Research Title

“Rapid assessment of preparedness and public health responses for COVID-19 of

Nepal”

DATE: 28 June 2022

 Proposal Summary

Background of Study
It has almost been over two years since the outbreak of the Pandemic of COVID-19. Both in
International and National context, the government imposed complete and partial lockdown within
and outside the respective affected countries and those at risk. Different modalities have been applied
to avoid crowds and extensive movement of people. For instance, only the most essential businesses
such as grossers, hospitals and pharmacies were allowed to run. But in the current situation, most of
the businesses and companies have reopened. In other words, even the inessentials have rejoined their
work. Along with that, the movement of people has greater access since public vehicles have started
operating as well. Apart from the movement in terms of the internal scenario of the country, the
borders and international flights which were shut down for almost a time period of six months now
have been opened.

Statement of the Problem and Rationale/Justification

Re-opening of the points of entries certainly means that there is going to be increased movement of
people, both inside and outside the country. Which further infers that the risk of the disease and its
transmission will surge. So, the question remains through which modality shall the country operate its
international point of entries. Moreover, the disease has quickly spread to all corners of the word and
even the most resilient health systems have been overwhelmed with its explosive spread with twenty
percent of the cases seen as severe or critical. In the context of Nepal where the health system is
already not strong enough and the airports and ground crossings have started to re-open, it becomes
essential to assess whether the criteria and measures have been met as per the guidance of IHR.
 Objective
General
· To assess the preparedness and public health responses for COVID-19 in Nepal and their alignment
with the International Health Regulation in the context of COVID-19.
Specific
· To explore the contingency plan
· To assess the cross-border coordination status
· To assess the status of disease surveillance
· To assess the capacity and availability of equipment and supplies
· To assess the measures applied for infection prevention and control including WASH

Type of Study
Descriptive cross-sectional study will be carried out. Mixed approach will be administered in the
study. Both the quantitative and qualitative study will be undertaken to better suffice the objectivity of
the study.

Study Site and its Justification

All 20 POEs (Primary and secondary) designated by the Embassy of Nepal all across the country will
be selected. They are:

Primary POEs: Kakadvitta (Jhapa), Rani (Morang), Madar (Siraha), Gaur (Rautahat), Birgunj
(Parsa), Belahiya (Rupendehi), Krishnanagar (Kapilavastu), Jamunaha (Banke), Gaurifanta (Kailali),
Gangachauli (Kanchanpur)

Secondary POEs: Pashupatinagar (Illam), Kunauli (Saptari), Thadi (Siraha), Bhittamod (Mahottari),
Malangwa (Sarlahi), Maheshpur (Nawalparasi West), Taulihawa (Kapilvastu), Gulariya (Bardiya),
Thulaghat (Baitadi), Darchula (Darchula) and Surajpur.

Study Population
The border management authorities will be the primary study population. For quantitative study,
representatives from different departments at ground crossing point will be interviewed face to face
for the assessment of POEs. The key informants for the qualitative study, will be the department head
within the border agencies at each Ground crossing point.

Study Unit
Each Point of Entry (POE) designated by the Embassy of Nepal will be the study unit. Study unit
consists of the individual participant selected from the study population.

Sampling Methods/Techniques
All 20 POEs will be the primary sampling unit for quantitative survey. At least one participant from a
different department will be selected conveniently from each purposely selected primary sampling
unit. The study population will be purposely selected from each ground crossing point depending on
the nature of question in each section that could be best addressed by the selected individual. For
conducting a survey at a single POE, representatives/officials from different departments will be
selected such that the real scenario of ground crossing point could be assessed extensively from the
perspective of each border agency.

Sample Size and Justification

This is an initial rapid assessment process designed to quickly acquire information on preparedness
and responses for COVID-19 at POE. The information shared by the 30 interview participants, who
represent each poe will be rich and sufficient to assess the information about their capacity, ongoing
responses and future plan that is required for infection prevention in future. Total of 20 POE will be
surveyed in this study for quantitative study. Different delegates from departments will be interviewed
face-to face as per the need of the study for each survey. Likewise, ten key informant interviews will
be conducted in ten of the primary points of entry that have been enlisted as the entry point with
highest volume of flow.

