PREVENTION 

COVID-19 prevention strategy — government interventions, health sector, agriculture and food supply sector and public and civil society.

1. Government interventions (provision, stimulus packages, migrants policy, businesses and jobs)

The COVID-19 pandemic has created an unprecedented scenario in which a socio-economic crisis has developed with an end to economic activities and a reduction in income opportunities for millions, especially those in the informal sector. COVID-19 has not only affected major economies and livelihoods across the world, it has also exacerbated many existing economic vulnerabilities in more fragile and emerging economies. Economic crises come with a time lag, so the socio-economic impacts may be greater still in the longer term.

The impact of the outbreak is felt most severely by those individuals and households in the informal economy, migration, tourism and travel sectors. In addition to macro-economic impacts, micro impacts are most visible especially in the informal sector of the economy, which is estimated to make up 60-70 percent of Nepal's workforce and are not covered by insurance (e.g. social security allowance, health insurance). Within this, urban areas have already witnessed the first phase of the economic slowdown to be potentially followed by rural areas due to their dependence on remittances, slower demand for agriculture products and labour in urban areas. Early indicators suggest that vulnerabilities may increase disproportionately for migrant workers, informal labour, small businesses, rural communities due to potential loss of employment, travel restrictions, inflation, food and fuel shortages etc.

Assessments indicate that the most affected and at-risk population groups are informal workers, daily wage dependent households with limited to no savings across sectors, seasonal and non-seasonal migrants returning to Nepal, micro-entrepreneurs from disadvantaged communities, women-led businesses (among others). The government wants to pre-empt and prioritize socioeconomic and livelihood recovery to more longer-term solutions for economic stabilization (COVID-19 NEPAL: PREPAREDNESS AND RESPONSE PLAN (NPRP), 2020).

The government of India is sending all the Nepalese workers back to Nepal. Upon their return to Nepal, people did not have to be quarantined and the cases of Corona have increased rapidly. The government of Nepal should immediately have obliged these people to quarantine upon return. That could have prevented many infections.

The World Bank approved on Thursday June 11, 2020 a $450 million project to help Nepal improve its roads and set the course for post-Covid-19 economic recovery through greater cross-border trade, more jobs especially for women, and better road safety (The Kathmandu Post, 2020). With this opportunity, the government can ensure that more jobs become available in their own country. Less people have to work in other countries, like India, and that can prevent the country from an economic crisis during an outbreak like the coronavirus. The project will reduce the time and cost of moving goods and boost Nepal's trade, which accounts for about 40 percent of the country's economic output.

The government of Nepal should provide awareness around the coronavirus. How can a company continue during a crisis? Think about the social distance and hygiene measures to prevent the country from further cases. In addition, the government must be transparent and clear in the measures that are taken. Current conditions create anxiety in people because they don't know what to expect. With the interventions that emerge from Nepal's preparedness and response plan, the government wants to protect the country from further economic decline.

  • Prevention and protection messages disseminated at scale through health and community workers with a focus on reaching vulnerable population groups.
  • Engage youth networks to reach out to children, teachers, parents and surrounding community members, promoting correct information about COVID-19 as well as good behaviors / practices in terms of hygiene and basic health care.
  • Mobilize migrant network/organizations to conduct migrant outreach/education activities to raise awareness in the migrant communities, internal migrants working at slums or brick industries, monasteries and other congregated settings.
  • Engage with social and media influencers in coordination with NHEICC to spread awareness on COVID-19.
  • Disseminate prevention messages, adapted to the local context and language, through mass media, social media and community-based networks.
  • Mobilize migrant communities to raise awareness on hygiene by developing linguistically and culturally appropriate modules (COVID-19 NEPAL: PREPAREDNESS AND RESPONSE PLAN (NPRP), 2020).

2. Health sector (WASH, hospitals, mental health)

WASH

Water, sanitation and hygiene. Universal, affordable and sustainable access to WASH is a key public health issue within international development and is the focus of Sustainable Development Goal 6.

