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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
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.

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.

Type
Original Research
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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References

Zhu, N, Zhang, D, Wang, W, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733.CrossRefGoogle ScholarPubMed
Worldometer. COVID-19 coronavirus pandemic. 2020. https://www.worldometers.info/coronavirus/#countries. Accessed July 4, 2020.Google Scholar
Bastola, A, Sah, R, Rodriguez-Morales, AJ, et al. The first 2019 novel coronavirus case in Nepal. Lancet Infect Dis. 2020;20(3):279-280.CrossRefGoogle ScholarPubMed
Ghimire, U, Shrestha, N, Adhikari, B, et al. Health system’s readiness to provide cardiovascular, diabetes and chronic respiratory disease related services in Nepal: analysis using 2015 health facility survey. BMC Public Health. 2020;20(1):1163.CrossRefGoogle ScholarPubMed
Adhikari, B, Mishra, SR. Urgent need for reform in Nepal’s medical education. Lancet. 2016;388(10061):2739-2740.Google ScholarPubMed
Mishra, SR, Khanal, P, Karki, DK, et al. National health insurance policy in Nepal: challenges for implementation. Glob Health Action. 2015;8:28763.Google ScholarPubMed
Pokharel, S, Raut, S, Rijal, KR, et al. Coronavirus disease 2019 pandemic - public health preparedness in Nepal and one health approach. Disaster Med Public Health Prep. 2020 May 29:1-2.CrossRefGoogle Scholar
Ministry of Health and Population Nepal. Situation report COVID-19 #109 (as of 28 May 2020). 2020. https://heoc.mohp.gov.np/update-on-novel-corona-virus-covid-19/. Accessed June 29, 2021.Google Scholar
Ministry of Health and Population Nepal. COVID-19 Update. 2020. https://covid19.mohp.gov.np/#/. Accessed June 13, 2020.Google Scholar
Nepali Times. Protecting those who protect us from the epidemic. 2020. https://www.nepalitimes.com/here-now/protecting-those-who-protect-us-from-the-epidemic/. Accessed March 28, 2020.Google Scholar
Rayamajhee, B, Pokhrel, A, Syangtan, G, et al. How well the government of Nepal is responding to COVID-19? An experience from a resource-limited country to confront unprecedented pandemic. Front Public Health. 2021;9:597808.CrossRefGoogle ScholarPubMed
Basnyat, B. How Nepal can survive 2nd covid wave. Nepali Times. 2021. https://www.nepalitimes.com/opinion/how-nepal-can-survive-2nd-covid-wave/. Accessed May 18, 2021.Google Scholar
Lai, J, Ma, S, Wang, Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976.CrossRefGoogle ScholarPubMed
Bahadur, BCU, Pokharel, S, Munikar, S, Wagle, CN, et al. Anxiety and depression among people living in quarantine centers during COVID-19 pandemic: a mixed method study from western Nepal. medRxiv. 2020.11.05.20224436. doi: https://doi.org/10.1101/2020.11.05.20224436 CrossRefGoogle Scholar
Awale, S. Why Nepal’s Covid-19 figures are deceptive. Nepali Times. 2020. https://www.nepalitimes.com/here-now/why-nepals-covid-19-figures-are-deceptive/. Accessed December 28, 2020.Google Scholar
The Himalayan Times. Nepal Government not to bear costs of Covid-19 test, treatment. 2020. https://www.hindustantimes.com/world-news/nepal-government-not-to-bear-costs-of-covid-19-test-treatment/story-RwN56cSag0QVn7n9Fh1E0M.html. Accessed December 28, 2020.Google Scholar
Adhikari, B, Ozaki, A, Marahatta, SB, et al. Earthquake rebuilding and response to COVID-19 in Nepal, a country nestled in multiple crises. J Glob Health. 2020;10(2):020367.Google Scholar
Mishra, SR, Adhikari, B. Planetary health in Nepal’s post-earthquake rebuilding agenda: progress and future directions. Lancet Planet Health. 2019;3(2):e55-e56.CrossRefGoogle ScholarPubMed
Adhikari, B, Mishra, SR, Babu Marahatta, S, et al. Earthquakes, fuel crisis, power outages, and health care in Nepal: implications for the future. Disaster Med Public Health Prep. 2017;11(5):625-632.CrossRefGoogle ScholarPubMed
Rhee, C, Gupta, B, Lal, B, et al. Mapping the high burden areas of cholera in Nepal for potential use of oral cholera vaccine: an analysis of data from publications and routine surveillance systems. Asian Pac J Trop Med. 2020;13:107.CrossRefGoogle Scholar
Tong, A, Sainsbury, P, Craig, J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-357.CrossRefGoogle ScholarPubMed
Groenewald, T. A phenomenological research design illustrated. Int J Qual Methods. 2004;3(1):42-55.CrossRefGoogle Scholar
Sargeant, J. Qualitative research part II: Participants, analysis, and quality assurance. J Grad Med Educ. 2012;4(1):1-3.Google ScholarPubMed
