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EFFECTIVENESS OF LOCAL GOVERNMENTS IN NEPAL TO ADDRESS THE COVID-19 CRISIS ASSESSMENT REPORT Prepared under Contract No. GS-10F-0033M / Order No. AID-OAA-M-13-00013, Tasking N083

This publication was produced for review by the United States Agency for International Development. It was prepared by NORC at the University of Chicago. The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

DRG LEARNING, EVALUATION, AND RESEARCH ACTIVITY

EFFECTIVENESS OF LOCAL GOVERNMENTS IN NEPAL TO

ADDRESS THE COVID-19 CRISIS ASSESSMENT REPORT

APRIL 2021

Prepared under Contract No.: GS-10F-0033M / AID-OAA-M-13-00013, Tasking N083

Submitted to:

Mousumi Sarkar, USAID COR

Submitted by:

Ritu Nayyar-Stone, Team Lead Jagadish Pokharel, Local Government Specialist Samantha Downey, Qualitative Specialist Alex Rigaux, Quantitative Specialist

Contractor:

NORC at the University of Chicago 4350 East West Highway, 8th Floor Bethesda, MD 20814 Attention: Renée Hendley Tel: 301- 634-9489; E-mail: [email protected]

DISCLAIMER

The authors’ views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.

mailto:[email protected]

CONTRACT NO.: GS-10F-0033M / AID-OAA-M-13-00013 / DRG-LER TASKING N083

USAID.GOV EFFECTIVENESS OF LOCAL GOVERNMENT IN NEPAL TO ADDRESS COVID-19 | i

TABLE OF CONTENTS

TABLE OF CONTENTS I

TABLES II

FIGURES II

ACRONYMS III

EXECUTIVE SUMMARY 1 FINDINGS 2 CONCLUSIONS 5 LESSONS LEARNED AND RECOMMENDATIONS 6

RESEARCH PURPOSE AND RESEARCH QUESTIONS 7

BACKGROUND 8

METHODS AND LIMITATIONS 9 QUALITATIVE DATA COLLECTION – KEY INFORMANT INTERVIEWS 9 QUALITATIVE DATA COLLECTION – FOCUS GROUP DISCUSSIONS 10 QUANTITATIVE DATA COLLECTION 11 QUANTITATIVE DATA COLLECTION – MUNICIPAL OFFICIALS SURVEY 12 LIMITATIONS 13

FINDINGS AND CONCLUSIONS 14 FINDINGS 14 CONCLUSIONS 42 LESSONS LEARNED AND RECOMMENDATIONS 44

ANNEX A: ASSESSMENT STATEMENT OF WORK 46

ANNEX B: ASSESSMENT METHODS AND LIMITATIONS 49

ANNEX C: DATA COLLECTION INSTRUMENTS 57

ANNEX D: SOURCES OF INFORMATION 89 KEY INFORMANTS 89 DOCUMENTS REVIEWED 90

ANNEX E: DISCLOSURE CONFLICTS OF INTEREST 96


USAID.GOV EFFECTIVENESS OF LOCAL GOVERNMENT IN NEPAL TO ADDRESS COVID-19 | ii

TABLES Table 1: KIIs in Kathmandu, Province 2 and Sudurpaschim 9 Table 2: FGD Participants in Province 2 and Sudurpaschim 10 Table 3: Quantitative data and gender breakdown Province 2 and Sudurpaschim 12 Table 4: Citizen’s Satisfaction with Assistance Received from Non-Governmental

Organizations, Counts 32 Table 5: Municipal Response and Challenges dealing with COVID-19 40

FIGURES Figure 1: Coordination with other levels of government 18 Figure 2: Type of assistance and collaboration with other levels of government 18 Figure 3: Greatest challenges in meeting the health and humanitarian needs of the people 19 Figure 4: Migration of citizens in the sample 21 Figure 5: Hiring during the COVID-19 Crisis by Municipalities 22 Figure 6: Regular municipal service delivery during the COVID-19 crisis 23 Figure 7: Citizens’ Awareness of services or resources provided by the federal, provincial, or

municipal government to this community in response to COVID-19 crisis 25 Figure 8: Citizens Perception of their municipality’s response to COVID-19 26 Figure 9: Feedback on Municipality’s handling of the COVID-19 crisis by various sources 27 Figure 10: Cooperation with the private sector, NGOs and other entities 30 Figure 11: Percent of citizens who received assistance from NGOs and other entities during

the COVID-19 crisis and were satisfied with the assistance 32 Figure 12: Citizen feedback on assistance received from the government during COVID-19 41


