ACT COVID-19 Nepal Nepal is currently in the grips of the second wave of the COVID-19 pandemic. The second wave began from mid-April 2021, and daily infection rates have steadily been growing to a daily average of almost 9,000 per day from 300+ per day a month ago. As of 18th May 2021, a total of 5,411 deaths, 472,354 confirmed cases and 114,529 active cases have been recorded. The positivity rate, which is highest in the globe at this moment, is hovering around 45% nationally, with a transmission rate of 1.8 %.  

This rapid spike in cases can be attributed to several things such as relaxing of social distancing rules, reopening of schools, resuming mass gatherings for family functions, meetings, hosting political rallies and festivals, among others. However, a key factor has been the rise in Covid-19 cases, and the emergence of more infectious variants in neighbouring India. Nepal shares 1800 kms of open border with India; more than 50% of youth from Western Nepal work in India as seasonal migrants. With cases in India spiralling out of control, many migrant workers returned to their villages and towns in Nepal. Consequently, districts along the border with India such as Banke and Nepalgunj among others have become hotspots for the outbreak, along with Kathmandu, the most populous city in Nepal. 
 
Strain on the health care systems

Nepal’s dependence on India for most supplies, has further aggravated the crisis, as India prioritises its own needs first. Currently, Nepal is not only facing critical shortages in vaccines, but also immediate lifesaving medical supplies such as oxygen, medicine and other medical supplies. As per the GoN, there is 1 ICU bed per 17,930 people, 1 ventilator per 34,048 people, and 1 doctor per 1,740 people in Nepal. Lack of crucial infrastructure such as ICU beds and ventilators, combined with inadequate preparedness, poor diagnostic capacity, shortages in trained health care professionals, and squeeze in the medical supply chain have created a perfect storm.  
 
Economic and social consequences

Apart from public health consequences, the economic consequences of Covid are also alarming, especially for the workers in the informal sector and daily wage labourers. More than 50% of enterprises in Nepal are in the informal sector, with many affected by the prolonged lockdown in 2020, made worse by the ongoing lockdown orders, essentially bringing all economic activities to a standstill. World Bank last year stated that more than 1/3 of the population has been pushed below the poverty line by Covid. Lack of social protections, government schemes and assistance mean the most vulnerable are more at risk of falling into extreme poverty. Additionally, the crisis has also been linked to a rise in Gender Based violence and suicides.   
 
Government response to the crisis

The GoN has been very slow to respond to the crisis, with concrete steps being taken only more recently. However, the delay in preparedness and early response means that the country’s healthcare system has been completely overwhelmed by the uptick in cases. Significantly, the central government’s decision to ask local governments to fund and run their own quarantine/isolation centres meant that the quarantine facilities were ill-equipped and underfunded.  Rather than focusing on expanding the number of beds, securing oxygen supplies, ventilators, genomic sequencing machines, and vaccines with their own resources, the GoN’s early response was to rely on aid from international donors. Finally on May 11, Nepal’s Prime minister reached out to international community and directly requested support to help Nepal cope with the crisis. Similarly, Ministry of Health & Population, regulatory body of INGOs Social Welfare Council have urged development actors to support government initiatives of responding to covid crisis. The most vulnerable communities and frontline health service providers in the targeted areas are assisted in surviving the second wave of COVID19 pandemic and thriving through the pandemic’s short- and longer-term impacts on their lives and livelihoods (Survive & Thrive)

Outcome 1 (Public Health):  Enhanced Public Health measures and improved health and hygiene behaviour for prevention and treatment of COVID19 cases through supporting public health institutions with provision of essential medical supplies and WASH facilities

Outcome 2 (Food Security & Livelihoods):  Improved food security in emergency situation of the most vulnerable communities and enhanced capacities of the communities to meet their basic needs in COVID19 context

Outcome 3 (Awareness and Advocacy): Increased awareness of people on COVID19 prevention and control, vaccination and effective response from local governments in responding to the COVID19 crisis through adequate risks communications, mobilization of community institutions and faith-leaders in managing beliefs, attitudes and social stigma, and ensuring community inclusivity, social cohesion (ACT Global Appeal), reduction of gender-based violence, and through active engagement with local Governments Participatory and inclusive approach- The project will ensure direct involvement of all sections of the beneficiary population (pregnant and lactating women, PWD, elderly, ex-bonded labour, dalits, boys and girls etc) through a participatory and inclusive approach focusing on the highly vulnerable and poor community members. The project will emphasize on engagement of targeted community and local government in all stages of project cycle management and project plan, project provisions, implementation arrangements and monitoring and reporting system will be shared with them in the project inception meeting. Project beneficiaries and their representatives will be invited in planning and review meetings; post distribution monitoring (PDM) process and public audit events.  

The beneficiary selection, including the targeting of women-headed households, pregnant or lactating women, single women, person with disability, senior citizens, people facing caste-based exclusion and COVID-19 affected/at-risk people.