Here are 10 ways Nepal govt can make amends
Kathmandu, January 19
Dealing with COVID-19 requires decisive and evidence-based leadership committed to working in the public interest. Unfortunately, Nepal is yet to demonstrate this, as is evident from the lazy, opaque, and visionless vaccination programme.
The COVID-19 vaccination drive can still be fixed with common sense and time-tested lessons from Nepal's home-grown immunisation experience.
One, scale-up vaccination sites. If Nepal has tens of thousands of vaccination sites when routinely immunising children, there is no reason not to have an even higher number for COVID-19 vaccination. Furthermore, the COVID-19 virus does not stop transmiting from 9:00am to 5:00pm and does not take Saturdays off.
Therefore, neither should the COVID-19 vaccination campaign in Nepal.
Two, widen reach by engaging the 70 per cent of the health care system of Nepal, which is private. If this can be done for testing and hospital beds, then there is no reason not to find a solution to this. Moreover, the hesitance of the technocrats in engaging the private health providers is puzzling as many of these technocrats have well nurtured private sector investments, interests, and practice.
Three, don't set up standards higher than those of high-income countries. This entails relaxing the criteria for who can administer vaccines. For example, instead of restricting the giving of vaccines only to trained health care professionals, allow medical students and trained volunteers to administer COVID-19 vaccines.
Four, lay out in public all your thinking about vaccines and vaccination. Information on vaccine stocks by brand and their expiry date must be released to the public. It is critical to share what else is in the pipeline with the public.
Five, release the vaccination calendar by district, criteria, date, time, and venue for the next one month. This will allow for proper micro-planning at the ward level. This schedule should be made available through TV, radio, leaflets, and social media.
No immunisation campaign has succeeded without microplanning.
Six, Communicate, Communicate and Communicate. Silence, mixed messaging, and piece-meal information erode trust.
The radio waves need to be jammed with encouraging messaging; miking in the narrowest lanes with catchy jingles should be conducted. Teachers, priests, and parents in the community need to be invited to help mobilise people. To achieve scale, vaccination information needs to be demonopolised from the custodians of social media platforms, websites, and mobile apps and be made available proactively through mediums that the ordinary people of Nepal use.
Pro-poor thinking needs to be the hallmark of vaccine communication in Nepal.
Seven, be honest and fair to health workers of Nepal. While health technocrats gracing their offices in Kathmandu have regularly received risk allowances, they have deprived the frontline health workers of the same.
The big elephant in Nepal's COVID-19 response room is pending risk allowance payments. They need to be settled immediately, or health workers will find a way of not cooperating and understandably so.
Eight, fix the information management chaos which you have created. If Pathao, Foodmandu, and FedEx can flawlessly track their supply chain in real-time in Nepal, why can't the government? The digitisation of vaccination and the QR bungling indicates incompetence, neglect, and possible corruption.
Nine, appeal to the Supreme Court to scrap all Non-Disclosure Agreements on the price of vaccine procurement in the public interest. Now that vaccine availability and efficacy data are all in the public domain, there is no justification to disclose how public money is being spent.
The call by the PM for procurement of more vaccines needs to be matched with transparency on spending.
Ten, technocrats need to generate a sense of urgency in their heads and hearts. They should consider that karma may be a better determinant of the health of the people they are entrusted to care for only after all scientific evidence-based decisions have failed.
Summa summarum, the way things are headed and in the absence of urgent course correction, Nepal's COVID-19 vaccination will not achieve its target of providing a safety blanket to its population for lack of quick coverage of the maximum people.
More will continue to succumb to this nasty disease. While we mourn the fallen, we should also mourn the psyche to fail by choice in the presence of resources and expertise in the land of Buddha's birth.
(Prof Kiteshwari Pootkotakis is a medical anthropologist of Greek-Nepali heritage. She writes on contemporary global health issues and on feminism. She calls Thessaloniki, Copenhagen, and Toronto her homes.
She has often visited Nepal the past 30 years and collaborates closely with Nepali academia on health and anthropology. She also advises international health organisations and governments on how to sustainably improve access to health)