USAID.GOV EFFECTIVENESS OF LOCAL GOVERNMENT IN NEPAL TO ADDRESS COVID-19 | iii

ACRONYMS CATI Computer-Assisted Telephone Interview

CCMC COVID-19 Crisis Management Center

CSO Civil Society Organization

CDCS Country Development Cooperation Strategy

COVID-19 Coronavirus Disease of 2019

CN Concept Note

DMF Disaster Management Fund

DRMF Disaster Risk Management Fund

DRG-LER Democracy, Human Rights, and Governance – Learning, Evaluation, and Research Activity

EQ Evaluation Question

FCHV Female Community Health Volunteers

FGD Focus Group Discussion

GoN Government of Nepal

ICU Intensive Care Unit

IP Implementing Partner

KII Key Informant Interview

LG Local Government

MoD Ministry of Defense (Nepal)

MoF Ministry of Finance (Nepal)

MoFAGA Ministry of Federal Affairs and General Administration (Nepal)

MoFA Ministry of Foreign Affairs (Nepal)

MoHP Ministry of Health and Population (Nepal)

MoHA Ministry of Home Affairs (Nepal)

MSD Ministry of Social Development

NORC NORC at the University of Chicago

NGO Non-Governmental Organization

PI Principal Investigator

PM Prime Minister

USAID United States Agency for International Development

USG United States Government

WHO World Health Organization


USAID.GOV EFFECTIVENESS OF LOCAL GOVERNMENT IN NEPAL TO ADDRESS COVID-19 | 1

EXECUTIVE SUMMARY Just a few months into the first half of 2020, the unprecedented COVID-19 pandemic infected millions across nearly every country in the world, killing hundreds of thousands as it inundated existing health care infrastructures, prompting widespread lockdowns resulting in mass unemployment, halting international travel as borders closed, and crippling local and global economies alike in the process. As of August 28, 2020 Nepal had 36,456 cases with 195 deaths. By April 4, 2021 this figure had increased to 277,944 cases with 3,032 deaths. Under the DRG-LER Contract, USAID asked NORC to design and undertake research on the Nepali local governments’ (LGs) response to COVID-19. The primary goal of this research is to explore the effectiveness of local governments in addressing the COVID-19 crisis across four key research questions at the local level, specifically in Province 2 and Province 7 (Sudurpaschim).

RESEARCH QUESTION 1 deals with LGs’ functions with respect to COVID-19 response, the roles and responsibilities for municipalities (Palikas) and wards (both urban and rural), and their cooperation and/or coordination with other levels of government in providing this response.

RESEARCH QUESTION 2 focuses on the capacity of LGs to deliver COVID-19 related services; if the provision of COVID-19 services affects the delivery of other government services; and the perception of the public towards LGs as they continue to respond to COVID-19.

RESEARCH QUESTION 3 examines if LGs developed partnerships with other entities, specifically CSOs and the private sector, in the provision of COVID-19 related services and the ways in which they did so; how LGs engaged the private sector to address the effect on supply-chains; and the short-term and long-term repercussions on the economy and household livelihoods.

RESEARCH QUESTION 4 describes the funds that were mobilized and provided for COVID-19 response; the systems of control and transparency that were established; how funds were used; the current local planning process (April-June 2020) of municipalities to deal with COVID-19, and if the plans target the most vulnerable groups of the communities.

In Nepal, the provision of various health and economic services at the municipal (Palika) level related to the COVID-19 response is exacerbated by challenges in implementing a constitutionally mandated transition to a more decentralized form of government that began in 2017 with the formation of The Federal Parliament of Nepal. Thus clear functional responsibilities, coordination and collaboration between the federal, provincial and local levels of government in providing these services are critical, especially for the COVID-19 response.

