The second coronavirus wave exposed Nepal’s fragile health system.

As the cases started to soar beginning April, hospitals started turning away patients while acute shortages of beds, oxygen and ventilators, besides other essential medical goods, were reported from across the country.

After creating a devastating health crisis, the second wave abated, but only after claiming the lives of around 6,000 people in two months or so. After the coronavirus overwhelmed Nepal, various countries came forward to provide assistance, supplying different kinds of medical goods like ventilators, intensive care beds and oxygen concentrators, among others.

Amid a dismal vaccination coverage—only 4 percent of the population has been fully vaccinated so far—and a possible third wave hitting the country, concerns have now grown over the lack of health workers.

According to officials at the Health Ministry, inadequacy of human resources has emerged as one of the biggest challenges as the country braces for a potential third Covid-19 wave.

“We need an additional 20,000 personnel, including doctors and nurses, to make our health system more resilient against a health crisis like the one during the second wave,” said Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry. “Specialist doctors and medical officers are in a greater need.”

As of mid-July 2020, Nepal had 90,946 health personnel, including doctors, specialist doctors and health workers. But the number decreased to 90,369 by mid-March of 2021, according to the Economic Survey 2020-21.

Infrastructure remains a challenge but it could be built on a temporary basis in times of crisis, officials say. However, they say it’s simply impossible to fill the gap between the need and demand of health workers.

“We need an additional 15,000 hospital beds and logistical management has been taking place smoothly,” said Adhikari. “But we are facing difficulties managing the required staff strength.”

Considering the time it takes to recruit permanent staff, the federal, provincial, and local governments have been recruiting health workers on a contract basis.

“During our recent survey about our strengths and weaknesses during the second wave of the pandemic, we found massive staff shortages at several health institutions. They may not be able to handle the potential third wave,” said Dr Krishna Prasad Paudel, spokesperson for the Health Ministry. “The provincial governments are not getting specialist doctors required for critical care even though they are making utmost effort to recruit them by paying competitive salaries.”

The Lumbini provincial government is a case in point.

It can hire health workers for the approved 583 posts for four hospitals on a contract basis and it has also allocated the necessary budget for the purpose. Of the total posts, 463 have been filled so far.

“Despite our effort, we are facing difficulty hiring doctors, particularly specialist doctors,” said Dr Bikas Devkota, secretary at the Health and Population Ministry of Lumbini Province. “Doctors are not showing interest to join the workforce at these hospitals. I don’t know why.”

According to officials at the Health Ministry, even though medical officers have reached Primary Health Centres at the local level, there are not enough specialist doctors.

There are also concerns about a lack of paediatricians, as many believe the third wave could affect children. Children aged 14 and below are not being vaccinated in Nepal, and doctors have warned that they could be vulnerable to the new coronavirus variants.

The government in the first week of June asked hospitals to set aside 20 percent of well-equipped beds for children. But the hospitals need doctors as well to attend to children.

District Hospital, Mugu is an example. It does not have a single paediatrician even though the hospital has arranged for doctors in adequate numbers.

“We have 12 doctors, including two specialists, and 10 medical officers at the hospital,” Dr Dabal Malla, medical officer at the hospital, told the Post over the phone. “But we don’t have a single paediatrician and there is no neonatal Intensive Care Unit.”

According to him, there is also a shortage of nursing staff at the hospital.

Besides human resources, the hospital also lacks Intensive Care Unit beds and ventilators, according to Dr Malla.

Nepal received 4,126 oxygen concentrators of different capacities, 6,945 oxygen cylinders, 1.48 million oxygen kits, 13,820 body bags and 218 ventilators, among other things, from different foreign governments and domestic and international agencies between April 14 and July 4, according to the Department of Health Services.

But the country lacks human resources with technical expertise to operate some of these equipment.

According to the Nepal Society of Critical Care Medicine, technical officials with years of experience are needed to run critical care and intensive units, but they are not available in most of the hospitals throughout the country.

“Equipment can be purchased or they may be received under donations, but what will we do with such equipment when we do not prepare the manpower needed to operate these equipment?” Hem Raj Paneru, general secretary of the society, had told the Post in May.

“In some hospitals, the problem is not a lack of equipment but a lack of people with expertise to operate them.”

When the second wave of Covid-19 was ravaging the country, Tikapur Hospital in Kailali was struggling to provide care for patients because it did not have the manpower to operate ventilators.

At that time, the hospital had to send patients in need of ventilator support elsewhere.

As far as human resources for children are concerned, Health Ministry officials say they are working out on some models.

Dr Paudel, the spokesperson for the ministry, concedes that apart from medical professionals, the country faces a crunch of human resources to operate some crucial machines and equipment.