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Covid-19 and Health Aid Scenario in Nepal

-    Sudeep Uprety

The spread of Covid-19 pandemic has affected lives and economy of millions globally. In Nepal as of September 3, 2020, 42877 Covid-19 positive cases have been reported with 257 deaths. To address this dire need for emergency health response, global humanitarian organizations have been extending its support. As per Devex platform, after the Covid-19 pandemic outbreak, globally more than $4.6 trillion has been pledged by governments, bilateral donors, multilateral institutions, philanthropic donors, NGOs, and private sector with more than 2600 initiatives.

Specifically with regards to funding opportunities in Nepal, there are 27 initiatives with the total value of $1,775 million. Some major funders include: World Bank (USD 803,000,000), Asian Development Bank (USD 616,500,000), International Monetary Fund (USD 214,000,000), European Union (USD 81,000,000) and USAID (USD 46,100,000). Key focus areas include: Economic (USD 966 Million), Response (USD 457 Million) and Health Systems (USD 284 Million). Most of the funds committed by these major donors have been directly transferred to the government response and there are limited downstream opportunities for development partners, I/NGOs. While these funding commitments are in response to the pandemic, due to the global financial crisis, the aid industry is also hit very hard. 

Health sector in Nepal has received significant funding from external development partners (EDPs). There have also been concerns regarding mismanagement of health aid resulting in overlap and duplication of services and poor harmonization. The ambiguity in control and monitoring of foreign aid has also not supported in better integration. Sector Wide Approach (SWAp)on health concept was introduced with the vision of better alignment of government agendas with contributions of foreign organizations to health. A qualitative study highlighted that SWAp emphasized MoHPto take leadership on foreign contribution to health.On the other hand, I/NGOs are also monitored by the Social Welfare Council (SWC) which does not directly work under MoHP. This ambiguity has not helped in addressing the duplication issues.

To address these concerns and criticisms, recently, for health and medical support from the donor community in response to Covid-19, the Ministry of Health and Population developed Minimum Standards on Assistance which included not accepting medical aid worth less than half a million rupees.The guideline also emphasized on quality control, mentioning the requirement of certification of the donated goods/supplies. Likewise, health workers and staff also need to be oriented for repair and maintenance of the medical equipment. Particularly to avoid the duplication and ensuring effective monitoring, the health ministry has asked donors to notify the ministry before donating at the local level.

The Ministry of Finance, Government of Nepal in its Statement of Technical Assistance highlights that international non-governmental organizations have pledged Rs. 21.62 billion as development aid for 2020-21 which is about 13 percent less than last fiscal year. Besides that the merger of foreign and commonwealth office and the Department for International Development (DfID) is also expected to have a significant impact on health aid opportunities in Nepal as DfIDhas been one of the key players on health aid in Nepal. 

Thus, in this testing times, aid effectiveness is the key. Norman Loayza in a blog for the World Bank, highlights these six key considerations for aid effectiveness: 
1.    International aid should be seen as a global public good. To dispense it at scale, introduce flexible mechanisms and update international rules to fit new realities.
2.    International aid should be unbiased. Donors should help those who need it. 
3.    Aid effectiveness can be improved if driven by the right incentives to deliver. Donors can help, but success depends ultimately on domestic ownership and accountability. 
4.    Use existing domestic institutions to deliver aid but be flexible in adopting new ways to reach the most affected. 
5.    Aid effectiveness depends on knowledge and information. Accountability requires real time data, and efficiency requires evidence-based strategies. 
6.    Don’t lose sight of long-run objectives. 

When millions of aid money is committed, naturally there are some eye balls raised, when and how that money in the name of people’s health and wellbeing is going to be utilized. Some academicians have even coined the aid mismanagement as ‘disaster capitalism’. Thus, it is very necessary for the national and provincial governments, Ministry of Health and Population, development partners and civil society to come together to utilize the money effectively to ensure that it reaches out to the most vulnerable and needy, at times of emergencies such as Covid-19 pandemic.

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