NORC collected data from both the supply side (entities providing the COVID-19 response) and the demand side (citizens, nongovernmental organizations and private sector actors requesting a response due to the pandemic). On the supply side, NORC conducted key informant interviews (KIIs) with LG officials at the provincial and municipal level, federal government officials from ministries engaged in COVID-19 decision-making, USAID implementing partners (IPs), and Donor staff. On the demand side, NORC conducted focus group discussions (FGDs) with citizen beneficiaries of COVID-19 services, with a particular focus on migrant workers returning from India and vulnerable (low income) populations. NORC also conducted FGDs with civil society organizations (CSOs) and private sector representatives as they sought economic relief from the government and also collaborated with the municipal government in responding to the pandemic. Based on the initial findings from KIIs with municipal officials, NORC drafted a short computer assisted telephone interview (CATI) survey for additional municipal officials in Province 2 and



Sudurpaschim. NORC also developed a short CATI survey for citizens. The primary data collected for this assessment is shown in the table below.

Key Informant Interviews

Federal Government Agencies and Officials

Implementing Partners

Donors

Provincial officers, Mayors/Deputy mayor

11 in Kathmandu

9 in Province 2

9 in Sudurpaschim

Focus Group Discussions

General Citizens

Private Sector

Civil Society Organizations

11 total, 5 in province 2 and 6 in Sudurpaschim:

Citizens 1

Private Sector 2/3

CSO 2

Surveys (Computer Assisted Telephone Interview)

General Citizens

LGA

400 (200 in each Prov.)

66 (33 in each Prov.)

FINDINGS

Research Question 1: The guidelines regarding health services during COVID-19 stated that the Department of Health Services, Provincial Government, and private hospitals shall be responsible for the supply of medical equipment, gloves, sanitizers, personal protection equipment (PPE)/masks, and to extend the capacity of hospitals. The guidelines also stated that the Ministry of Health and Planning shall play the role of coordination, including providing insurance of NPR 2.5 million to the doctors, nurses, ambulance drivers, security forces and other persons working directly on Covid-19; and the Ministry of Finance shall provide the resources. Furthermore, all three levels of government—federal, provincial and municipal—shall be responsible for operating quarantine facilities including providing food for people living in quarantine as per the guidelines relating to operation and management of the quarantine. Provincial and LGs were therefore involved in: (i) operating quarantine locations, (ii) collecting statistics on people needing relief during the pandemic and (ii) providing relief as decided by the cabinet. Municipalities and wards were tasked with front line management and implementation of both health and non-health related decisions at the community and individual level.

Municipal officials in Province 2 and Sudurpaschim identified a variety of actions to be their responsibility: (i) initiating public awareness campaigns, (ii) transporting returning migrants and putting them in quarantine, (iii) distributing a variety of health products such as sanitizers, masks and requesting citizens to follow social distancing, (iv) conducting PCR tests, enlisting the help of volunteers, and (v) providing relief materials like food and resources for their vulnerable populations.

All key informants at the provincial level had a clear understanding of their roles and responsibilities. However, respondents had differing impressions of the role that the federal government played to support LGs, stating that there is still confusion regarding the roles and responsibilities of different levels of government, and this affects effective management of the COVID-19 response.



In the Municipal Officials survey, respondents indicated a high level of vertical and horizontal coordination and collaboration. Everyone said they coordinated with the provincial government and wards in their municipality, and there was high coordination with the federal government (95 percent) and neighboring municipalities (89 percent) as well. Municipal officials noted that they received virus tests, direct funding, and PPE or masks from the provincial and federal government. They collaborated with wards and neighboring municipalities for crisis response and the mobilization of labor/returning migrants.

Research Question 2: Many municipal officials felt they lacked sufficient knowledge and resources to deal with the pandemic, and this capacity gap was highlighted by other stakeholders including donors and federal officials. Municipal capacity gaps included: (i) limited resources, (ii) management of migrants and vulnerable populations, (iii) human resources/new hires, and (iv) a cumbersome public procurement system. The top three challenges in meeting the unexpected health and humanitarian needs of the people include inadequate resources/funds (91 percent), managing the quarantine centers (89 percent), and awareness of citizens regarding the pandemic (52 percent).

Addressing the virus became the primary focus of the municipalities, and this affected other service delivery. According to the Local Government Operations Act (2074), Clause 79, municipalities can shift 25 percent of their capital budget from one heading to another in the budget approved by the Assembly, and most municipalities did this. Citizens who attended FGDs had varying experiences accessing regular municipal services, and there appeared to be some differences between the experiences of interviewed citizens in Province 2 and in Sudurpaschim, with citizens in the later province being more positive about the municipalities continuing with the normal duties during the pandemic. In the citizen survey, 68 percent of respondents indicated that their municipality was able to fulfill regular service delivery mandates during the crisis. Of the 35 percent of respondents who reported requesting regular services during the pandemic, 68 percent said their service attempt was successful.

