Detection of new tuberculosis cases has declined by 50 percent across the country since the nationwide lockdown was enforced on March 24. Doctors say undetected and untreated tuberculosis cases could lead to a major spike in new infections and deaths.

“If not treated, one TB patient can transmit the disease to 10 others,” Dr Kedar Nursing KC, a senior chest physician and tuberculosis expert, told the Post. “If such a huge number of people infected with TB are not being diagnosed, it will lead to a public health disaster.”

In the six months since the lockdown, 102 women have died of pregnancy related complications on the way to hospital or after reaching the hospital. The comparative figures were 98 women in fiscal year 2018-19 and 95 in 2017-18.

Besides, 748 neonatal deaths were recorded in the fiscal year 2019-20, compared to 680 in the fiscal year 2018-19.

“Both maternal and neonatal deaths have increased,” Dr Punya Poudel, chief of Safe Motherhood Programme at the family Welfare Division under the Department of Health Services, told the Post. “Fear of coronavirus infection, lockdowns, and a halt in public transportation are some of the factors for the rise in death rate.”

Meanwhile, 85,492 women received safe abortion services in the fiscal year 2019-20, compared to 95,673 in the previous.

This clearly shows that access to health services has been severely affected by the Covid-19 pandemic.

“We have not only lost the hard won achievements made in the health sector but also pushed the country many years back,” Dr Kiran Regmi, former secretary at the Health and Population Ministry, told the Post. “Failure to envision the possible risks has also exposed our [lack of] contingency plan and working style.”

There is more.

Agencies under the Health Ministry said that mental health patients have been deprived of medication, suicide rate has gone up, non-Covid patients are deprived of treatment, malnutrition cases have increased in several districts, immunisation rate has declined, outbreaks of measles have been reported in several districts including in Kathmandu Valley, institutional delivery rate has declined, and antenatal and postnatal visits have declined manifold.

Lockdowns, prohibitory orders and restriction in public transportation to check the spread of coronavirus are considered responsible for the setbacks in the health indicators. Fear of infection, halt to services in several health facilities and the government decision to focus on Covid-19 made things worse, according to public health experts.

“We already have many other problems—maternal deaths, neonatal deaths, nutrition TB and HIV,” Dr Sarad Onta, former assistant dean at the Tribhuvan University Institute of Medicine, told the Post. “Coronavirus is an additional burden when we have to deal with other problems. But we are forgetting all other existing problems to focus on Covid-19, which is a mistake.”

The surge in death rate and new infections of Covid-19 show whatever the achievements or plannings the government made, the country is always at risk of losing it if it does not have contingency plans.

When the second Covid-19 case was detected on March 23, the government enforced a nation-wide lockdown the next day, which barred thousands of people from getting health care services.

As of Saturday, 71,821 have been infected and 467 have died of the virus across the country.

The Ministry of Health and Population had directed agencies under it to focus on the Covid-19 early on.

Most of the programmes of health, including immunisation and out-patient department services at health facilities, were halted.

“Due to the fear of infection and halt in public transportation, immunisation services were disrupted for some time,” Dr Jhalak Sharma, chief of the immunisation section at the Family Welfare division, told the Post.

“We have provided safety gear—personal protective equipment—and resumed the services throughout the country now.”

But the damage seems to have been done if the outbreaks of measles are any indication.

Dr Mingmar Gyelgen Sherpa, former director general at the Department of Health Services, said that contingency plan or Plan B is required when the original plan does not work but the lack of vision in the leadership and their advisers is responsible for the setbacks in achievement made by the rigorous investment of time and money over the years.

“Ministers may not know everything but their advisers should present visions for a way out,” Sherpa told the Post. “How can we expect more, when instead of experts and experienced professionals, people close to the party are appointed as advisers?”

But it is not only the political leadership and bureaucracy that have been found wanting.

International non-governmental organisations and national non-governmental organisations working in the health care sector have failed to fill the gap left by the government agencies.

“Had those agencies worked seriously, we could have avoided so many deaths,” added Sherpa.

Jitram Lama, president of the NGO Federation of Nepal, concedes that due to the restriction in public transportation and fear of infection, NGO workers could not continue their work after the government enforced the nationwide lockdown.

“We all know that this is an abnormal situation,” said Lama. “In the initial stage, we could not continue the work, but later we resumed doing our best to address the problems.”

The Association of INGOs on their part said they too have been focussed on fighting the pandemic but are ready to help in other ways.

“The Nepal government can communicate better on some of the cohesive policies like how we can continue to strengthen the health system but also support economic aspects,” said James Ginting vice, chair of the association.

Doctors say that the impact of the ongoing pandemic will remain for years.

Usha Jha, the National Planning Commission member who looks after health, said that maternal health and other non-Covid ailments became neglected issues as all are focussed on Covid-19.

“Yes, ongoing maternal, neonatal deaths and other health issues show that we are not prepared to handle a pandemic like Covid-19,” Jha told the Post. “This pandemic is something that demands much more than what we are capable of. We have not envisioned this kind of emergency.”

Authorities concerned could not make immediate action plans in the changed context.

“We have realised that we need short-, mid- and long-term planning along with contingency plans to deal with possible emergencies,” Jha added. “We have already started discussions to address the implications caused by the pandemic for health care sectors.”

Former chief secretary Bimal Koirala said that lack of planning and the will of the political leadership to mitigate risks is responsible for the increased number of deaths and the worsening plight of people.

“We do not lack resources, what is lacking is the will in the government to address the suffering of people,” said Koirala.