With the adoption of a power-sharing interim constitution in January 2007, Nepal seemed to be back once again on the road to a democracy, albeit a fragile one. However, the challenges that Nepal faces today have never been greater or more serious and they are likely to become even more complex.
Nepal is in political disarray... the change that Nepal has undergone in the recent past has been breathtaking in some respects and alarming in others. The country decided not only to embrace a republican system of government but also a federal one. In this time of political ferment every ethnic, religious, racial and linguistic group became politically conscious and aware of their rights…
BNMT’s own programmes reflected this, with the rights-based approach focusing on helping the most disadvantaged in addition to remaining focused on its original mission of improving the health of Nepalese people. However, tackling TB continued as a priority, with new and significant challenges of drug resistance and the impact of HIV and AIDs.
Two seismic changes occurred during this period that will have a lasting impact on BNMT.
First, in 2012 BNMT established and registered a Nepal-based organisation called BNMT Nepal that could work with BNMT UK as a local partner. It enabled BNMT Nepal to apply for funds available only to local NGOs and to ensure the long-term future of BNMT’s vision and values in a changing political and development environment. BNMT UK had always known that it wanted to hand over its work – whether to the government (in the case of the TB programme) or to a local organisation that would be more sustainable than one based in the UK. The two organisations are now referred to as BNMT Nepal (https://bnmtnepal.org.np) and BNMT UK.
Second, in April and May 2015, two massive earthquakes struck Nepal, killing thousands, injuring tens of thousands, and depriving millions of people of their homes, schools, health facilities and livelihoods. Many of those worst hit were the most vulnerable: the elderly and very young in the hills, in villages where the entire young male population has gone elsewhere for work, and poor families living in poor quality housing in the worst hit towns. The government, still in disarray and permanently distracted by political infighting, was not in a strong position to provide a timely and adequate response to the devastation.
BNMT Nepal’s response to the earthquake exemplifies one of BNMT UK’s lasting legacies: because BNMT Nepal is relatively small and local, it can respond quickly to problems as they arise. And all this was made possible by the continuing generosity of loyal and new supporters globally to BNMT UK who donated nearly £200,000 to our earthquake appeal, which was operationalised through BNMT Nepal.
BNMT Nepal, with a presence across the country and especially in the areas worst affected by the earthquake, was able to quickly mobilise its teams to provide immediate support and relief. Often, it did so alongside the government, and never in competition with it. BNMT Nepal initially provided immediate relief and later much needed mental health and psychosocial support. It subsequently supported work in communities to provide water, sanitation, hygiene, and rebuild the health sector.
2018 to date
BNMT UK continues to support TB control in partnership with BNMT Nepal by ensuring that cases of TB are found, accurately diagnosed, and treated. For this to happen, the general public need to know the signs of the disease and understand the importance of seeking treatment; and diagnosis and treatment methods need to be accessible and effective.
Health education: To improve public understanding of the disease, the Trust runs health education programmes in schools, where students learn about the signs and symptoms of TB and are encouraged to share the knowledge in their family and community (see left).
In the TB Reach project, female community health volunteers (FCHVs) are mobilised to find cases of TB, trace the contacts of people who have the disease, and encourage people in high-risk groups to go for testing. Diagnostics have improved with BNMT installing GeneXpert machines in government hospitals, to improve the speed and accuracy of diagnosis.
Quality control: BNMT manages the Eastern Region Quality Control Centre, which monitors the quality of TB microscopy in all 16 districts of the region. As well as crosschecking sputum smear slides, the Trust is responsible for laboratory supplies, training microscopy staff, and supervising the region’s microscopy centres. The centre makes an essential contribution to the quality assurance of TB microscopy in the laboratories.
Supporting households: Tuberculosis often strikes adults of working age, with dire consequences for their dependants. In April 2018 BNMT embarked on a research project to examine the needs of TB-affected households and devise practical, locally appropriate ways to support them. The aim is to ensure an alternative source of income if the family’s main breadwinner is unable to work, and also to ensure that the TB patient has access to care and treatment.
Contributing to international research: BNMT is participating in research into TB diagnosis technologies, with the aim of finding the best and cheapest way to scale up the tried and tested methods of case finding at community level and apply them nationwide. The Impact TB research project is led by Liverpool School of Tropical Medicine and funded by an EU grant. It compares two diagnosis methods – smear microscopy and GeneXpert machine testing – and is being implemented in Nepal and Vietnam.
The relationship between our implementing partner, BNMT Nepal, and leading global research and policy institutions has strengthened the research capacity in Nepal with three staff currently undertaking their PhDs as part of the programme. This research has highlighted the benefits of modern diagnostic techniques over standard microscopy. Importantly, it has also shown how active case-finding significantly reduces the catastrophic costs for households affected by TB, making a strong case for the introduction of routine active case-finding in the Nepal TB control programme.
Improving Cancer Treatment
BNMT is supporting the UK Institute of Cancer Research (ICR) and Royal Marsden Hospital in establishing four oncology fellowships for Nepal, funded by the Global Challenges Research Fund.
In Nepal – as in other developing countries – health care needs are changing. As healthcare provision overcomes the challenges of infectious disease, cancer and heart disease increase. It therefore becomes more important for Nepal’s doctors to develop specialised knowledge in these areas.
Funding was secured for four oncology fellowships of three months at the ICR and Royal Marsden Hospital for clinicians from the Bir Hospital in Kath,mandu and the Bhaktapur Cancer hospital in Bhaktapur.
Our partnership with the Royal Marsden NHS Foundation Trust, Institute of Cancer Research, Bhaktapur Cancer Hospital and Bir Hospital Department of Oncology seeks to strengthen cancer care in Nepal and to support the development of palliative care services, which are currently in their infancy.
The COVID-19 pandemic spread rapidly across the globe with high mortality, severe strain on health systems and caused significant social disruption and economic damage.
When the first wave of Covid hit Nepal in 2020, the number of cases and deaths remained relatively low. But in March 2021, cases began to surge. This time the health services were rapidly overwhelmed and as elsewhere, authorities faced impossible choices between the catastrophic economic effects of lockdowns and protecting the health service and saving lives.
It is clear globally that high vaccination coverage is the only way to defeat Covid-19 and recover economically. Unfortunately, Nepal has struggled to secure sufficient vaccines, despite early success in rapidly administering 2 million Covishield vaccine doses donated by India. By the end of June 2021, only 3.88 per cent of Nepal’s population had been fully vaccinated.
Procuring additional vaccines, whether by purchase or donation, is the urgent priority now and BNMT has worked tirelessly with other concerned organisations, including Britain Nepal Academic Council and Britain Nepal Society, amongst others, to try and secure UK government support for vaccine provision for the government of Nepal in its time of need.
In 2019/20 we have:
- provided rapid relief and response to COVID-19, supporting frontline health workers, TB-affected families, public information efforts, and the development of Nepal’s COVID-19 information app;
- generated evidence to support policy reform in Nepal and beyond: our work has shown that active case finding and socioeconomic support can drastically reduce the catastrophic costs of TB for families, and our findings have been published internationally;
- ensured diagnosis and treatment of hidden TB cases in the community in Eastern Nepal;