In the Municipal Officials’ survey, respondents said that they were unable to undertake capital improvement projects, regular maintenance and operations, regular administrative duties, invest in infrastructure development, reforms, and pay staff salaries while focusing on the pandemic. They also had to postpone training on income-generating and skill development activities.

Major stakeholders’ assessments of LGs’ performance are mixed. Of the respondents of the citizens survey who said they received government assistance, 25 percent were not satisfied with the assistance they received, but overall satisfaction with the performance of the municipality was 64 percent. When asked “to your knowledge did the government collect any information from citizens about their needs during the COVID-19 crisis, 62 percent said “no,” Provincial officials noted that municipalities in Province 2 were struggling, and those in Sudurpaschim felt that while the work of municipalities was effective at first, efforts slowed down with the lengthening duration of the pandemic. CSOs in Province 2 felt that municipalities could have mobilized them more effectively; while CSOs in Sudurpaschim took measures to carry out a Public Expenditure Tracking Survey as a result of increased corruption in the province. Donor key informants were generally positive, and noted that the performance of municipalities was good despite limited capacity and various challenges. While most private sector respondents were critical of municipalities and reported receiving little to no support from LGs, there were some respondents who felt that the municipalities worked hard to support citizens during the crisis.

Research Question 3: Municipalities received support from the private sector in the form of funds, relief distribution, transportation assistance, and health related material. Organizations that



provided support included Hulas Steel, Jagadamba Steel, and the Federation of Nepalese Chambers of Commerce and Industry. Some private sector respondents claimed that they engaged in the COVID-19 response on their own volition and that municipalities neither requested their assistance nor facilitated the work they did at the local level. Private sector actors in both Province 2 and Sudurpaschim criticized the municipalities for their lack of effective coordination and mobilization of the private sector; despite this the private sector sees an opportunity, and is open towards future partnership and collaboration with municipalities in managing the crisis.

CSOs were engaged differently from private sector actors in helping the municipality respond to COVID-19, with some municipalities making an open call for CSO support. While not all CSOs reported receiving a formal invitation for collaboration from the municipalities, many were glad to support the municipalities in handling the crisis; most were critical of the ways local governments engaged (or did not engage) their support. Only 31 percent of the citizens’ survey respondents reported receiving assistance from NGOs or other non-governmental entities during the COVID-19 crisis. However, a higher percent were satisfied with the assistance they received from private individuals (93 percent), NGOs (98 percent), and private firms (90 percent) compared to assistance received from the government (74 percent).

The nature and severity of the effect of the lockdown varied with the type of industry and business. Interviewed private sector actors felt that their municipality did not work effectively to reestablish the broken production supply chain and they had to depend on others to access supplies. The broken supply chain proved problematic for a number of businesses that were not able to restock their products nor get their products from other countries in a timely way. Industries that were particularly affected included the agrovet, hotel, and tourism industries.

Other societal impacts of COVID-19 include the disruption of social, economic and governance systems, with severe social and economic impacts affecting peoples’ business and lives in multiple ways. Several businesses shut down, there was a decrease in tourism and youth were affected due to decrease in employment opportunities and postponement of various skills development and training programs.

Research Question 4: Municipalities obtained funding from a variety of sources to deal with the pandemic—the Disaster Management Fund, the Disaster and Risk Management Fund, the COVID-19 fund, donors and INGOs as well as the private sector and individual citizens. However, the amount was insufficient to deal with the scale of the pandemic. Several LGs diverted funds in their own budgets from one line item/heading—usually for developmental work, agriculture related activities, training and equipment—into COVID-19 response. Border municipalities dealing with the influx of returning migrants were especially constrained; they did not receive sufficient extra support to deal with the large influx of returning migrants and faced many problems with setting up holding and quarantine centers.