As Nepal is one of the world's poorest countries with 45% of the population below the poverty line. It is thus far unlikely that a large part of the population has daily access to clean water, affordable sanitation and good hygiene. The earthquake in 2015 left the preparedness of Nepal for a virus as the COVID-19 less than ideal. Most people were still rebuilding their house and the costs for that rebuilding didn't make the population less poor. As a little of 80% of the population lives in rural area the supply chain of hygiene products and good sanitation to those areas are limited. This results in that of the 28,9 million people only 10.8 million people in Nepal do not have access to improved sanitation, and 3.5 million do not have access to basic water services." The main causes of morbidity are diarrheal disease, dysentery, cholera and typhoid. But now that COVID-19 has also infected its first patients in Nepal, precautions and extra attention must be going to healthcare.

The goal of a well-coordinated effective WASH response to the COVID-19 among the government, can specified in the following objectives:

  • Establish WASH services in schools, healthcare facilities and accessible, public spaces for prevention and control of the COVID-19, focusing on facilities in the provinces/districts of Nepal already effect.
  • Encourage coordination between provinces and districts for effective execution of WASH response for COVID-19 for the entire population to promote personal hygiene and establish essential WASH services.
  • Establish WASH services in quarantine facilities and or quarantined areas by the government in case of a large outbreak.
  • Establish the continuance of the essential WASH services (drinking water supply, sanitation and handwashing) in both rural and urban areas by service providers
  • Establish health education on the essential subject WASH and the importance of it, whether this is virtual or at a safe distance (World Health Organization, 2020).

HOSPITALS

There are approximately 301 private hospitals in Nepal, among which 67 are located in the Kathmandu Valley, compared to approximately 123 government hospitals under the Ministry of Health and Population, there is a vast difference between private and government in costs, equipment and care. The private healthcare is the most used caregiver in Nepal (Thapa, 2016).

Before COVID-19 Nepal's hospitals were ill equipped to deliver even normal health care to its 28 million people. For every 1600 people there is one doctor, which is way more that the recommended 1000 people per doctor by the World Health Organization. There are about 18,000 doctors and 35,000 nurses in Nepal for the approximately 500 hospitals, compared to the 1100 intensive care beds and 600 ventilators (Adhikari, 2020).

There is also talk of corruption within both private and public hospitals. Within private it is said that a substantial amount of costs are asked for treatment (personal communication, June 9 2020). The government has been accused of buying faulty equipment from china for the public hospitals (Adhikari, 2020).

The goal of a well-coordinated effective hospital response to the COVID-19 among the government and private sector, can specified in the following objectives:

  • Increase the health care budget from 4% to higher than 10%, to invest in equipment, intensive care beds and quarantine locations.
  • Decrease the control of private hospitals on the costs of treatment.
  • Improve the conditions of the quarantine facilities with the right equipment, enough nutrition and equal care.).

MENTAL HEALTH

Nepal has been in lockdown for over two months and it has caused people to start talking about mental health and the long term issues that result from the lockdown. The mental issues that could rise in the future because of the lockdown, include: depression, anxiety and panic attacks, frustration and irritation, sleeping problems, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD) or even self-harm and serious eating disorders. There is also reason to believe that suicides, alcoholism, drug use and criminality will rise (Baral, 2020).

 The goal of a well-coordinated effective mental health response to the COVID-19 among the government, can specified in the following objectives:

  • Encourage the conversation and help seeking around mental health problems among teenagers and adolescents.
  • Promote online platforms about mental health and social media communication to decrease the threshold of beginning a conversation.
  • Invest in school education on the subject of mental health to normalize the conversation.  

