IN A NUTSHELL
Editor's Note
Adding to what already highlighted by PEAH, the piece here is a further excerpt from the final manuscript ‘Health Sector Disaster Management Handbook: Nepal’, just edited by the Author, which is soon going to print.
As in the Executive Summary, the Handbook ‘…serves as a comprehensive guide for enhancing Nepal’s health sector preparedness, response, recovery, and resilience in the face of disasters and public health emergencies. Given Nepal's unique geographical, socio-political, and environmental context, the health sector faces growing risks from natural hazards, climate change, disease outbreaks, and technological accidents…’
As the Author maintains ‘It is designed as a comprehensive, context-specific guide for health professionals, policymakers, emergency responders, development partners, and community actors seeking to build a robust and resilient health system that can withstand and respond to the multifaceted challenges posed by disasters’.
Please refer to the Author for in-depth information over of the entire work
By Damodar Adhikari
Executive Director SIMEX Hub
Nepal
Way Forward: Building a Resilient Healthcare System in Nepal
This section outlines the strategic priorities, policy directions, and investment areas necessary to build a disaster-resilient health system. A resilient health system is crucial because it can adapt, absorb, and recover from shocks, ensuring that health services remain accessible to all, even during crises. The information is particularly relevant for national policymakers, donors, and strategic health planners who are responsible for guiding and investing in the development of a robust and adaptive health system.
Building a resilient healthcare system in Nepal is crucial for effectively responding to future disasters. This involves enhancing the health sector’s ability to anticipate, withstand, and recover from shocks while providing essential services. The way forward includes strengthening healthcare infrastructure, fostering partnerships, building local capacity, and addressing emerging challenges with innovation.
Resilience Defined: Resilience is the ability of a system, community, or society to resist, absorb, and recover from the effects of a disaster in a timely and efficient manner. A resilient healthcare system is one that can continue functioning during and after disasters, ensuring that essential health services are delivered even in crisis situations.
A resilient healthcare system is essential for Nepal to manage the impact of natural and man-made disasters. To achieve this, several key actions are needed:
Investing in Disaster-Resilient Infrastructure: Health facilities must be designed or retrofitted to withstand a variety of disasters, including earthquakes, floods, and storms. Currently, only 21% of health facilities in Nepal are earthquake-resistant, highlighting the urgent need to increase this proportion to safeguard lives and maintain service continuity. Sustainable technologies such as solar power systems and rainwater harvesting should be integrated into facility design to ensure operational functionality during disruptions. Moreover, adopting a multi-hazard approach is crucial, requiring that facilities are constructed with consideration for all potential risks, including fires, landslides, and extreme temperature fluctuations.
Enhancing Healthcare Workforce Capacity: Building a capable healthcare workforce is essential for effective disaster response. This includes providing specialized training in emergency medicine, mass casualty management, and public health surveillance. To retain skilled professionals, strategies such as offering incentives, clear career advancement opportunities, and mental health support are vital. Additionally, conducting regular drills and simulation exercises helps maintain the readiness and effectiveness of healthcare personnel during emergencies.
Improving Supply Chain Resilience: Ensuring a resilient supply chain involves creating and maintaining strategically located stockpiles of essential medicines and medical equipment to meet surge demands during disasters. Real-time monitoring through digital tools allows for accurate tracking of inventory levels and timely replenishment, reducing the risk of shortages. Furthermore, flexible procurement policies should be in place to facilitate rapid acquisition of supplies and resources when emergencies arise, enabling a swift and efficient response.
Partnerships and Local Capacity Strengthening
Fostering Partnerships with Regional and Global Stakeholders: Disaster management is inherently a collective effort that requires strong collaboration among various stakeholders at regional and global levels. On the regional front, cross-border coordination is vital; strengthening partnerships with neighboring countries like India and China enables shared knowledge, resource pooling, and coordinated disaster response exercises. Integrating Nepal into regional early warning systems for floods, landslides, and epidemics further enhances preparedness and timely action. At the global level, engaging with international health organizations such as WHO, UNICEF, and global NGOs provides access to technical expertise and critical resources. Additionally, tapping into global funding mechanisms like the Green Climate Fund can support the development of climate-resilient health systems. Active participation in international forums allows Nepal to share experiences and learn from global best practices in disaster management.
Strengthening Local Capacity for Disaster Management: Local capacity forms the foundation of an effective disaster response system. Empowering communities and local authorities ensures that interventions are timely, culturally appropriate, and sustainable. Public awareness campaigns play a key role in educating communities about disaster risks and preparedness measures. Training volunteer networks enhances community support for health services during emergencies. Additionally, equipping local responders with basic first aid and triage skills helps address immediate medical needs effectively.
