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SSBH Protocols Saved Lives During Nepal’s COVID-19 Epidemic

As the second wave of COVID-19 struck Nepal in Spring 2021, Tulsipur Sub-Metropolitan City in Dang District saw a steep rise in patients coming from neighboring hilly districts to the north. Health officials moved quickly to establish a COVID-19 isolation center at the Tulsipur Metro Hospital in April 2021. As the hospital’s intensive care unit reached capacity, the hospital added 50 beds to accommodate more patients.

Overworked hospital staff struggled with infection prevention and control protocols. The rapidly constructed isolation center relied on a single point for both entry and exit. Poor adherence to guidelines for donning and doffing personal protective equipment (PPE) and rules for waste management increased the risk of COVID-19 transmission.

Then USAID’s Strengthening Systems for Better Health (SSBH) Activity stepped in. SSBH’s primary responsibility is to support the Government of Nepal (GoN)’s efforts to improve access to and quality of maternal, newborn, child health, and family-planning services. But with lives at stake due to the pandemic, SSBH took on the additional task of working with the GoN to support its COVID-19 response through the Health Emergency Response (HER) program.

Among other things, the program provided technical operational support and in-kind support to provincial and local governments and health care providers to improve their ability to surveil COVID-19. That, in turn, enabled governments and health care providers to launch timely and appropriate responses to their community’s health needs, including planning, implementing, and managing COVID-19 vaccination campaigns.

As a part of the program, SSBH conducted onsite coaching on clinical case management and infection prevention and control for the health workers at the isolation center. SSBH introduced hospital staff to safety protocols and guidelines for treating COVID-19 patients that included proper disinfection, waste management and safe use of PPE. As a result, health workers at the isolation center improved their ability to treat their patients while minimizing risk of transmission.

“After receiving orientation from SSBH, we followed standard donning and doffing procedures,” says the Nurse-in-Charge at Tulsipur Metro Hospital. “We even created separate entry and exit points from the isolation ward. Since we started to follow good infection prevention and control practices in our homes and our workplace, none of us have been infected from COVID-19. Our support staff are also using disinfectants to clean the ward properly. Now, we feel safe and confident while treating COVID-19 patients.”

To support rapid response efforts, the program helped 50 municipalities conduct vulnerability and capacity assessments and draft municipal health emergency, disaster preparedness, and response plans. Subsequently, the HER program designed its support activities to meet immediate local needs to respond to the pandemic. HER’s achievements included:

  • Reaching 3,715,343 people 18 years and above through public service announcements and social and behavior change communication materials.
  • Providing 24 hospitals equipment repair and maintenance support, repairing 321 COVID-19 pieces of biomedical equipment, and assessing and cataloging 8,104 pieces of biomedical equipment.
  • Screening more than 570,000 travelers for fever and COVID-19-like symptoms (as of 9/23/2022), identifying 167,143 COVID-19 cases (as of 9/28/2022), and training over 3,304 people in various aspects of surveillance, case investigation, contract tracing, reporting, and health desk operations.
  • Training 5,413 people in 24 hospitals on various aspects of infection prevention and control and case management to enhance COVID-19 patients’ treatment, counselling, and management.
  • Training 24,871 health workers on COVID-19 vaccine handling and administration.
  • Orienting and mobilizing 147 female community health volunteers (CHVs) in low vaccine coverage municipalities. The CHVs supported achievement of 100% vaccine coverage (1st and 2nd dose) in Lumbini province and 80% 1st dose and 79% 2nd dose vaccine coverage in Karnali province.

The work concluded in August 2022, with SSBH making substantial technical, material, and human resource contributions to the GoN’s response to COVID-19. HER stabilized and maintained quality standards of care in the face of the significant stresses that the pandemic caused. That saved lives—and helped the country prepare for the next health emergency.

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