Key informants in Kathmandu felt that since LGs were working under pressure to respond to the pandemic, it was difficult for them to track expenses. However, according to a USAID IP, there were inconsistencies in the rationalization provided for diverting funds as well as for how they were used. At the municipal level several mayors indicated that they had made their COVID-19 accounts public, discussed their COVID-19 accounts during public hearings and council meetings, and followed guidelines indicated by the provincial cabinet and chief minister. However, CSOs in Sudurpaschim said that due to the increased corruption during relief distribution they carried out a Public Expenditure Tracking Survey (PETS). They requested the municipality to provide expenditure details in a format that citizens would understand, but officials did not cooperate or accommodate this



request. Citizens either noted the lack of information on how municipalities spent the money received for COVID-19, or were unaware of funds being received by the municipality to deal with COVID-19. In Province 2 practically all the citizens in the FGD were aware that the municipality had received funding but said “we don’t know where the money went.” In Sudurpaschim, citizens said they were not aware or did not know the details about the funding.

There are mixed opinions on the overall response of the government to the pandemic. While municipalities undertook health and relief efforts and dealt with vulnerable populations and migrants at the border, all of their actions faced challenges. In spite of these obstacles, one Mayor in Province 2 said that “had the government structure been like before, [the LG response to the pandemic] wouldn’t have worked. That is, if everything was centralized and had to be controlled by the central level, things could have gone haywire. But now the local government also has the capacity and the authority to carry out various tasks on its own.” In a KII, a federal ministry official noted that “If local governments and provinces were not there we couldn’t have achieved what we did to manage the COVID-19 crisis. We passed the test of federalism at the time of COVID.”

Looking forward, LGs have realized the need to plan for the next year and deal with the new context with respect to high unemployment and school closures. A budget template has been prepared by MOFAGA for the next years’ budget which is now being used by LGs. While MOFAGA has indicated there should be a separate budget for COVID-19, it has not yet provided written guidelines for this.

CONCLUSIONS

Municipalities and wards became the front line in both managing and implementing the health and non-health related decisions regarding COVID-19 response. At the start of the pandemic, municipal officials were overwhelmed by the numerous guidelines and instructions that were sometimes unclear and contradictory; weak coordination across the three levels of government was often cited as the cause of the confusion. Practically all the municipalities surveyed collaborated with higher levels of government, most also collaborated with their wards to deal with the pandemic and collaborated with neighboring municipalities on the mobilization of migrants returning home through the border.

Many municipal officials felt they lacked sufficient knowledge, medical equipment and supplies to deal with the pandemic and had to deal with issues on an ad hoc basis. Most mayors stopped development work in their municipalities and diverted these funds to deal with the pandemic. As such, repair work as well as ongoing maintenance and regular administrative duties were affected in the majority of the municipalities that responded to the Municipal Officials survey. However, 68 percent of citizens surveyed responded that their municipality was able to fulfill their regular service delivery mandates during the pandemic.

The majority of the municipal officials surveyed (64 percent) said that their municipality cooperated with NGOs, and 58 percent said they cooperated with private individuals; the majority were satisfied with this cooperation. Some municipalities made open calls for CSO support with the pandemic, however, both the private sector and CSOs were critical of the way they were engaged. The supply chain impact of COVID-19 was mostly felt by the agrovet industry, and in some municipalities, the supply chain was completely broken. The pandemic also affected private businesses, tourism, and employment opportunities for youth.



Municipalities obtained funding from a variety of sources to deal with the pandemic, but the amount was insufficient to deal with the scale of the crisis. Most municipalities lack the capacity and staff to keep good records and accounts, and CSOs and citizens did not agree with mayors regarding transparency and public disclosure of their COVID-19 accounts. Looking forward, LGs have plans to focus on the health sector and have a separate COVID-19 budget.

LESSONS LEARNED AND RECOMMENDATIONS

• There is a need for a better data collection system and management of citizens working abroad.

• Improve municipal capacity and resources to deal with crises in the future.

• Streamline procurement procedures and accounting systems.

• Create disaster risk financing options and insure housing and businesses during emergencies.

• Prioritize the health sector in an integrated way.

• Improve cooperation with the federal and provincial government, and coordination with multiple stakeholders across several sectors.

• Increase private sector/local government engagement.

• Increase engagement with CSOs.