Inspired by the UNICEF strategies for teens handling their mental health during the corona. It applies to both teenagers and adolescents for facing the (temporary) new normal (Rich, 2020): 

  • Accept that your anxiety is completely normal. These feelings of anxiety, fear and loneliness are completely normal, accept them.
  • Create distractions. Passing the time can be difficult when there is no way of knowing when life will be normal again, but finding new hobbies can give you a distraction.
  • Find new ways to connect with your friends. In this day and age, we are happy with the online communication that we have. If this is not possible, keeping distance but still meeting is a possibility.
  • Focus on yourself. If there is something you have always wanted to do, now is the time.
  • Feel your feelings and express them. The feelings of anxiety, fear and loneliness should not be cropped in your head, talk about them with family and friends. Start a conversation and continue talking.
  • Be kind to yourself and others. In these scary times it is possible to act out on the fear and be triggered into anger much faster than normal. Keep treating everyone around, like you want to be treated.

3. Agriculture and food supply

In Nepal is more than sixty percent dependent on agriculture as a form of income. At the moment with the lockdown these farmers aren't able to have workers to harvest or sell their products at the market. The farmers are forced to leave their produce on the field to go bad and people without their own produce garden have difficulty getting fresh fruits and vegetables. People are forced to buy a huge amount of produce, which in turn can parish again. The daily income of the population has decreased which is both negative for the buyer and the farmer.

So this is both the harvesting and planting of the produce and the supply to the population. The result is that peoples days to day activities/jobs are affected with the disruption of consumption of nutritious and sufficient food. 

The goal of a well-coordinated effective agriculture and food supply response to the COVID-19 among the government, can specified in the following objectives:

  • Establish a market for the perishable produce by the The NACCFL (Nepal Agriculture Cooperative Central Federation Limited) instead of the famers to the markets through the procedural steps:
  1. Collection of demand from customers through email, direct call.
  2. Packaging as agro-produces as per the demand.
  3. Home Delivery of agro-produces.
  • Establish safety guidelines for farmers to safely harvest their produce and get the produce in a social distance to the market without cross contamination
  • Encourage co-organization between farmers and several markets by the NACCFL (Rupakheti, 2020).

4. Protection by public and civil society actors

Nepal's pre-existing protection issues include misogyny, violence against children including child marriage, child labour, high rates of institutionalization and family separation, unconventional traditional practices and human trafficking. On top of that, socio-economic marginalization, social consequences of migration, challenges for adolescents and youth, barriers to accessing legal documentation/citizenship, and mental health concerns, with suicide highly prevalent among women aged 15-24, also prevail. Furthermore, national welfare systems face institutional challenges because federalization has made the systems to protect women and children weaker by suspending the women and children desks as entry points for certain response services. Therefore, the identification and response to protection risks requires specific attention and collaboration between public and civil society actors (COVID-19 NEPAL: PREPAREDNESS AND RESPONSE PLAN (NPRP), 2020).

The current situation presents an opportunity to reinforce the humanitarian-development nexus around protection through strengthened engagement of duty bearers and community actors on protection particularly as regards: 

  • Engagement of the security sector (police, border management, corrections) on the enforcement of lockdown/quarantine measures and ensuring age and gender considerations are addressed in this process.
  • Ensuring the continuity of lifesaving and survivor-centered care and support to survivors of gender-based violence.
  • Addressing the needs of detainees, particularly vulnerable detainees, including support for diversion processes for young offenders.
  • Enhancing mental health prevention and response services, such as remote and mobile services including for frontline health workers.
  • Strengthening mechanisms to prevent family separation and supporting family-based care.
  • Ensuring that issues around legal documentation do not adversely impact people seeking protection or access to services.
  • Strengthening capacity and local governance of protection systems in support of provincial and municipal levels' alert, response and referral mechanisms.
  • Preventing and addressing stigma and ensuring standards of privacy and confidentiality are upheld in the response to COVID-19 and factoring in the cultural and ethnic diversity of Nepal, while ensuring equal access to information, prevention messaging, care and alert systems.

These will be extremely important in order to mitigate the social impact of COVID-19 on the most vulnerable, to preserve social gains and investments, to support social cohesion in times of social distancing and paving the way for recovery as containment measures evolve.

Priority Response Activities:

• In collaboration with the Ministry of Women, Children and Senior Citizens, National Child Rights Council and Nepal Red Cross Society implement tracking mechanism for families separated by hospitalization or quarantine and establish temporary alternative care measures in coordination with health authorities, if necessary.

