‘Nepal risks losing decades of progress on health care’Dr Bibek Kumar Lal, director of the Family Welfare Division under the Department of Health Services, on Covid situation, vaccination challenges and how badly the pandemic impacted the country’s regular health programmes.
The government has committed to vaccinating all eligible populations by mid-April. So far 16,324,979 people, or 55.9 percent of the total population, have been fully vaccinated against Covid-19. It took over a year for the authorities concerned to reach the 55 percent mark since the country launched its vaccination campaign on January 27 last year. Now, the government has to inoculate around 10 million more people to make the country fully vaccinated against Covid-19, as per the total population of Nepal estimated by the Central Bureau of Statistics at 29,192,480.
Vaccination of children aged between five and eleven years has not started yet and immunisation drives have been halted in some places due to various problems.
The pandemic created such chaos in the second wave last year that the entire focus has been on fighting Covid-19. Then the Omicron variant threatened the country a few weeks back. After seeing a surge in cases, infections have declined over the past few days.
In a country like Nepal, which has a fragile health care system, the pandemic posed a major challenge, as there are other health issues that cannot be ignored.
In this context, the Post’s Arjun Poudel spoke with Dr Bikek Kumar Lal, director at the Family Welfare Division under the Department of Health Services, about the challenges in meeting the vaccination target and other health related issues of Nepal.
This interview has been condensed for clarity.
The government has committed to inoculating all eligible populations by mid-April. It’s just two months. Will we be able to meet the target?
Every public health programme initially faces a challenge, starting with hesitancy. It’s not easy to convince people about something that’s new.
But when people understand the importance of the programme, they gradually accept it. Whenever there is a rise in cases, acceptance is faster as people see and hear about ways to tackle the disease. Then at one point, we reach the plateau. In the case of Covid-19 and vaccination also, it was the same.
We all know the journey after the base camp becomes even more challenging. So we also have challenges ahead when it comes to meeting the target. We have already immunised people in the accessible areas, and those who were aware of the risk and importance of vaccines and who are educated.
We have to administer the vaccine in a proactive manner. We have to work hard, focus on micro-planning measures, reach every door and launch a search and immunise programme. If we do these things, we can meet the target by the set deadline.
In some districts, the vaccination programme has halted since November and in other mountain districts, the programme has been discontinued, due to adverse weather conditions. What is the plan to address these hindrances?
I accept that we have huge challenges ahead. The ongoing vaccination is a national campaign—launched aggressively for a short period. Concentrated efforts should be made for the maximum coverage. And we have been into the programme for more than a year now. When the timeline extends, the whole purpose could get weakened.
We from the federal government can only make an appeal to provincial and local level government bodies. We cannot enforce our decisions. Not only the vaccination programme, but other health programmes are also being implemented purely on a goodwill basis.
The vaccination programme might have been halted only in some districts and in some local units. In mountain districts, there are some practical problems. If the vaccination programmes have been halted despite having sufficient doses and there are no practical problems, it is a serious issue, which must be addressed at the earliest.
The government does not have the accurate data on the vaccinated and unvaccinated people. Nor does it have detailed records of vaccine supplies. What is the plan to address the problems of data management, which has been an issue since the start of the vaccination drive?
Electronic medical record is a good concept and many countries throughout the world have been using it. Countries like India have proved that it is possible. When a country of more than 1.3 billion people can keep its medical record up to date by using electronic methods, why can't Nepal, which has less than 30 million population?
For proper medical record keeping, we should have planning and long-term investment. We used the paper-based record system for a long time. Due to lack of sufficient staff, our medical record keeping system has not improved. Health workers, who have to administer the jabs, have to update the medical records as well. They are also the people who have to be deployed to deal with the surge of infections as well as to address other regular health issues. They are overstressed and overburdened.
Having said this, I am not trivialising data management as it is a major issue. We must improve our data keeping.
What is the current stock of vaccine doses? Are they sufficient for booster doses?
Actual number of the doses in stock can be provided only by the Logistic Management Section. I can say that we have sufficient doses to administer booster shots to those who were inoculated six months ago. And we have several commitments of the supply, which will help us continue the vaccination programme. We have requested all eligible people to get inoculated, if they have not got any doses yet; get second doses if inoculated with the first dose only and get booster shots if they got their second shot six months ago.
From the stage of crisis of vaccine doses, we have succeeded in managing sufficient doses to inoculate the entire population of the eligible age group. That we have also started booster programmes for all eligible people, we must say we are on track.
We have many other health issues apart from Covid-19. Since the start of the pandemic, the entire strength of the government has been diverted to fight Covid-19. What have been the impacts of the pandemic on other health issues?
We all know that we have limited financial as well as human resources. Due to Covid-19, our regular health programmes have been badly affected. There’s no doubt about that. We had to divert our human resources for the management of Covid cases. Those who have been employed for regular childhood vaccination have been deployed to vaccinate people against Covid-19. Health facilities have been designated Covid-19 treatment facilities.
Patients of other ailments even feared visiting health care facilities for services.
Several programmes related to maternal health, child health, nutrition, mental health, regular health care services and non-communicable diseases have been impacted by the pandemic.
The progress we made in the health care sector by spending millions of rupees and years of investments faces a risk. Several indicators of health have worsened after the pandemic.
Health workers who have been working continuously for more than two years are exhausted. As the pandemic is a big issue and has affected the entire nation and the world, our priority was saving the lives first.
But there is no denying that the pandemic has caused such a huge impact on our regular health programmes, that we might have to start all over again, and this will be an enormous task.
For how long will we keep focussing on Covid-19?
This is a million dollar question. As long as the pandemic continues to be a big issue, we cannot ignore it. The world has not seen such a devastating health crisis in decades. If other variants of lethal types do not emerge and the infection rates decline, we can—and should—focus on our regular health programmes.
What would have been our situation had Omicron, the new super contagious variant of the virus, been as deadly as the Delta that wreaked havoc during the second wave?
The third wave of the pandemic, driven by Omicron, the new iteration of the virus, spread so fast that we could not get time to enforce restrictive measures. The virus appeared to be milder than Delta, hence there was not much damage. If the virus variant was deadly like the Delta variant, our situation would have been much much worse. Like some European countries, which faced the worst and terrifying situation in the first phase of the pandemic, our condition would have been worse than theirs, as our healthcare system is weaker.
What lessons have we learned from the pandemic?
How we will deal with the future pandemic could provide a better answer to the question as to what we learned from the ongoing pandemic. If we start digging a well after a fire breaks out, it will mean that we learned nothing, like we forgot everything after the devastating earthquakes of 2015.
I think we have learned a lot from this pandemic. Despite having limited resources, and so many constraints including confusion due to the implementation of federalism, we managed to cope with the situation.