On the health system front, decentralizing services by establishing mobile health units and emergency clinics in disaster-prone areas improves accessibility. Training Community Health Workers (CHWs) to provide essential health services and collect data strengthens grassroots health responses. Finally, reinforcing referral systems ensures the rapid transfer of patients to higher-level facilities when necessary, enhancing overall health system resilience during disasters.
Future Challenges and Opportunities
As Nepal continues to develop a resilient healthcare system, it will face several significant challenges alongside promising opportunities to enhance its disaster management capabilities.
Challenges: Climate change presents a major challenge, with Nepal experiencing increasingly frequent and severe weather events that heighten the risk of disasters such as floods and landslides. For instance, the 2024 floods affected over 2.5 million people and submerged numerous health facilities, severely disrupting healthcare services. Additionally, resource constraints pose a barrier to progress, as limited financial resources and heavy reliance on foreign aid can slow down implementation of vital programs. Infrastructure gaps remain a critical concern, particularly in rural areas where many health facilities lack disaster-resistant retrofitting and are situated in hazard-prone locations.
Opportunities: Despite these challenges, Nepal has several opportunities to innovate and improve its disaster preparedness. Technological advancements like Geographic Information Systems (GIS) can enhance risk mapping and enable better resource allocation. Telemedicine offers the potential to expand healthcare access in remote areas, while mobile health applications can strengthen public health surveillance and early warning systems. Public-private partnerships present another avenue for growth by engaging private sector entities to support disaster preparedness and response efforts, including funding climate-resilient infrastructure projects. Finally, integrating climate adaptation strategies into the design and construction of healthcare facilities will help ensure long-term sustainability and resilience against future disasters.
Way Forward Summary
Building a Resilient Healthcare System in Nepal requires comprehensive action, including:
Policy Reforms: Effective disaster resilience begins with strong policy frameworks that mandate the integration of disaster risk reduction and emergency preparedness within the health sector. Developing and enforcing such policies ensures that all levels of the health system—from national to local—prioritize infrastructure safety, resource allocation, training, and coordination during emergencies. Policies should also promote multi-sectoral collaboration, clarify roles and responsibilities, and establish legal mechanisms for accountability. Importantly, regular review and updating of policies based on evolving risks, lessons learned from past disasters, and emerging best practices are necessary to maintain relevance and effectiveness.
Infrastructural Investment: Investing in health infrastructure is critical to ensure that facilities can continue providing essential services during and after disasters. This includes retrofitting existing health centers, hospitals, and clinics to improve their structural resilience against earthquakes, floods, and other hazards prevalent in Nepal. Equally important is the construction of new facilities designed with a multi- hazard approach that incorporates sustainable technologies such as solar energy and rainwater harvesting. Infrastructure planning must prioritize accessibility, safe evacuation routes, and the availability of essential utilities to maintain uninterrupted healthcare delivery under adverse conditions.
Community Engagement: Empowering local communities is vital for effective disaster preparedness and response. This involves educating communities about health risks, early warning signals, and protective measures through tailored awareness campaigns. Strengthening community health systems by training community health workers, volunteers, and local leaders enables prompt identification of health threats and facilitates timely interventions. Community participation in planning and maintaining emergency open spaces, referral mechanisms, and stockpiles fosters ownership, trust, and sustainability. Furthermore, culturally sensitive communication strategies help address diverse needs and promote inclusive disaster resilience.
International Cooperation: Nepal can enhance its disaster resilience by leveraging partnerships with regional neighbors and global organizations. Regional cooperation facilitates cross-border resource sharing, joint training exercises, and harmonized early warning systems for transboundary hazards like floods and epidemics. On the global stage, collaboration with entities such as WHO, UNICEF, and international NGOs provides technical assistance, capacity building, and access to innovative tools and funding sources, including climate adaptation grants. Engaging in international knowledge exchange forums allows Nepal to learn from global experiences and adopt proven strategies adapted to its unique context.
Innovation: Harnessing technology is key to transforming disaster preparedness and healthcare delivery. Geographic Information Systems (GIS) enable precise risk mapping, vulnerability assessments, and optimized resource allocation. Telemedicine expands access to specialized care in remote and disaster- affected areas, overcoming geographical and infrastructural barriers. Mobile health applications support real-time disease surveillance, public health messaging, and coordination among response teams. Embracing digital communication platforms and data analytics enhances situational awareness and decision-making efficiency. Innovation also extends to adopting sustainable energy and water solutions to ensure uninterrupted health services during disasters.
By promoting preparedness, resilience, and informed decision-making, this handbook aims to safeguard public health during emergencies and build a robust healthcare system capable of withstanding future challenges. Stakeholders—including policymakers, healthcare providers, community leaders, and development partners—are encouraged to use this resource to foster a culture of readiness and resilience throughout Nepal’s health sector.
