After Nepal was hit by the first wave of the Covid-19 pandemic in April last year, the Health Ministry, based on the number of hospitalisations, started estimating the amount of medical supplies the country would need in the event of a second wave.

This was a joint project between the Covid-19 Crisis Management Centre (CCMC) and the ministry.

“It was agreed that 50 percent of the supplies would remain in stock, while the rest would be distributed as per the need to different hospitals,” states a government document titled Responding to Covid-19: Health Sector Preparedness, Response and Lessons Learnt, which was released early this year.

Even though it was agreed long ago between the ministry and the CCMC that the country needs to maintain a good stock of medical supplies to tackle the pandemic, the government’s failure to stock up on such crucial supplies resulted in a massive shortage of oxygen, ventilators and hospital beds, among other things, during the second wave of the pandemic this April.

But, on July 30, the Covid-19 Management Directive Committee headed by the Prime Minister instructed the Health Ministry and the CCMC to do the needful to ensure a reserve of enough medical equipment, goods and human resources to tackle the pandemic.

“We are preparing a plan on how to maintain a reserve of medical supplies in line with the discussions held at the CCMC,” said Upendra Dhuganana, a senior official at the Department of Health Services. “We have yet to determine the quantity of medical supplies we would need, how long they would last and the place for storage.”

Although he did not give details of the existing stock of medical supplies, he claimed that the stock is enough for at least a month. The government’s document says one of the lessons learnt from the first wave of the pandemic is that the clinical management of cases needs to be effective, with a focus on hospital beds, ICU beds, ventilators, and other medical supplies, especially medical oxygen.

But to meet the urgent need for medical supplies, especially oxygen-related, during the second wave of the pandemic, the government almost fully relied on foreign governments, donor agencies, domestic and international non-governmental organisations and the private sector donations.

According to Dr Bhim Sing Tinkari, director at the management division under the Department of Health Services, the department procured 1,000 oxygen cylinders and 50 ventilators when the country was hit by the second wave of the pandemic. The ventilators arrived in early July after Covid-19 cases had come down significantly.

In contrast, the department’s data show that the country received 4,126 oxygen concentrators, 6,945 oxygen cylinders, 13,820 body bags and 218 ventilators, among other things, from different foreign governments and domestic and international agencies during the period from April 14 to July 4.

But after a year, things appear to be back to square one.

“There has been discussion on the need to maintain a strategic reserve of medical goods and equipment. The CCMC Directive Committee has directed the Health Ministry and CCMC on the matter,” said Nurahari Khatiwada, spokesperson at the CCMC. “But I don’t know whether there has been any assessment of the available medical goods and equipment and how long the existing stock would last.”

He said that the required stock of medical goods should be evaluated based on potential Covid-19 cases and hospitalisations.

“If the assessment is for maintaining the stock of medical goods for six months, we have to work accordingly,” he said.

Khatiwada, quoting Health Ministry officials, said the country has the stock of personal protective equipment and face masks for a month.

“We have learnt that there is a huge shortage of human resources in the areas of critical care with many types of equipment having remained idle at hospitals in lack of human resources to operate them.”

With the country seeing a rise in Covid-19 cases, Health Ministry officials say the shortage of human resources has emerged as one of the biggest challenges for tackling the looming third wave of the pandemic.

“We need an additional 20,000 personnel, including doctors and nurses, to make our health system more resilient against a health crisis,” Dr Samir Kumar Adhikari, joint spokesperson for the Health Ministry, told the Post in late July. “There is a huge need for specialist doctors and medical officers.”

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.

Dr Baburam Marasini, former director of the Epidemiology and Disease Control Division under the Department of Health Services, said that the country lacks both medical equipment and human resources to tackle pandemics like the current one.

“Even in normal times, the government lacks medical equipment and human resources in the health sector,” he told the Post.

According to him, internationally accepted norms are that there should be a medical officer per five ICU beds and each bed should have a designated nurse.

“But this has not happened in the case of Nepal,” said Marasini. “There should be 44.5 health workers per 10,000 population to meet the Sustainable Development Goals. But we are far behind.”