RESEARCH PURPOSE AND RESEARCH QUESTIONS Just a few months into the first half of 2020, the unprecedented COVID-19 pandemic infected millions across nearly every country in the world, killing hundreds of thousands as it inundated existing health care infrastructures, prompting widespread lockdowns resulting in mass unemployment, halting international travel as borders closed, and crippling local and global economies alike in the process. In early March 2020, the World Health Organization (WHO) placed Nepal in the high-risk category for COVID-19. Soon after, the Government of Nepal (GoN) enacted a mandatory nationwide lockdown on March 24th. As part of this lockdown, borders with India were sealed, international flights were halted, and “all movement on the roads, by vehicle and on foot, [was] prohibited with very limited life safety exceptions.” The complete lockdown was extended multiple times, with some easing starting on June 15th 2020, at which point there were 6,211 confirmed cases of COVID-19 in Nepal with 19 deaths. As of August 28, 2020 Nepal had 36,456 cases with 195 deaths. By April 4, 2021 this had increased to 277,944 cases with 3,032 deaths.1 The Government of Nepal (GoN) continues to face challenges in implementing its constitutionally mandated transition to a new federal structure, which creates further difficulties as it tackles the coronavirus disease of 2019 (COVID-19).

Under the DRG-LER Contract, USAID asked NORC to design and undertake research on the Nepali local governments’2 (LGs) response to COVID-19. The primary goal of this research is to explore the effectiveness of local governments in addressing the COVID-19 crisis across four key research questions at the local level, specifically in Province 2 and Province 7 (Sudurpaschim).3 Findings are intended to inform USAID’s existing activities and future democracy and governance program designs as well as the Mission’s future Country Development Cooperation Strategy (CDCS).

• Research Question 1: What are the LGs’ functions with respect to COVID-19 response in Nepal? In particular, what are the roles and responsibilities for municipalities (Palikas) and wards (both urban and rural), and what is their cooperation and/or coordination with other levels of government in providing this response?

• Research Question 2: What is the capacity of LGs to deliver COVID-19 related services? To what extent does the provision of COVID-19 services inhibit or stress systems related to delivery of other government services? What is the perception of the public towards LGs as they continue to respond to COVID-19?

• Research Question 3: In what ways do LGs develop partnerships with other entities, specifically CSOs and the private sector, in the provision of COVID-19 related services? How have LGs engaged the private sector to address how the pandemic affects supply-chains and the various

1 Johns Hopkins Coronavirus dashboard. https://coronavirus.jhu.edu/ 2 There are four levels of government in Nepal – Federal; Provincial (7); Local Governments (district assemblies (77) and a total of 753 municipalities comprising of rural municipalities (460), and urban municipalities (293)); and Wards (total 6743 comprising of rural (3208) and urban (3535) wards). The District Assembly coordinates between urban and rural municipalities within the district. The District Assembly consists of chairpersons and vice-chairpersons of rural municipalities and mayors and deputy mayors of municipalities within the district. It elects a nine-member District Coordination Committee including a chief and deputy chief and at least three women and one member from the Dalit or minority communities for a five-year term. The District Coordination Committee coordinates between the local levels in the district as well as with the provincial and federal governments and monitor development within the district. 3 NORC’s tasking request included 15 possible research questions. These were consolidated into 4 main research questions and some were dropped. As discussed with USAID, NORC focused on the Nepali migrant population returning from India during COVID-19 and other low-income populations. Other marginalized and ethnic populations were not considered.

https://coronavirus.jhu.edu/



first- and second-order impacts of COVID-19 (impacts across the economy, tourism, agriculture, and food security)? What are the short-term and long-term repercussions not only on the economy and household livelihoods but also on overall stability in Nepal?

• Research Question 4: In terms of finance and financial management, what federal and local government funds have been mobilized and provided for COVID-19 response? What systems of control and transparency have been established? How are funds being used? How has the current local planning process (April-June 2020) of municipalities advanced COVID-19 sensitive plans and budgets for FY 2020/2021? How do these plans target the most vulnerable groups of the communities?

The research team included Dr. Ritu Nayyar-Stone (Team Lead), Dr. Jagadish Pokharel (Local Government expert), Alex Rigaux (Quantitative specialist) and Samantha Downey (Qualitative Specialist). Given the pandemic, all interviews were conducted remotely. Dr. Pokharel conducted all interviews in Kathmandu and Solutions Consultants Pvt. Ltd (Solutions), a data collection firm based in Kathmandu, Nepal collected the data from the two provinces. Primary data collection in Nepal took place between December 2020 and January 2021.

BACKGROUND The provision of various health and economic services at the municipal (Palika) level related to the COVID-19 response is exacerbated by challenges in implementing a constitutionally mandated transition to a more decentralized form of government that began in 2017 with the formation of The Federal Parliament of Nepal. While several functions have been decentralized to local governments, some sectors such as health, infrastructure, education, etc. are on the concurrent list, and for these sectors, local government laws and policies should not contradict Federal and State/Provincial laws.4 Thus clear functional responsibilities, coordination and collaboration between the federal, provincial and local levels of government in providing these services are critical, especially for the COVID-19 response.