• In coordination with Health Cluster support mental health and psychosocial well-being of affected population and their families traumatized by pandemic, including those hospitalized or in quarantine with focus to psychological first aid and risk communication messaging.

• Provide essential lifesaving relief materials and supplies including dignity kits, kishori (adolescent) kits etc.

• Disseminate protection messages with a focus on child protection, gender-based violence, in particular domestic violence due to heightened tensions in the household and risk of increased violence.

• Provide essential GBV prevention and response health and social services including psychosocial counselling, female friendly spaces and shelters and strengthen referral pathways.

• Scale up remote modalities to address GBV, such as hotlines and mobile counselling services, with training for frontline workers.

• Ensure that the most excluded women and girls including disabled, LGBTQI, displaced persons, migrants, and other have equal access to GBV prevention and response services.

• Organize training and capacity building workshop for health workers seconded at the points of entry (PoEs) for migrant sensitive mental health and psychosocial counselling of migrants from India and other third countries.

• Establish migrant friendly spaces at border check points and make referrals as required.

• Provide Mental Health and Psychosocial Support (MHPSS) activities at POEs for travelers and migrants returning back to Nepal either from Nepal or other countries, as required.

• Coordinate with health and justice sector to ensure persons in jails/detention/correction facilities have access to information and continued quality sanitation services with a specific focus on the situation of children and women in detention.

• Regularize the protection cluster/working group coordination meetings at provincial and local level and conduct coordination meetings at outbreak areas.

Sources

Adhikari, D. (2020, April 9). Coronavirus in Nepal: Laborers returning home allege bias in hospitals. Retrieved June 12, 2020, from https://www.aa.com.tr/en/asia-pacific/coronavirus-in-nepal-laborers-returning-home-allege-bias-in-hospitals-/1798135

Baral, A. (2020, May 20). COVID-19 pandemic likely to unleash long-term mental health issues in Nepal. Retrieved June 12, 2020, from https://myrepublica.nagariknetwork.com/news/covid-19-pandemic-likely-to-unleash-a-long-term-mental-health-issues-in-nepal/

Bhusal, A. (2020, June 3). Agriculture and COVID-19: problems and opportunities. Retrieved June 12, 2020, from https://ypard.net/2020-06-03/agriculture-and-covid-19-problems-and-opportunities

The Kathmandu Post. (2020, June 11). World Bank approves $450 million project to help Nepal improve roads and fight Covid crisis. Retrieved June, 2020, from The Kathmandu Post: https://kathmandupost.com/national/2020/06/11/world-bank-approves-450-million-project-to-help-nepal-improve-roads-and-fight-covid-crisis

Rich, M. (2020). How teenagers can protect their mental health during coronavirus (COVID-19). Retrieved June 12, 2020, from https://www.unicef.org/nepal/how-teenagers-can-protect-their-mental-health-during-coronavirus-covid-19

Rupakheti, D. (2020, May 4). Cooperative in Nepal: Fighting Against COVID-19. Retrieved June 12, 2020, from https://www.wfo-oma.org/covid-19/cooperative-in-nepal-fighting-against-covid-19/

Thapa, A. (2016, December 18). The sound and lively HEALTH CARE INDUSTRY. Retrieved June 12, 2020, from https://www.grandehospital.com/news/online/the-sound-and-lively-health-care-industry#:%7E:text=There%20are%20301%20private%20hospitals,between%20private%20and%20government%20hospitals.

€400

World Health Organization. (2020, April). COVID-19 NEPAL: PREPAREDNESS AND RESPONSE PLAN (NPRP). Retrieved June, 2020, from https://www.who.int/docs/default-source/nepal-documents/novel-coronavirus/covid-19-nepal-preparedness-and-response-plan-(nprp)-draft-april-9.pdf?sfvrsn=808a970a_2

World Health Organization. (2020). WHO Nepal Situation Updates on COVID-19. Retrieved May, 2020, from https://www.who.int/nepal/news/detail/24-04-2020-who-nepal-situation-update