Nepal ramps up disease surveillance after earthquakes
Every morning since the first of two recent earthquakes struck Nepal on 25 April, Dr Sharmila Shrestha and researcher Sanjita Thapa have made the hour-long journey from Kathmandu to Kavrepulanchok, a district east of Kathmandu valley, with one goal in mind – to protect people against disease outbreaks.
Following the buckled Araniko Highway toward the hilltop town of Dhulikhel, the district headquarters, the pair pick up Chief District Health Officer Rajendra Prasad Shaha before arriving at the district health office for their morning meeting.
Amid the pleasantries, the strength of their working relationship – which predates the recent disaster – is clear. Such ties are proving critical to addressing immediate public health challenges, including monitoring and controlling communicable diseases, such as diarrhoeal disease, seasonal flu and upper respiratory tract infection. There is a heightened risk of outbreaks following the first and subsequent 12 May earthquakes due to disruption of shelter, water and sanitation, as well as the coming rainy season.
“Before the earthquakes I was a WHO surveillance medical officer monitoring routine immunization drives in four districts. Now I am focusing on one district, Kavre, which I visit daily” says Dr Shrestha, who now works for the WHO supporting the Ministry of Health and Population’s (MoHP) Emergency Disease Surveillance programme (EDS).
The EDS programme monitors the 14 most affected districts, using nine surveillance medical officers from pre-existing WHO monitoring programmes in Nepal, in addition to five Nepali staff drafted in from WHO offices around the world.
According to Dr Shrestha, familiarity with the “zero-reporting strategy,” first implemented in Nepal as a result of WHO’s worldwide polio eradication campaign that began in 1988, has allowed authorities to gain daily intelligence on disease prevalence in outlying areas since the earthquakes. Though cases of communicable diseases have been documented, an outbreak has not yet occurred.
“Zero reporting means that every ward, every day, must report to the district office on each and every case they have received during that day. If no cases have been received, then they must still report,” says Dr Shrestha. “If there are any issues, the local authorities can then investigate.”
Sharing of information at each level of Nepal’s governance structure – from ward to village, and then district and national levels – enables local authorities to investigate any risks and potential outbreaks that may arise, while also feeding into a central, national database at the Health Emergency Operations Centre at the Ministry of Health and Population in Kathmandu.
Rather than being solely a reactive mechanism, this infrastructure is disseminating public health messages, including advice on sanitation and hygiene developed by WHO to prevent possible outbreaks.
“We have Female Community Health Volunteers in each ward. Through them we communicate with the public and provide community health awareness programmes,” says Narayan KC, Kavrepulanchok’s focal person for post-disaster communications.
According to KC, mothers’ group meetings convened by the female volunteers are vital to ensuring that health messages reach vulnerable populations.
“All the mothers of the ward gather and they have a meeting. Mostly they focus on children because they are the most susceptible to communicable diseases,” he says.
The Female Community Health Volunteer system means that WHO-approved messages are disseminated in local languages, by local community leaders.
“If the mother is aware, then the family and community will be protected,” says KC.
As the rainy season draws close, the realignment of pre-existing WHO and MoHP health surveillance and reporting mechanisms provides the best opportunity to guard against possible disease outbreaks. At the same time, local communities are empowered, and Nepal’s health system made more resilient.