Key Takeaways

Each afternoon, Dr. Sharad Baral enters the coronavirus disease (COVID-19) ward he leads at the state-owned Pokhara Academy of Health Sciences. He receives briefings from nurses, dons protective equipment, and begins his rounds once more.

It has been Dr. Baral’s routine since September 2020, when Nepal became engulfed by the first wave of COVID-19 infections. When the virus would peak, all his beds would be occupied.

“I was spending more than 10 hours a day in this ward,” says Dr. Baral, 36.

While conditions improved for a while late last year, Dr. Baral once again began spending long hours in his ward as 2022 began as the rapidly spreading the Omicron variant brought a third wave of infections.

Yet this time, his hospital was ready.

“We were not as nervous as during the first and second waves,” says Dr. Baral. “Our confidence level was high because of our experience in dealing with this health crisis. Also, the availability of better medical equipment improved our morale.”

Indeed, Dr. Baral’s ward has undergone major improvements since being established shortly after the pandemic’s onset. It has new beds, medical monitors at bedsides, wall-attached oxygen dispensers and other critical equipment to aid and monitor the labored breathing of its critically ill patients.

“We are now in a better position to fight COVID-19 and other diseases,” he says.

Shortage of medical equipment

Nepal detected its first COVID-19 case on 23 January 2020. By 23 March, a second confirmed case sent Nepal into a total, roughly 4-month lockdown. The lockdown helped contain the spread of the disease. But as the country opened up, both COVID-19 cases and hospitalizations rose, pressuring the health care system.

“What was extremely worrying at that time was the lack of equipment such as PPE, oxygen tanks, ventilators, and monitors to check patients’ vitals,” says Dr. Baral. And at all public hospitals treating COVID-19 patients, he says, the problem was the same.

There were other problems, too. Testing kits and facilities were in short supply, and too few quarantine centers existed to house migrant workers returning from countries like India.

Critical support

ADB’s support included procurement of critical medical equipment and supplies and personal protective equipment for frontline health workers in partnership with other development partners in the country. Photo: Narendra Shrestha/ADB

In response, the Government of Nepal jumped into action early on.

In March 2020, even before the swelling of the pandemic, it introduced its $1.26 billion National Relief Program (NRP) to address the crisis overall and mitigate adverse economic and social impacts. To help, the Asian Development Bank (ADB) provided $250 million of support in May 2020 under the COVID-19 Active Response and Expenditure Support (CARES) Program.

ADB’s support via the CARES Program focused on increasing testing capacity, expanding quarantine facilities, and providing incentives to health and frontline personnel responding to COVID-19. The program also came with technical assistance to provide policy advice and enhance the capacity of government agencies to implement the NRP.

ADB provided a grant of $3 million in June 2020 from its Asia Pacific Disaster Response Fund (APDRF) to improve quarantine facilities and purchase medicine, infection control supplies, and laboratory and medical equipment. ADB, in partnership with the United Nations Children’s Fund (UNICEF), also provided critically needed medical supplies for health care staff and others who are on the frontline of response efforts in Nepal. These supplies were procured by UNICEF in June 2020 in direct response to the needs identified by the Ministry of Health and Population.

  The health and medical support under ADB’s CARES Program focused on increasing testing capacity, expanding quarantine facilities, and providing incentives to health and frontline personnel responding to COVID-19.

“Development partners were prompt in supplying emergency medical equipment. Their support came at a crucial time and helped us to better deal with the situation,” says Health Secretary Dr. Roshan Pokhrel.

Building a better health system

Supplemental support helped Nepal weather the pandemic’s first wave, to some extent, better than many developed countries. But by April 2021, the country was in the grip of COVID-19’s second wave—a period that would prove far more devastating and place the medical system under extreme pressure.

“Our hospital was swamped with patients, and everything from beds and oxygen tanks to ICU and ventilators were in short supply,” says Dr. Anup Bastola, former director of Sukraraj Tropical and Infectious Disease Hospital, Nepal’s first medical facility dedicated to COVID-19.

In response, the Government of Nepal tapped into its reserves again—while also tapping support extended by its development partners like ADB— to buy medical equipment such as oxygen plants, intensive care unit (ICU) beds, and ventilators. At that time, the number of polymerase chain reaction (PCR) testing laboratories was also expanded to around 100, testing capacity was boosted dramatically by about 4,600%— from a mere 500 daily tests in April 2020 to more than 23,000 daily tests in May 2021. Newly-built quarantine facilities accommodated more than 200,000 people.

“The addition of new medical equipment, and protocols created to respond to the pandemic have helped the country to strengthen the health care system,” says Gandaki Province Health Secretary Binod Bindu Sharma. “We are now better equipped than ever to face the next wave of the pandemic or any health emergency.”

Gandaki Province, for example, has equipped each of its 11 district hospitals with three to five ICU beds. Before the pandemic, each had none.

“We also have new PCR laboratories, which will be used to conduct tests of infectious diseases, such as HIV-AIDS and tuberculosis, after the pandemic is over,” says Mr. Sharma.

Vaccines make people feel safer

The $165 million loan from ADB in July 2021 helped the National Deployment and Vaccination Plan in Nepal which is expected to benefit 6.8 million Nepalese. By February 2022, Nepal has vaccinated more than half of its population and has rolled-out booster shots. Photo: Narendra Shrestha/ADB

With Omicron and other variants extending the crisis, the government has accelerated its vaccination drive. Nepal has fully inoculated around 64% of its citizens since its immunization campaign began in January 2021, and has started providing booster shots as well.

Nepal has received vaccines in donations from various countries through the COVID-19 Vaccines Global Access Facility (COVAX). It also used vaccines donated by several countries, and purchased them using its own funds as well as financing provided by ADB and the World Bank.

To procure vaccines, ADB provided the government a concessional loan of $165 million in July 2021 from its Asia Pacific Vaccine Access Facility. This support was augmented by a technical assistance grant of $1.18 million to strengthen the vaccine delivery system, communication needs, and community engagement to raise awareness about risks of COVID-19 and the benefits of vaccination.

  In July 2021, ADB provided the Government of Nepal a concessional loan of $165 million to purchase an estimated 15.9 million doses of COVID-19 vaccines, which will benefit about 6.8 million Nepalese.

As occurred elsewhere globally, improved vaccine availability has helped reduce the hospitalization rate in Nepal. Improving conditions have bolstered the confidence of many Nepalese, including among service industry workers who must engage in close contact with customers.

“I barely opened my shop after the first wave of the pandemic engulfed the country because of fear of getting infected, as I was pregnant,” says 24-year-old Guddu Kumari Gupta, who sells street foods—panipuri and chatpat—at Lakeside, a popular tourist hub in Pokhara. To earn a living, she must interact daily with locals and tourists alike.

Mrs. Gupta recently received her second COVID-19 vaccination. “I feel protected and safe now,” she says.

Arnaud Cauchois, ADB Country Director for Nepal, says that “procurement of safe and effective vaccines is key to averting prolonged risks from the pandemic. ADB plans to help Nepal purchase about 15.9 million doses of vaccines, which will be administered to about 6.8 million Nepalese by 2024.”

Mr. Cauchois adds: “ADB is also pleased to provide critical budgetary support to the government for the implementation of the National Relief Program, which has helped upscale and expand the health system to contain the pandemic’s adverse effects. Without the excellent collaboration between the government and all development partners, it would not have been possible to mobilize this support so quickly.”