Thursday, October 6, 2022

COVID-19 and health sector corruption in Nepal

Navesh Chitrakar/Reuters

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Manish Pokharel, Ramhari Khadka and Shiva Khadka

Manish Pokharel

 

Ramhari Khadka

 

Shiva Khadka

During the pandemic, rise in corruption is witnessed all over the world. Both developed and developing countries are affected with it. Globally, about five percent of resources allocated for healthcare is estimated to be embezzled financially. Past experience indicates that corruption in the healthcare system spiral up during the epidemics. This has been demonstrated during Ebola crisis.

Government of Nepal implemented two key strategic approaches: (a) public health prevention and (b) hospital based interventions during the pandemic. This paper aims to explore corruption in both facilities during COVID-19 pandemic in Nepal. The paper also describes how health sector corruption spanned from one forms to the other and from one sector to the other during the pandemic, thereby paralyzing policy makers to grapple with the situation.

First case of COVID-19 reported in Nepal was on 23 January 2020, a 32-year old Nepali man returning from Wuhan. After the first case was screened, the government installed point of entry (PoE) in borders, various cities and Tribhuvan International Airport, limiting the influx of travellers. COVID-19 became a double threat to low income countries like Nepal. The pandemic carried heavy consequences for Nepal’s future; the outbreak hit nearly every sector of the economy, shaving up to 0.13 percent of the GDP and rendering 16,000 people jobless.

Essential items such as masks, hand sanitizers and face shields were not provided everywhere despite a separate budget allocated by the parliament. Price gouging was rampant everywhere. Even shop keepers and every other merchandise provider sought to maximize their gains during the crisis situation. Especially, the food and vegetables providers gouged prices and many people were unable to afford basic food and protective gear. Every aspect of social structure was influenced and could observe the spiralling up of every forms of corruption during the troubling times. Extensive corruption mainly in the health department by health care providers could be observed. 

State of emergency 

On March 1, the Nepal government formed a “High Level Coordination Committee for Prevention and Control of COVID-19” after a student was diagnosed with SARS CoV2 virus. It resulted in the first lockdown all over the country starting from 24 March 2020 to 21 July 2020. The funds allocated for this task force were not disclosed to the public at first. There was no transparency in fund allocation and this led to more in-house corruption among high level politicians. Although the government had formed a Covid-19 Crisis Management Center (CCMC), the Cabinet took most of the decisions on its own, forcing the CCMC to exist only on paper. There were case investigation and contact tracing teams formed under the strategic plan to combat coronavirus. To ensure protection and safety of all citizens, proper surveillance was planned to be executed in all health facilities and crisis centres. CCMC’s plan to combat the virus was ineffective mainly due to corruption.

In May 2020, in response to exponential increase in Covid 19 cases, the parliament formed the “Health sector Emergency Response plan COVID-19 pandemic”. 

There was severe depletion in mental and physical health of people. During the first phase of lockdown, 487 suicides were reported. Government did not anticipate these results when the lockdown was executed. Basic rights to health were compromised for citizens. 
Health care system corruption 

This kind of corruption is predominant in lower and middle income countries. Usually, this is due to the lack of transparency in budget and allocation of resources in the health care system. Every section of health institutions are infected by informal payments, over prescription of drugs by health professionals, favouritism and nepotism. Hospitalised patients were not given proper care due to lack of workforce or due to discrimination against infected people. There were many incident reports throughout the country where hospitals denied entry of COVID19 positive patients. Municipality/local government officials mishandled or misused their power to provide free PCR in local hospitals though guaranteed for all citizens. Petty corruptions, such as, health care professionals hoarding COVID19 testing kits and supplying them illegally to privileged groups thrived. Failure to report the number of SARS-Cov2 cases was exponentially high. There were reports of policemen providing illegal travel-passes in lieu of bribes during lockdown situation. Writing to the Himalayan Times, Jaishwal writes, “Corruption in healthcare threatens accessibility, utilisation and quality of healthcare services and ultimately paralyses the healthcare system.”

