Current Research in Emergency Medicine
[ ISSN : 2832-5699 ]

COVID-19 in Nepal: Health Sector Emergency Response and Unique Challenges

Review Article
Volume 2 - Issue 2 | Article DOI : 10.54026/CREM/1021

Ramu Kharel1*, Subada Soti2 , John A Lee3 , Prabhat Adhikari4 , Subarna Adhikari5 , Soniya P Regmi6 , Sudip Khadka7 , Pranawa Koirala8 , Adam R Aluisio9

1Department of Emergency Medicine, Brown University Alpert Medical School, 55 Claverick St., Providence,
2Department of Internal Medicine, Emory University School of Medicine, 49 Jesse Hill Dr. SE, Atlanta, GA,
3Department of Emergency Medicine, Brown University Alpert Medical School, 55 Claverick St., Providence,
4Department of Internal Medicine, Critical Care Division, Grande Hospital, Kathmandu, Nepal
5Department of Emergency Medicine, UC Davis Health, 2315 Stockton Blvd, Sacramento, CA, USA
6Dhulikhel Hospital, Kathmandu University School of Medical Sciences, Dhulikhel 54200, Nepal
7Department of Molecular Medicine, Mayo Clinic, 200 First St. SW, Rochester, MI, USA
8Pranawa Koirala, MD, MBBS, Department of Emergency Medicine, University of Maryland School of
Medicine, 110 South Paca St., Baltimore, MD, USA
9Department of Emergency Medicine, Brown University Alpert Medical School, 55 Claverick, St., Providence,

Corresponding Authors

*Corresponding author Ramu Kharel, MD, MPH, Department of Emergency Medicine, Warren Alpert Medical School of Brown University, 55 Claverick Street, Providence, RI 02903


Keywords: COVID-19; Emergency Response; Health Sector; World Health Organization

Received : February 16, 2022
Published : March 04, 2022


Background Coronavirus Disease’s (COVID-19) rampant rise has caused numerous challenges to the already strained health infrastructure of Nepal. The combination of underlying geographic and socioeconomic risk factors, and Nepal’s unique challenges with its rural majority population, the influx of migrant workers returning during the pandemic and catastrophic monsoon flooding has potentiated disease spread. This review describes the country’s health sector response, key strategies, challenges and strengths, and provides lessons learned for future response. Methods Open access information from the Nepali government was used to describe the COVID-19 response plan and implementation. The World Health Organization’s weekly situation reports, United Nations documents, and local news articles were also reviewed to find key evolution of COVID-19 and challenges faced in response. Findings Nepal’s COVID-19 response strategy was detailed in the government’s Health Sector Emergency Response Plan (HSER) in May 2020, and the strategy can be divided into four main areas: public health and social measures, hospital-based intervention, management and oversight, and budget allocation. Nepal has had COVID-19 cases in all 7 provinces and 77 districts, and due to a large rural population, the sudden influx of more than 1.3 million people from reverse migration and massive monsoon floods contributed to the rise in community spread of the virus. The second wave (Delta wave) found Nepal with the worst viral replication in the world and collapsed the health infrastructure. Conclusion Nepal’s COVID-19 response was strained by its unique challenges and key lessons were identified from this review that will be needed for future pandemic and disaster response. These include early planning, data centralization, transparent leadership, clear communication and coordination between three tiers of government, private-public partnerships, and utilization of its working population.