Liu, Q, Luo, D, Haase, JE, et al. The experiences of health-care providers during the COVID-19 crisis in China: a qualitative study. Lancet Glob Health. 2020;8(6):e790-e798.CrossRefGoogle ScholarPubMed
McMahon, SA, Ho, LS, Brown, H, et al. Healthcare providers on the frontlines: a qualitative investigation of the social and emotional impact of delivering health services during Sierra Leone’s Ebola epidemic. Health Policy Plan. 2016;31(9):1232-1239.CrossRefGoogle ScholarPubMed
Raven, J, Wurie, H, Witter, S. Health workers’ experiences of coping with the Ebola epidemic in Sierra Leone’s health system: a qualitative study. BMC Health Serv Res. 2018;18(1):251.CrossRefGoogle ScholarPubMed
Singh, DR, Sunuwar, DR, Shah, SK, et al. Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders. BMC Health Serv Res. 2021;21(1):174.CrossRefGoogle Scholar
Abimbola, S, Pai, M. Will global health survive its decolonisation? Lancet. 2020;396(10263):1627-1628.CrossRefGoogle ScholarPubMed
Khan, M, Abimbola, S, Aloudat, T, et al. Decolonising global health in 2021: a roadmap to move from rhetoric to reform. BMJ Glob Health. 2021;6(3):e005604.CrossRefGoogle ScholarPubMed
Adhikari, B, Pokharel, S, Raut, S, et al. Why do people purchase antibiotics over-the-counter? A qualitative study with patients, clinicians and dispensers in central, eastern and western Nepal. BMJ Global Health. 2021;6(5):e005829.CrossRefGoogle ScholarPubMed
Adhikari, B, Mishra, SR, Dirks, KN. Green space, health, and wellbeing: considerations for South Asia. Lancet Planet Health. 2020;4(4):e135-e136.CrossRefGoogle ScholarPubMed
Saunders, B, Sim, J, Kingstone, T, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-1907.CrossRefGoogle ScholarPubMed
Crabtree, B, Miller, W. A template approach to text analysis: developing and using codebooks. In Crabtree, BF, Miller, WL, eds. Doing Qualitative Research in Primary Care: Multiple Strategies. Newbury Park, CA: Sage Publications; 1992:93-109.Google Scholar
Fereday, J, Muir-Cochrane, E. Demonstrating rigor using thematic analysis: a hybrid approach of inductive and deductive coding and theme development. Int J Qual Methods. 2006;5(1):80-92.CrossRefGoogle Scholar
Acharya, S, Ghimire, S, Jeffers, EM, et al. Health care utilization and health care expenditure of nepali older adults. Front Public Health. 2019;7:24.CrossRefGoogle ScholarPubMed
Singh, DR, Sunuwar, DR, Adhikari, B, et al. The perils of COVID-19 in Nepal: implications for population health and nutritional status. J Glob Health. 2020;10(1):010378.CrossRefGoogle ScholarPubMed
World Bank Group. Global responses to COVID-19 in slums and cities. 2020. http://pubdocs.worldbank.org/en/359311591302725959/June1-Response-to-COVID-in-Slums-and-cities.pdf. Accesed June 15, 2020.Google Scholar
Patel, CK, Selvam, VK, Sahu, DK. Railway anaesthesiologists and Indian railway COVID-19 management system. Indian J Anaesth. 2020;64(Suppl 2):S132-S135.Google ScholarPubMed
Ministry of Health and Population Nepal. Human resources for health Nepal country profile. 2013. https://bit.ly/2YxdZl3. Accessed June 13, 2020.Google Scholar
Shrestha, GS. COVID-19 pandemic: shortage of personal protective equipment, use of improvised surrogates, and the safety of health care workers. J Nepal Health Res Counc. 2020;18(1):150.CrossRefGoogle ScholarPubMed
The Kathmandu Post. Nepal’s budget: not quite all there. 2020. https://kathmandupost.com/editorial/2020/05/28/nepal-s-budget-not-quite-all-there. Accessed June 13, 2020.Google Scholar
Khanal, P, Devkota, N, Dahal, M, et al. Mental health status among health workers in Nepal during COVID-19 pandemic (Policy brief). Pulic Health Update. 2020. https://bit.ly/3dYiSdr. Accessed June 13, 2020.Google Scholar
Raven, J, Baral, S, Wurie, H, et al. What adaptation to research is needed following crises: a comparative, qualitative study of the health workforce in Sierra Leone and Nepal. Health Res Policy Syst. 2018;16(1):6.CrossRefGoogle ScholarPubMed
The Kathmandu Post. Health workers deployed at Covid-19 frontline deprived of their allowances. 2020. https://kathmandupost.com/national/2020/06/07/health-workers-deployed-at-covid-19-frontline-deprived-of-their-allowances. Accessed June 13, 2020.Google Scholar
My República. Doctors ‘manhandled’ at Nepal Medical College. 2020. https://bit.ly/2XZpnXO. Accessed June 13, 2020.Google Scholar
Lanctôt, N, Guay, S. The aftermath of workplace violence among healthcare workers: a systematic literature review of the consequences. Aggress Violent Behav. 2014;19(5):492-501.CrossRefGoogle Scholar
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