KATHMANDU, Nepal—With the number of cases taking off, Nepal has decided it needs to cut back on what it spends fighting Covid-19. It needs to save its money for a huge vaccine bill it expects to have to pay soon.
“We can’t overspend now and be left with nothing,” said Nepal’s health secretary, Laxman Aryal. “The rate of infection can only be controlled by a vaccine.”
As the sprint to try to reverse the spread of Covid-19 has turned into a marathon, some developing countries are dialing back spending on containing the pandemic.
The government of the impoverished Himalayan nation tried to stop free testing and treatment for all but the poorest, shut down its quarantine centers and reduce help to families for funerals. All the government support has cost Kathmandu an estimated $167 million.
The changes set off protests across the country, and Nepal’s supreme court reversed the decision to have most citizens pay for their own testing and treatment, saying citizens have a right to basic health services.
Since then, the government has limited the availability of testing, treatment and quarantine centers to those most in need, even as the number of cases has been rising. The number of coronavirus tests done a day in the country has decreased about 40% from a month ago, and the number of people in government quarantine centers has fallen by more than 80%.
At the center of the debate in Nepal and other developing countries is whether they can afford to continue battling the coronavirus while they wait for a vaccine.
“It ’s very challenging for resource-poor countries to fight a pandemic like this,” said Amesh A. Adalja, senior scholar at the Johns Hopkins Center for Health Security. “They have to think about a sustainable approach that looks at all of the needs of their country.”
From Pakistan to Peru, governments have cut back or ended food and cash handouts, and subsidies for phone, water and electricity bills that are aimed at encouraging people to stay home.
Uganda shut down most of its free quarantine centers, and stopped paying for funerals and providing free tests to anyone who asks for them. It is still subsidizing tests but expects citizens to foot part of the bill.
“The government needs to recover some of the expenses,” said Diana Atwine, permanent secretary at Uganda’s Health Ministry.
Many developing countries don’t have the savings or ability to borrow or tax to raise more money for a drawn-out campaign. Some are just hoping for a vaccine as a quick fix and conserving cash.
In Nepal, some say they feel abandoned by their government. With per-capita income in the country at slightly above $1,000 a year, most families can’t afford private health care or insurance.
Nepali schoolteacher Narendra Paudel, 35, caught Covid-19 this month. He had to pay for the test and got no help with quarantine, and no one tried to figure out where he might have caught the virus or whom he might have passed it on to.
He is worried he has infected his family but can’t get them tested until they get sick.
“It would cost a lot of money if all of them go to the private labs to get their tests done,” he said. “The government is no longer providing free tests to people until they show severe symptoms.”
The number of cases and deaths in Nepal has shot up in recent months. The country of 30 million has more than 210,000 cases. The number of new daily cases has increased to more than 2,000 a day from about 700 three months ago. With fewer tests being done, the number of new infections discovered each day is down from a peak of more than 5,500 last month, but the country’s positivity rate has jumped to 25%.
Meanwhile, its economy has been particularly hard hit as it is more dependent on remittances, tourism and aid than most. Its growth in gross domestic product skidded to 0.2% in the fiscal year through July 15, from 7.0% a year earlier. The government’s tax receipts have also dwindled just when it needs the money most. The World Bank predicts the country’s ratio of fiscal deficit to GDP will double this year to 6.4%.
Kathmandu has been trying to cut back on other spending by temporarily reducing the salaries of federal ministers and through other austerity measures but still had to look for ways to slow the flow of the government money being used in the fight against the virus.
Lumbini Provincial Hospital, a government-run hospital near Nepal’s border with India, has seen a slow buildup and then sharp rise of Covid-19 patients in recent months. Its intensive-care units are full. Doctors are besieged with cases and have to turn away all but the sickest at the hospital doors.
“The government underestimated the enormity of the challenges,” said Dr. Rajendra Prasad Khanal, chief medical superintendent and radiologist at the hospital. “As the cases increased and resources became scarce, it became clear that Nepal’s public hospitals can’t bear free treatment.”
Nepalis say they have lost an important safety net.
Farmer Tek Bahadur Magar, 48, tried to get government aid for his wife after she tested positive for Covid-19. He couldn’t afford to pay for a hospital stay, so he brought her home to recover. He was told to isolate her, but the only place he had to put her was the shed where he keeps chickens and buffaloes.
Late last month, his wife hanged herself. Mr. Magar said she was scared for her life and upset she couldn’t be with her family.
“She was feeling sad about not being able to afford the treatment at hospital,” Mr. Magar said. “I had nowhere to turn to for help.”
—Nicholas Bariyo contributed to this article.
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