In 2015, two powerful earthquakes hit Nepal, killing almost 9000 people. Starting from 2020, the COVID-19 pandemic has taken the lives of more than 12000 people in Nepal. Health is one of the fundamental rights in the constitution of Nepal. Article 1 (35) states “Every citizen shall have the right to free basic health service from the State, no one shall be deprived of emergency health services.” The constitution provides the authority for disaster risk reduction and management at all levels including the health system.

Nepal only had the Natural Calamity act, which provided relief work after a disaster. And, only in the aftermath of the 2015 earthquake disaster risk reduction and management (DRRM) act was formed, which recognized the importance of risk reduction and preparedness for disaster. The constitution, Health/ Public health service Act, and regulations includes: Infectious Disease Act (1964), Public Health Service Act (2018), and the Public Health Service Regulations (2020). The Public health service act and regulations contain a provision for emergency health service and management. It has provided the right to all three tiers of government to form and implement emergency health plans with standards determined by federal law. The infectious disease act of 1964, enforces necessary steps for the prevention, information, and management of infectious diseases by health organizations.

Nepal has now achieved a legal framework, which purposes a multilevel disaster risk management institutional structure at the national, provisional, district, and community levels. This ensures a reduction in dependency on international aid, improved health outcomes, and fast economic recovery.

The structure is primarily divided into two bodies. The first one makes policies and administrative decisions and includes the DRRM national council (led by the prime minister of Nepal), the DRRM executive committee (led by the home minister), and the expert committee. The expert committee is responsible for the formulation and implementation of policies and plans which are purposed to the DRRM national council for approval. There is a division in the Ministry of Health and Population (MoHP) under the Minister and Secretary of Health Emergency and disaster management unit (HEDMU) composed of Medical officer and a section officer. This unit coordinates through the health emergency operation center (HEOC) and acts as the secretariat of MoHP-ICS and health sector center point and the central communication body for health emergencies and disasters. The HEOC Network consists of provincial HEOCs known as PHEOC which were established as a coordination hub in 2015. It aims at coordinating with the 25 hub hospitals and satellite hospital network, relevant health partners, and non-health EOCs for disaster preparedness and response. The HEOC has also been entitled to activate the health (WHO) and nutrition (UNICEF) cluster during emergencies followed by the inclusion of key humanitarian partners.

Furthermore, there is district disaster management at the district level as District Emergency Operating Centre (DEOC) which is chaired by Chief District Officer (CDO), and Local Emergency Operating Centre (LEOC) at the municipality level under the chairperson of the Mayor. The LEOC coordinates with PEOC directly and NEOC through DEOC. Besides HEOC, NEOC also coordinates with National Bhukampa Mapan Kendra, TIA, UN emergency center, Disaster Adhyananushadhan Kendra, NRCS, Nepal Army, APF, Nepal Police, Fire brigade, and Meteorological division.

Disaster is always a challenging situation at all levels including the health sector despite the preparedness. The healthcare system becomes a high-profile element, critical to the immediate health response and recovery phase during any disaster. The earthquake in 2015 was a big wake-up call for disaster management in Nepal. Though there has been remarkable progress in all phases of disaster management cycle after 2015, we still felt the void during the COVID19 pandemic 2020. Awareness, education and understanding of the existing system is important for progressiveness in disaster management therefore this write-up is a small nudge regarding our existing disaster management in the health system of Nepal.

Dr. Dipesh Mangal Joshi (MD, Fellowship in EM) and Dr. Rony Maharjan (MD, Fellowship in EM) are faculties at Patan Academy of Health Sciences, Lalitpur, Nepal

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