Rapid Assessment of Hospitals’

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Key findings: Capacity to cope Key Findings- Capacity to cope

• All hospitals reported the reduction in the usual

• Despite media reports highlighting that hospitals were
overcrowded and running short of supplies, the
assessment found the hospitals had managed the inflow
of casualties well
• The assessed hospitals, particularly at the central level
were prepared to cope with emergencies of the scale
witnessed
• Within Kath valley, although disaster plans existed in 3 of
6 assessed hospitals. almost all displayed readiness
with adequate drugs, supplies, HRs
• Outside Kath & Lalitpur, 12 hospitals reported having
disaster plans but other findings such as the availability
of emergency drugs & other supplies in 3 of these
suggests otherwise
caseload due to curfew as the main reason why
the hospitals had sufficient capacity to cope with
the emergency.
• The implication of course is that the hospitals
are unlikely to be able to cope in a normal
situation with a normal caseload and a similar
crisis
• Further the same operational capacity cannot be
expected during sudden onset disasters such as
earthquakes which compromise the integrity of
the health system and lifelines, such as water
and electricity

1
 Key findings: Nos. of casualties
• The NRCS reported 15 crisis deaths & 5000 related
casualties.
• The accumulated caseload in the 6 central hospitals was
1,100 patients & 676 in the 27 peripheral hospital
• Of these, 93% suffered only minor injuries and were
discharged the same day
• 7% (128 cases) were admitted to hospital; no deaths
were reported.
• Half of all injured and a third of all admissions were at
Model Hospital, in the centre of Kathmandu
• 75% casualties outside Kathmandu were managed in
MOH hospitals and 64% of admissions, despite their
inadequacies
Key findings: Central hospitals
• None of the assessed hospitals at the centre
had run out of drugs and essential supplies &
had managed to mobilise funds to replenish
stocks
• The curfew however made it difficult to purchase
goods & transport staff, supplies and patients.
• Cooking gas and food supplies were more
affected than stocks of drugs & supplies.

Key Findings: Central hospitals

Assessed hospitals:
Key findings: Peripheral hospitals
2 govt institutions (Bir & TUTH)
4 pvt/ board (Patan, Model,Om, Medicare) Peripheral (private & Army)-10
3 Medical Colleges
• Sufficient nos. of skilled human resources; only Model
Hospital reported inadequacy probably due to the large 6 private hospitals
nos. of patients admitted 1 Army Hospital,
• All had sufficient hardware- beds, operation theatres
• All hospitals had adequate supplies of emergency drugs Peripheral MOH institutions-17
& supplies, except for Model H where demand
outstripped supply. 1 Regional Hospital
• Infection prevention and sterilization were not 3 Zonal
compromised although Model reported some difficulty 13 district hospitals
coping.
• 24 hour water & electricity were not a problem
14 terai & 13 hills (mostly easy access)

2
 Key findings: Peripheral hospitals MOH
The report highlights the intrinsic weakness of the health system, with
poor infrastructure, lack of skilled human resources (doctors and
nurses) and overall inadequate infection prevention even in every
day practice and yet a fairly high utilization
• 88 % (15 of 17 MOH hospitals ) understaffed
– 13 hospitals grossly understaffed
– 2 others reported some understaffing
• 47% (8) hospitals reported inadequate beds, OTs and space even
in a normal situation
• 47% (mostly the same 8) hospitals reported inadequate emergency
drugs, supplies
• Several hospitals reported their IP/ sterilization capacity as being
inadequate.
• Blood transfusion was not available in 9 hospitals- largely the same
hospitals
Referral
• Central hospitals: No referral system in
place
• Peripheral hospitals: Reported some
sembalnce of a referral system (seems
unlikely given the reported weaknesses)
Transportation
• In general mobility of staff, patients limited due
to curfew restrictions
• At the centre, ambulances were largely available
though mobility was restricted due to lack of
curfew passes and lack of fuel
• Surprisingly, 19 of the 27 peripheral hospitals
had access to ambulances, mostly not properly
equipped for emergencies (but adequately
equipped given that no paramedic accompanies)
Co-ordination
Central hospitals: No co-ordination system was in place
• Distance between emergency site and health facility is a key factor in
determining where casualties seek treatment. Prospects of free
treatment is another key factor along with political considerations
(might explain why Model Hospital received the majority of cases)
• Bir: Mass casualty management coordination was initiated by MOHP
6 months ago. The Medical Superintendent at Bir Hospital played a
role in establishing catchments areas along the contested ringroad
• Om and TUTH: Nepal Medical Association played a key role in
establishing ad hoc coordination among various hospitals.
Peripheral hospitals: No co-ordination system was in place
• Some co-ordination efforts by NRCS, ICRC, NCDA, with Medical
Colleges, human rights organizations, UN agencies, journalists etc
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 Donations Conclusion & Recommendations

• The assessment raises key concerns regarding transport

Widespread contributions of cash from: of casualties, medical staff and supplies. Free movement
in these areas must be addressed
• Nepalese citizens
• ICRC- supplies • Lack of emergency preparedness especially at the
peripheral MOH hospitals & the Army Hospital .
• Government & private hospital staff Establish nationwide mass casualty management
system with NRCS
• Pharmacies
• WHO & UN Agencies to facilitate emergency health
sector co-ordination to consolidate findings & prepare for
future contingencies
Free treatment was also provided
• Preposition essential medical supplies to enhance
disaster capacity

Conclusion & Recommendations

• In the absence of a functioning district health
system, emergency response is unlikely
• Link with Health Sector Reform Process
– Hospital infrastructure, water, electricity
– Drugs, equipment, supplies
– Human resources
– Management systems, infection prevention
• Strengthen linkages with existing programs that
strengthen district health systems