Healthcare Disaster Preparedness in Nepal

Dr. Calvello Hynes is currently teaching in the Colorado School of Public Health. She offers her students the opportunity to create blog posts to highlight current policies in global health.

This entry is by Alexa Hansen MPH candidate, submitted July 22, 2019

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Monsoon Conditions Impacting South Asia

Monsoon conditions starting on July 11th, 2019 have resulted in massive flooding and landslides, impacting areas of South Asia including India, Bangladesh, and Nepal. In Nepal alone, the most recent estimates include 90 deaths, 29 missing, and nearly 12,000 households displaced due to massive flooding and landslides. The most current report on the situation can be found here. The total impact on the Nepalese population is still to be determined, as these natural hazards continue to impact the country.

Most commonly reported are the immediate impacts and consequences, such as he death toll and damages. Less commonly reported are the long-term impacts that affect people’s livelihoods and wellbeing. It has been reported that the government of Nepal has deployed response teams to the region, but comprehensive assessments of the damages and losses are not yet known.

Historical Context

In 2015, 7.8 earthquake devastated regions of Nepal, killing around 9,000, injuring over 22,000 and displacing about 2 million, not to mention the total damages to infrastructure and people’s long-term livelihoods. The majority of health facilities in the affected areas were completely destroyed or partially damaged. The destruction of regular healthcare facilities resulted in thousands going without primary care required to treat chronic conditions such as diabetes, cardiovascular disorders, tuberculosis, respiratory infections, or even mental health conditions. It was not until 2016 that facilities were operating at a normal capacity. Steps have been taken towards improving disaster preparedness since the aftermath of the 2015 earthquake, including healthcare infrastructure, community engagement and health education.

Lessons Learned from 2015                                                                               

The World Health Organization (WHO) published a report on the post-earthquake health-service support in Nepal. Gaps in health services were identified following the earthquake, including the critical challenge of meeting the population’s regular health needs when the facilities had been damaged or were nonoperational and the amount of time it took before the facilities reached pre-disaster operational capacities. It had also been realized that health officials had to budget or means to repair facilities following disasters, or even a way to replenish supplies, including medication. The Nepal Center for Disaster Management (NCDM) aims to improve community awareness, capacity building strategies, resource availability, interagency coordination between government, agencies and stakeholders to more adequately address risk reduction and response during disasters. The NCDM acknowledges challenges with poor governance and public awareness, especially in a region prone to multiple natural hazards. According to the Nepal Disaster Management Reference Handbook (August 2017), the Nepalese government has been working to improve resiliency and preparedness through policy change and program development, such as the Natural Calamity Relief Act and the Central Natural Disaster Relief Committee. Within this handbook, challenges within the national healthcare structure are addressed, highlighting the various aspects of public health that are threatened during natural disasters.

Looking Forward & Questions to Consider

Nepal faces various challenges in improving emergency response and preparedness, including that in their national healthcare system. Many rural communities are difficult to reach and may be a considerable distance from the closest healthcare facility. If that facility is damage and unable to function, it leaves populations without needed medical care. Humanitarian aid and United Nations agencies have worked with Nepal in relief, recovery and rehabilitation efforts, but ultimately the responsibility of implementing adequate disaster preparedness in Nepal’s healthcare system lies with the government. In a country that is economically struggling, what can be done to substantially and rapidly improve in an area so prone to disaster cycles interrupting infrastructure development? Furthermore, how can an adequate health response and preparedness plan be developed and implemented in all regions including communities that are geographically isolated? This is a complex issue that requires examination, collaboration and discussion across multiple disciplines. While healthcare facilities have been rebuilt after the 2015 earthquake, the constant risk of natural hazards threaten an already fragile infrastructure. For Nepal to “build back better,” is outside aid an international cooperation required?

With the destruction ongoing the full impact of the monsoon on Nepal’s heath system has yet to be revealed. While there seems to be a significant effort in discovering the wide array of health threats and gaps in treatment during disasters, implementing policy change and preparedness plans are another step that require dedication, time, and resources, and examples of these successes are more difficult to come by. One can only hope that even amidst unavoidable damage during disasters, the lessons learned from previous disasters and identified gaps in services will prove to be making some progress.