Anup K.C.

Health is a concurrent power listed in Schedule-9 of the Constitution of Nepal that falls under the jurisdiction of governments of federal, provincial and local levels. In addition, Schedule-8 has stated basic health and sanitation as one of the power that falls into the domain of local governments.
As mandated in the constitution, Public Health Act 2075, Local Health and Sanitation Act and other operational anti-COVID-19 directives, local governments are fighting with their full strength to control the spread of the new coronavirus. The local bodies should ready itself to manage mild cases at the local level and exercise the constitutionally conferred power to fully strengthen their health systems.

Recruitment of Health Personnel
The legal provisions have authorised local governments to recruit necessary health workforce for health posts and Primary Health Care Centre (PHCC). With a surge in COVID-19 cases, public health experts have expressed concerns over shortage of health workers at local level. Hence, local levels should exercise its power to recruit health workers to meet demand of necessary health workers.
The Ministry of Health and Population on May 12 directed local governments to form Case Investigation and Contact Tracing Team (CICTT) consisting Public health officers with at least Bachelors Degree in Public Health and nurses and lab technicians to conduct contract tracing and investigation at every local level.
Most of local levels don’t have public health officers with public health degree. The ones who were in government jobs prior to implementation of federal set-up are now designated at federal and provincial level. It will be wise to recruit additional medical officers, paramedics, nurses, and supporting staff at Health posts and PHCC to manage mild cases by them so that the corona hub-hospitals will not be flooded with a rapid surge of COVID-19 cases.
Local governments should collaborate with non-governmental, bilateral and multilateral organizations to strengthen their capacity amid COVID-19 outbreak. At the same time, local governments should ask non-governmental organizations working in their local level to revise their workplan and budget and to focus and invest on COVID-19 response by forging coordination with local government.

Managing Quarantine
Local governments' grievances they have been unable to maintain quarantine facilities as per WHO protocol owing to lack of necessary resources. However, it is evident that local governments are effortful of keeping quarantine centers safe by using local resource and expertise. Local governments can deploy its ward members by training them regarding management of quarantine shelters. Local governments are spending huge amount of money in bed sheets, mosquito nets, soaps, towels, toothpaste and other materials. However these necessary things, if possible, can also be arranged from homes of quarantined people to reduce expenses. All the clothes and other washable materials used by quarantined people must be dissolved in 1% hypochlorite for up to at least 30 minutes before washing. Re-using or sharing of these items including bed sheets should be strictly avoided.
The local governments should keep quarantined people in gender-friendly facilities with proper and separate sleeping shelters, toilet and bathrooms for men and women. Even the Parliamentarians have called for a separate facility in wake of incidents of sexual assaults against women in some of facilities across the country. Similarly, safe water and frequent cleanliness should be ensured while sanitary pads should be provided to women. Also, to prevent the unwanted psychological effects like depression, loneliness, anxiety and suicidal thoughts, local governments can co-ordinate with local FM stations to air counseling-related programs or even can arrange counselors to counsel them via phones to instill positivity and hope and to guide them during difficult time of epidemic.
Diets and supplementary foods cannot prevent COVID-19 infection. However, balanced diet and good food habits definitely strengthen a person's immunity. Due to strict restriction measures in place to curb the spread of infection, supply of vegetables, fruits and other food items has been impacted.
Quarantine centers are facing difficulties in collecting necessary food materials. Still, there is a way to ensure healthy food during this difficult time. It has been witnessed local ward members of some local governments are collecting food items including fruits and vegetables from local farmers to fulfill the demand at the quarantine centers which can be followed by all local governments.

Medicine, Equipment Procurement
Pandemic induced disturbance in production and supply chain has led to shortage of medical stuffs and viral transport media (VTM) at local level for storage of nasopharynx samples to conduct PCR test. The shortage will gradually peak with spike in PCR tests. In such a backdrop, local governments should coordinate with health institutions under its authority to notify the Federal and Provincial health authorities for managing the drugs, equipment and reagent. In addition, local governments should procure the medical equipment, drugs and chemical reagents including oxygen concentrator and VTMs through its internal funds.
The coordination between federal and local governments is indispensable for safe repatriation of Nepali nationals including migrant workers stuck abroad due to the outbreak. Local government with active involvement of their ward members can prepare a list of abroad-based people and coordinate with family to learn if their foreign-based members wish to return home. In this regard, local levels should assure the federal government that they will provide quarantine shelters to those returnees for at least 14 days from the day of their arrival including regular medical check-up.

Window of Opportunity
Local governments can also develop standardised communication materials prepared by the Health Ministry into local languages targeting specific communities and sign language-based materials for deaf-mute people. If any COVID-19 patients succumb to the infection at home, local governments should assure that final rites are performed as per provision mentioned in Dead Body Management Guidelines with COVID-19. Local ward members including community leaders and FCHV can prepare list of vulnerable groups like elderly, malnourished and people with immuno-compromised conditions like cancer, diabetes, HIV/AIDs, hypertension and adopt safety measures to prevent them from contracting virus.
The COVID-19 pandemic, in fact, has offered a window of opportunity to the local governments to fulfill one of their pledges of providing better healthcare. To materialise such opportunity, local governments must exercise their authority and execute the responsibility of strengthening public health mechanisms and ensuring smooth operation of basic health services including maternal and child health care from health institutions based in its region.

(The author is a Graduate in Epidemiology and Bio-Statistics )