The Ministry of health and prevention (MoHP) ordered hospitals to close out-patient department services for non-emergency patients. Nno effective alternatives were provided to the out-patients. Quality of healthcare was severely depleted during lockdown; women’s health care being compromised utmost. Most importantly, pregnant women were neglected which ensued in 200 percent increase in maternal mortality rate during the lockdown period. Pregnant ladies from rural areas were stuck without health care facilities and immobilised to travel to cities due to lockdown situation and COVID-19 restrictions. 

Public hospitals 

Public hospitals were always underfunded and surrounded by corruption issues. The government rolled out rapid testing across the country, without waiting for validity testing from the Nepal health research council. This raised a serious question on reliability Rapid test kits. There is a lack of equal and prioritised distribution of resources in public health. Medical equipment, when broken, are replaced rather than repaired. People's faith in public health care is slim in Nepal. Disadvantaged groups are either denied or medical treatment is provided inadequately. 

Private hospitals 

Nepal’s healthcare system is dominated by private institutions. Public hospitals are utterly underfunded and neglected mainly because of deep rooted corruption. Even before pandemic, there has been a huge gap in health care services between rich and the poor/marginalized groups. Pandemic situation has revealed a vivid picture of privatised health facilities. Obviously, they prioritized for fund over better health care. Abrupt rise in COVID-19 cases led government to seek help from the private sector health institutions. This led to the “Partnership model guided by memoranda of understanding”. Although this policy was approved by the parliament, almost all privatized hospitals declined several virus symptomatic patients. There were reports all over Nepal, hospitals refusing to intake patients and already registered patients being ignored. Hospitals charged unscrupulous fees and prices. 

Isolation and quarantine centres 

There were few designated centres for isolation and quarantine for symptomatic people. Some schools, hotels and other facilities were temporarily converted into isolation centres. These places were supposed to be equipped with a number of health care workers to provide proper care and medicine. National human rights commission noted quarantine sites lacked basic water, food, bedding and toilets facilities which led to symptomatic patients fleeing the centres or under reporting of positive cases. These quarantine sites were called ‘breeding grounds’ or ‘death traps’ for COVID-19. There were reports of overcrowding due to poor management of these facilities. Centres with a capacity of 100 were occupied by 1000 people without proper social distancing. Health care workers were so depleted throughout the country; there were no officials in many centres. There was no security and safety of patients in the quarantine centres. A 31-year old woman in a facility in Lamki Chuha Municipality-1, Kailali was gang raped by three volunteers. Accused were identified and arrested but no effective actions were taken against them. This incident triggered local outrage, raising a protest against the municipality. 

Safety and security of the frontline staff 

There is a global trend of stigmatisation of health workers. In Nepal too there were reports of violence against front-line workers during the first wave of pandemic. Residents of New Baneshwor, Kathmandu gathered to protest in front of a hostel where doctors and health care providers were lodged. The locals feared health officials spreading the virus in the community. Although the government issued a “Health sector emergency plan” stating the safety and security of the front-line workers, however, it was not provided. The plan ensured front line workers, availability of protective gears, security systems and zero tolerance to violence towards them. However, policemen physically assaulted three doctors returning from duty during lockdown. Officials in charge of safety and protection of the front-line staff happen to be the abusers. Doctors were vandalised and demoralised all over Nepal. In many health institutions, workers were terminated from jobs or not paid due wages. Many were working longer hours and without personal protective equipment (PPE) or buying PPE out of their own pocket. Apart from high risk of infection, anxiety, mental toll due to dying patients and separation from family members, health workers were socially stigmatised, physically assaulted, verbally abused and were not compensated.

