon. K.P. Sharma Oli Prime Minister IV KATHMANDU NEPAL MINISTER OF HEALTH AND POPULATION Message from the Health Minister There is no doubt that COVID-19 is the biggest viral threat overwhelming situations. As the government had announced humankind has had to face this century. The pandemic has not a nationwide lockdown much before cases had proliferated, it only caused immense damage to human life but also put the world also had time to train lab technicians to handle tests, as well economy on a standstill, pushing millions further into poverty. as security personnel. The Ministry also kept all information related to COVID-19 transparent with the public and broadcast When the first-ever case surfaced in Wuhan, China, on December a daily media briefing to provide updated information. 31, 2019, we had no inkling of the crisis that awaited us. The Ministry effectively coordinated with its neighboring It took less than a week for the virus to reach Nepal, with the country, India, who generously donated 1 million vaccine doses. first case being detected on January 23, 2020. The country The vaccination drive has begun and the MoHP has been directed responded quickly with varying public health interventions in by the Cabinet to purchase additional vaccine doses directly from an effort to curb the spread of the virus, but the government did India to vaccinate the elderly and other vulnerable groups. not have any infrastructure in place to carry out tests. However, sensing the urgency of conducting as many tests as possible, I would like to thank WHO, UNICEF, and other external the Ministry of Health and Population jumped into action and development partners for their support in combating the crisis. My within a few months we were able to enable over 80 labs with special thanks goes to MoHP officials, provincial level officials and the capacity to test over 10,000 samples a day. local leaders for their coordinated efforts in dealing with the crisis. To further bolster its response to the virus, under the Deputy This report contains detailed information about how the Prime Minister and the Minister for Defence Ishwar Pokhrel, Government of Nepal tackled the crisis brought on by the novel the government formed the Corona Crisis Management Centre coronavirus. In the following pages, readers will find not only (formerly functioning as the High-level Coordination Committee) an overview of the decisions, policies, and directives adopted on March 1, 2020 (Falgun 18, 2076). by the Nepal government to fight the deadly pandemic but also the progress the Ministry made in its efforts to prevent and Under the new body, all three tiers of government worked control the spread of COVID-19. We hope readers will be able together tirelessly to keep the spread of the virus under check to actively engage with the information thus provided.