Criteria for Sample Selection

i) The selected POE will be a registered ground crossing point that has been enlisted by the
Embassy of Nepal.
ii) The study participants selected will be government staff designated to perform their duty at
ground crossing point.
iii) The key informant selected will be the head of departments/coordinator providing service at
ground crossing point
iv) The KII participants will be the delegates from ten primary points of entries of Nepal.

Data Collection Techniques/Methods

1. Face-to-face structured in-depth interview

2. Observation
3. Key informant interview

Data Collection Tools

The structured rapid assessment tool will be developed to conduct face-to-face in-depth interviews.
The assessment tool will provide the instructions that are to be followed in an interview process,
which would ensure the consistency between interviews and increase the reliability of findings. This
tool will be guiding the interviewer through the steps that are to be followed during the process. The
answers that require spontaneous or prompt response, and single or multiple response questions are
well explained in the tool to make the process easy.
The assessment tool includes the observation checklist for some of the study variables with clear
mention on the process and items to observe. Likewise, the interview protocol will be developed to
conduct key informant interviews. This protocol will guide the administration and implementation of
the interview process. The guideline will have key questions and related probing questions. The
probing questions help reflect the meaning of the experience of research participants more clearly and
help supplement the purpose of the study.

Validity and Reliability of the Study Tools

● The researchers will be well trained on both qualitative and quantitative tools.
● Pretesting will be done for the validity of the tool.
● The validity will be assessed using statistical tests

Limitation of the Study

1. The study might be generalizable as this does not cover all the ground crossing points in the
country, even the unregistered ones.
2. The tool has been designed with an assumption that each ground crossing point have
different individual departments performing activities, which might not be the case in many
scenario
3. The individual interviewed for in-depth interview could also be the study participant for key
informant interview for our study
4. The tools designed is under the influence of the COVID-19 pandemic scenario, therefore, the
feeling of normalcy in the country and upcoming rules on returnee migrants might affect the
study variables

Expected Outcome of the Research

· A first of its type, the research will give a detailed understanding on the available
facilities at the POEs and its alignment with the provisions set by International Health
Regulation.

· The research will inform the decisions of MoHP and its agencies to strengthen the
capacities of the POEs.

Plan for Dissemination of Research Results

· Findings will be shared in the form of an elaborated report to MoHP and its agencies.
· A virtual meeting shall be held to disseminate the results.
· A scientific paper will be published based on the findings of the assessment.
 Ethical consideration
● Are human participants required in this research?
- Yes

● How many participants are required for the research? Explain

- 110

● What is the frequency of participant’s involvement in the research?

- Once
Since, the study is cross-sectional study.

● Clearly indicate the participant’s responsibilities in the research. What is expected of the
research participants during the research?
- To participate in the research process and answer the questions related to assessment of
ground crossing points and available facilities and services there.

● Are vulnerable members of the participants required for this research? If yes, provide
justification.
- No

● Are there any risks involved for the participants? If yes, identify clearly what are expected
risks for the human participants in the research and provide a justification of these risks.
- Study involves the risk of privacy at the workplace as study will be carried out during
their duty hours. Therefore, prior approval will be taken for conducting the survey as
per their time convenience.

● Are there any benefits involved for the participants? If yes, identify clearly what are the
expected benefits for the participants.
- The participants will get an opportunity to share their experience working in ground
crossing points. This will be valuable to draw an insight towards the condition of
human resources, supplies, facilities, and services at the point of entry of Nepal for
returnee migrants or any other cross border traders. This would be helpful to improve
the present situation and get the nation prepared for any uncertain circumstances or
pandemic situation starting from ground crossing points.

● Informed consent
- Verbal and Written consent will be taken. The consent form is attached.