Vaccine distribution 

The Government of Nepal implemented weak and non-efficient vaccine distribution system from the very start. According to officials, priority for vaccines was given to the older generation and essential workers such as: health professionals, teachers yet nepotism and favouritism influenced the decision making system. Illegal documentation of people posing as health workers led to shortages in the supply of vaccines. Educated people in cities were more aware about the disease therefore there was high demand for vaccines in the cities. The limited supply led to bribing of health professionals and health authorities by the rich and the powerfuls thereby skewing the distribution curve. Two health workers were arrested for soliciting bribes from people for the vaccines meant to be distributed free of cost. They demanded a bribe of Rs20,000 for each vaccine. This kind of corruption was rampant all over the country. 

Increased violence on women and minorities 

The National Women Commission (NWC) recorded 604 cases of domestic and gender based violence in the lockdown period. It is noted that cases of domestic violence spiked by 77 percent. Most of the perpetrators are usually husbands, relatives and neighbours. In most cases, the victims were children and women. According to Nepal police, rate of women being raped increased three fold during lockdown period. Due to limited movement, there was less proactive approach by police and security agencies towards addressing assault against women as well as Dalits. According to a survey conducted by Dalit NGO Federation (DNF) about 38 percent of the people felt caste-based discrimination during lockdown situation. In addition, the Dalit women and children reported 81 percent rise in discrimination compared to non-Dalits who felt only 18 percent of discrimination at the same time period. The information materials were not accessible to disable people. Government was unable to protect sexual minorities, daily wage earners and dalits. Safety for women and minorities was completely neglected. Because of fear and intimidation, many victims failed to report the cases of abuse. There were cases of brutal killings of Dalits.

Political corruption 

Former Prime Minister K.P. Oil’s remarks that “Corona is like the flu, if contracted, one should sneeze and drink hot water and drive the virus away” has baffled the whole nation which went viral in the social media. He continuously spread misinformation at a time of crisis saying ‘Nepalis have stronger immune systems and will power’, ‘daily diet of ginger, garlic and turmeric will cure COVID-19’ and continuously undermined the severity of the virus during his reign. He also failed to provide transparency on Rs10 billion spent fighting coronavirus. His administration prioritized political manoeuvres to retain the prime minister’s power by focusing on creating controversial ordinance and censorship of the media. 

Frustrated much by the government’s inaction, a group of young people launched public protest program that goes by the name of “Enough is Enough” campaign. Initially, started as a facebook group brought people across the country to the streets demanding the government to discontinue rapid diagnostic tests (RDTs) and employ only polymerase chain reaction (PCR) testing. As a result of 10 day long hunger strike by two youths, a 12-point agreement was made. That agreement was never honoured by the government. 

OMNI scandal 

OMNI Business Corporate International (OBCI) was caught in a procurement scam of $10.39 million. The contract with OBCI was signed on March 26 for medical equipment. The company had no prior experience in procuring medical equipment. According to a media source, OMNI got the deal on the basis of close ties with the then PM K.P. Oli. The company bought supplies three times higher than the market price from a Chinese firm. First cache of supplies arrived on March 29 which were mostly faulty and gave negative results even to positive cases of COVID 19. After the controversy, the Department of Health Services annulled the tender on April 1. Validity and reliability of the RDTs were questionable.

The Public Accounts Committee (PAC) investigated the irregularities of the purchase of the materials. The preliminary report implicated the health minister and the authorities for the manipulation of public funds. The parliament asked the Commission for Investigation of the Abuse of Authority (CIAA) to look into this matter. The case filed at the CIAA states that the officials embezzled millions of rupees by awarding the procurement tender to a company without seeking bids from the competitors. Even after nine months, the anti-graft body has not arrested any officials or party related to the issue. Health Minister Mr Dhakal who was summoned for clarification denied any involvement and addressed the issue to be a cabinet decision. The anti-graft agency, CIAA, cannot investigate Cabinet decisions. 

The writers are pursuing MA in Governance and Anti-Corruption, Central Department of Economics, Tribhuvan University, Nepal.

Published on 22 August 2022

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