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Health System Preparedness for COVID-19 and Its Impacts on Frontline Health-Care Workers in Nepal: A Qualitative Study Among Frontline Health-Care Workers and Policy-Makers

Published online by Cambridge University Press:  18 June 2021

Nipun Shrestha Open the ORCID record for Nipun Shrestha [Opens in a new window] ,
Shiva Raj Mishra ,
Saruna Ghimire ,
Bishal Gyawali ,
Sujan Babu Marahatta ,
Smriti Maskey ,
Sushila Baral ,
Nilima Shrestha ,
Rakesh Yadav  and
Sunil Pokharel Open the ORCID record for Sunil Pokharel [Opens in a new window]
...Show all authors
Nipun Shrestha
Affiliation:
Department of Primary Care and Mental Health, The University of Liverpool, Liverpool, United Kingdom
Shiva Raj Mishra
Affiliation:
Nepal Development Society, Chitwan, Nepal
Saruna Ghimire
Affiliation:
Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
Bishal Gyawali
Affiliation:
Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark Community Health Development Nepal, Kathmandu, Nepal
Sujan Babu Marahatta
Affiliation:
Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
Smriti Maskey
Affiliation:
University of North Texas, Fort Worth, TX, USA
Sushila Baral
Affiliation:
Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
Nilima Shrestha
Affiliation:
Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
Rakesh Yadav
Affiliation:
Nepal Public Health Research and Development Center, Kathmandu, Nepal
Sunil Pokharel
Affiliation:
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Bipin Adhikari*
Affiliation:
Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
*
Corresponding author: Bipin Adhikari, Email: biopion@gmail.com.
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Abstract

Background:

Rapidly growing coronavirus disease 2019 (COVID-19) pandemic has brought unprecedented challenges to the health system in Nepal. The main objective of this study was to explore the health system preparedness for COVID-19 and its impacts on frontline health-care workers in Nepal.

Methods:

Semi-structured interviews were conducted among 32 health-care workers who were involved in clinical care of COVID-19 patients and four policy-makers who were responsible for COVID-19 control and management at central and provincial level. Interviews were conducted through telephone or Internet-based tools such as Zoom and Skype. All interviews were audio-recorded, transcribed into English, and coded using inductive and deductive approaches.

Results:

Both health-care workers and policy-makers reported failure to initiate pre-emptive control measures at the early stages of the outbreak as the pivot in pandemic control. Although several measures were rolled out when cases started to appear, the overall health system preparedness was low. The poor governance, and coordination between three tiers of government was compounded by the inadequate personal protective equipment for health-care workers, insufficient isolation beds for patients, and poor engagement of the private sector. Frontline health-care workers experienced various degrees of stigma because of their profession and yet were able to maintain their motivation to continue serving patients.

Conclusion:

Preparedness for COVID-19 was affected by the poor coordination between three tiers of governance. Specifically, the lack of human resources, inadequate logistic chain management and laboratory facilities for testing COVID-19 appeared to have jeopardized the health system preparedness and escalated the pandemic in Nepal. Despite the poor preparedness, and health and safety concerns, health-care workers maintained their motivation. There is an urgent need for an effective coordination mechanism between various tiers of health structure (including private sector) in addition to incentivizing the health-care workers for the current and future pandemics.

Keywords

COVID-19health systemhealth system preparednesshealth workersNepal
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 16 , Issue 6 , December 2022 , pp. 2560 - 2568
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

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