At a time when the nation is going through the second wave of the Covid-19 pandemic, news about deaths mostly attributable to a paucity of oxygen, ventilators and intensive care unit (ICU) beds has a telling effect on the mental, psychological and social well-being of people. Of late, healthcare supply chain bottlenecks, among others, has emerged as one of the most critical challenges. Nepal is struggling to grapple with the pandemic due to perennial challenges such as the non-availability of qualified healthcare professionals and other personnel in adequate numbers, and strained health infrastructure due to lack of beds, hospitals, modern technology and medical equipment.

Undoubtedly, Covid-19 has exposed the vulnerabilities of our overstretched healthcare system and the disaster seems to be looming large every passing day. However, such a precarious situation could have been averted had there been a robust supply chain with efficient management of medical logistics. Faced with similar breakdowns, countries have come up with innovative solutions. Failure to learn a lesson from the first wave is proving costly. The government has not succeeded in assessing the need for building a viable and sustainable healthcare system. The shortage of doctors and nurses is acute as is evidenced by the fact that they are available in the ratio of 0.17 and 0.50 respectively per 1,000 population as per the 2013 data, and the situation has hardly improved today.

Possible remedies

Mobilising and utilising the services of interns and students in their fourth year pursuing an MBBS degree under the supervision of a senior retired medical professional to take care of Covid-19 patients can be a viable solution to resolving the issue of inadequate doctors. This can be done by allotting an open dedicated area with the necessary infrastructure, such as mobile toilets and tents used during the earthquake. Such an alternative in the form of makeshift hospitals can be built instead of treating patients in crammed regular hospitals. For instance, the United Kingdom converted an exhibition centre into a temporary hospital in just nine days.

Timely procurement of the required medicines by setting up the necessary infrastructure is preliminary. Should Nepal be receiving overseas vaccines like Pfizer in the form of a grant, their storage and supply would be another challenge. Effective inventory management demands timely initiatives. Diversifying the sourcing of vaccines is desirable as there is a possibility of donor countries stopping supply either on account of capacity constraints at their end, vaccine nationalism or vaccine geo-politics.

The pandemic has thoroughly exposed the hollowness in our data management system. Until some entrepreneurs started an online data management system, there was no mechanism to track the availability of the number of beds, ventilators and ICU beds in hospitals. Neither is there any mechanism to estimate the required personal protective equipment (PPE) kits for medical personnel, paramedical staff, ambulance drivers and those involved in clearing and carrying dead bodies, nor any means to estimate the usage and need for oxygen cylinders in hospitals. Had such mechanisms been in place, the oxygen used for industrial and other commercial purposes could have been diverted for the timely treatment of patients.

It is important to revamp the existing health care supply chain. Experts with proper database governance leading to better logistics management of Covid-19 and health-related supplies are the need of the hour. Monitoring of medical supplies in the market such as PPEs, sanitisers, masks and gloves need to be done on a regular basis. By designing and instituting proper control mechanisms, hoarding and misuse of medical supplies like PPE, gloves and oxygen and panic buying could have been averted. Any unauthorised and unverified use of oxygen cylinders for individual purposes at homes should be tracked to ensure their equitable distribution among the needy. News about people convicted of selling adulterated sanitisers and engaging in black marketing need to be publicised so that it acts as a deterrent to potential offenders.

A well-designed data management system will help in coordinating the initiatives and interventions on the part of the government, hospitals and private businesses. The way the Health Management Information System appears on the website of the Department of Health Services within the Ministry of Health and Population looks archaic and non-functional. The small-scale initiatives undertaken by individuals in the private sector regarding data management need encouragement and support from the government. The resolution of issues and solutions for problems during pandemic times warrant the needed technical support and IT platforms. Reliable data which can be timely accessed can be vital in overcoming most Covid-19-centric challenges.

Local production

The worldwide shortage of PPE kits and especially the clarion call by the World Health Organisation to ramp up their production by 40 percent to meet growing global demand suggest that we rely on local innovative solutions. To become self-reliant, local manufacturers need to be motivated and incentivised. At present, low-cost PPEs made by local garment houses are providing some protection to Covid-19 warriors. Despite the fact that they may not meet international standards, domestic innovations in the production of gloves, face masks, face shields, N-95 respirators and gowns besides PPE kits are praiseworthy.

To contain Covid-19 effectively, there has to be proper coordination and alignment of the efforts put in by the state and local government units and agencies to rule out fragmented efforts in ordering and procuring health-related supplies. The creation of a Covid-19 fund by the government at the provincial and local levels to systematise the entire gamut of activities under logistics management would be a step in the right direction. Effective testing, tracking and treatment of infected people bear results only when the data management system is maintained efficiently at all levels. These testing times do call for maintaining transparency in the existing centralised supply system as well. Adequate preparations on all fronts is the need of the hour to keep the country ready to deal with a potential third wave.