When Nepal witnessed the peak of a devastating second wave of the pandemic last month with people dying from a lack of oxygen and almost every second test returning positive, the world’s eyes turned to the country.

Much medical aid poured in.

From oxygen cylinders from China to antigen test kits from Switzerland, from oxygen concentrators from Spain to ventilators from the United States and United Kingdom, Nepal received much in coronavirus relief. More than two dozen countries have extended support to Nepal during the last one month alone to fight the pandemic.

But there were also reports of politicians taking oxygen cylinders to their constituencies, bypassing the government mechanism.

This has raised questions on whether the foreign aid is reaching places it is needed the most and put the spotlight on not only the government’s process of distributing aid across the country but also donors’ scrutiny on the utilisation of their support.

“Accountability should be established as we have heard that some politicians have misused these medical goods provided by foreign donors,” Amod Pyakuryal, a medical sociologist, told the Post. “The medical support should not be seen as the optics and their arbitrary distribution should be discouraged.”

According to serving and former government officials that the Post talked to, there is a system in place to disburse the aid and to audit the distribution system.

“We prepare a distribution plan every week and as per the plan we distribute the medical equipment to needy hospitals,” Upendra Dhungana, a senior Health Ministry official who looks after logistical and management issues, told the Post. “We also send them to different provinces as per our plan which is based on demand from them.”

Once medical assistance lands at Kathmandu airport, it is received by either the health minister or senior Foreign or Health Ministry officials.

After the materials go through the customs, they go to a warehouse near Tribhuvan International Airport where the aid is logged into the electronic logistic management information system (eLMIS) of the Ministry of Health and Population, helped set up by the US Agency for International Development, and stored at the humanitarian aid staging area at Sinamangal.

The electronic logistics management system provides real-time information on medical supplies and commodities across Nepal’s supply chain which starts in Kathmandu and includes the National Public Health Laboratory, nine central medical stores, 39 designated Covid-19 treatment hospitals, seven provincial warehouses and public health laboratories, 77 district health offices and 753 local government stores.

Every week the Management and Supply Division of the Health Ministry prepares a distribution plan as per the demands placed by various hospitals and provincial governments as well as part of its own arrangement.

“There is no chance of misuse of such foreign assistance because we have to later report each and every foreign mission about their aid,” said Dhungana. “We do not keep records of the distribution of small stuff like masks or gloves but all items donated by foreign missions are under our auditing purview.”

But former Health Ministry officials say such aid does get misused.

“There is no exact data on how much of such donation or support goes unused or misused but around five to seven percent of medical support either the government has procured or received in grant is misused,” former health secretary Kedar Bahadur Adhikari said.

According to him, in his experience, a donor country or agency hardly seeks reports on deployment of its aid or assistance and the status of its utilisation.

“If they get third party information that their support or aid is being misused or has not come into use or left in limbo, then they pick up such issues during the meeting,” Adhikari told the Post.

The Post contacted a number of Kathmandu-based diplomatic missions of donor countries to ask them how they are monitoring their pandemic aid to Nepal. Some responded, others didn’t and some talked on condition of anonymity.

Some countries like Australia extend support directly to the local and international non-governmental organisations they have partnerships with.

On May 21, the Australian Embassy in Kathmandu announced an additional 7 million Australian dollars (NPR 635 million) in funding to Nepal to support the response to Covid-19.

“This funding will be delivered to our trusted and established partners working on the ground across Nepal, in coordination with the work being undertaken by other donors including the US, UK, Japan and UN agencies,” the Australian Embassy said in a statement issued earlier.

According to Dhungana, when foreign donors have their preferences, the Nepal government channels the aid as per those preferences when it goes through the Health Ministry.

In an email response, the US Embassy in Kathmandu said that USAID keeps track of the commodities from the time they are unloaded upon arrival into the country until they reach their end user.

“We are also supporting Nepal’s Ministry of Health and Population through additional human resources as they take the following steps to track the commodities and make sure that they end up where they are most needed,” the US Embassy said.

The United States says it has three steps to keep track of its aid.

The first is counting the incoming shipments of commodities to make sure the quantities and items match what was expected; the second is feeding the information on the incoming items and quantities into logistics management software (eLMIS); and the third is making and following a distribution plan for moving the commodities rapidly and efficiently to where they are needed the most.

The plan uses information on stock levels and requirements in different areas to decide where, when, and in what quantities to ship commodities, the embassy said.

During the second wave of the Covid-19 pandemic, China has donated the largest amount of medical support from its mainland and provincial governments.

But the Chinese Embassy in Kathmandu, despite repeated calls and messages from the Post, said that it had “no comment” over whether the Chinese medical support to Nepal is properly used or not and on whether it is following up with the government of Nepal or not.

On the other hand, in an email response to the Post, the European Delegation to Nepal said that the EU is keeping track of the status of medical equipment and supplies provided by the EU member states through the government system.

“All these can be tracked in eLMIS,” it said.

But foreign donors are also aware of misuse.

“At the ground level, we are planning to request our project partners to monitor the use of the equipment and supplies,” said the European Union Delegation to Nepal in the email.

A senior official of a western embassy told the Post, on condition of anonymity, that it is very difficult to get updates on its aid from the government side.

“So we have adopted the multi-pronged strategy,” the official said, referring to its disbursement of aid through the government as well as its development partners.

An official of another diplomatic mission, however, said that they do not have the authority to monitor the government of Nepal so they follow up after delivering the support.

But the agency does express concern if it gets reports of misuse.

“Once we hand over the medical support to the government, that comes under the purview of Nepal government but if we read news or get information that our support has gone useless or misused, we do raise the concern with the relevant government agencies,” he told the post on condition of anonymity.

Dhungana of the Health Ministry, however, said that the government will let the donors know how and where their aid was utilised.

“Once this Covid-19 pandemic situation gets normalised, we will then send reports on where their medical assistance has gone,” he said. “There is no chance of misuse of such foreign assistance because we have to later report to each and every foreign mission about their aid.”

But Adhikari, the former health secretary, is sceptical about Dhungana’s claims.

“There is no culture of informing donors about their support or of donors asking us about the status of implementation,” said Adhikari.