Fighting the COVID-19 pandemic is a national priority set by the Federal government and measures taken by federal, provincial and local governments have been crucial in reaching the public and implementing preventive and relief activities in response to the pandemic. While immediate attention is focused on health and humanitarian assistance, a holistic response is required to protect democratic principles and rights, build citizen trust and a more effective and accountable response. USAID’s Democracy and Governance Office is interested in exploring the role, functions, effectiveness of the LGs, as well as the lessons learned while addressing the COVID-19 crisis at the local level. This assessment will help USAID understand the effectiveness of governance and capacity of local governments to handle the crisis, deliver quality services and protect the lives of citizens. USAID is interested in learning about these aspects as they have the potential to compound the negative impacts of COVID-19 on communities and individuals. This assessment also seeks to develop USAID’s understanding of how the lack of a coordinated response, policy and holistic approach across federal, provincial and local governments can heighten lack of trust and threaten legitimacy, which in turn makes it more difficult for all levels of government to enforce public health guidance and policies, and can pave the way for corruption-related incidents and human rights violations.

4 For a list of local government functions as well as functions that are on the concurrent list with the provincial and federal government please see Annex D, Documents Reviewed.



METHODS AND LIMITATIONS In order to define a framework by which to assess the GoN’s response to the COVID-19 crisis, NORC designed the research as a service-delivery case study, where COVID-19 assistance in target provinces is the service being provided. To this end, NORC developed instruments to collect a mix of both qualitative and quantitative data from a wide variety of associated stakeholders in Kathmandu, Province 2, and Sudurpaschim. All instruments were translated into Nepali.

NORC collected data from both the supply side (entities providing the COVID-19 response) and the demand side (citizens, nongovernmental organizations and private sector requesting a response due to the pandemic). On the supply side, NORC conducted key informant interviews (KIIs) with LG officials at the provincial and municipal level, federal government officials from ministries engaged in COVID-19 decision-making, USAID implementing partners (IPs), and Donor staff. On the demand side, NORC conducted focus group discussions (FGDs) with citizen beneficiaries of COVID-19 services, with a particular focus on migrant workers returning from India. NORC also conducted FGDs with civil society organizations (CSOs) and private sector representatives as they sought economic relief from the government and also collaborated with the municipal government in responding to the pandemic. The perspectives from this mix of stakeholders allows NORC to triangulate findings across and within groups to better explore Nepal’s COVID-19 response from those most familiar with it.

In addition, quantitative data was collected from 66 LG officials at the municipal level (33 respondents in each of province 2 and Sudurpaschim) and from 400 citizens (200 each in Province 2 and Sudurpaschim) via a hybrid computer assisted telephone interview (CATI) and phone interview. Our qualitative and quantitative sample is detailed below.

QUALITATIVE DATA COLLECTION – KEY INFORMANT INTERVIEWS

Key informant interviews (KIIs) were conducted in Kathmandu, Province 2 and Sudurpaschim. The total number of 29 KIIs were conducted as shown in Table 1 below.

Table 1: KIIs in Kathmandu, Province 2 and Sudurpaschim

Stakeholder Kathmandu Province 2 Sudurpaschim

Donors 3

[1 female; 1 male; 2 females, 4 males]

USAID IPs 3

[1 female; 2 males]

Ministry Officials 3

[3 males]

Local Government Association Representatives

2

[2 males]

Provincial Officials 3

[1 female; 2 males]

3

[3 males]



Stakeholder Kathmandu Province 2 Sudurpaschim

Municipal Officials 6

[1 female; 5 males]

6

[2 females; 4 males]

Total 11 9 9

The sample frame for the municipal level KIIs consisted of all the municipal contacts for Province 2 and Sudurpaschim compiled from MOFAGA website. When quasi-randomly selecting potential and replacement municipalities from the sample frame, NORC considered the following stratification5 criterion:

• Population: Big and small (Metropolis, Sub-Metropolis and Municipalities)

• Urban and rural Municipalities (before and after the restructuring of local units)

• Old and new Municipalities

• Women-led municipalities (female mayors)

• Municipalities bordering India

The Solutions team assisted NORC in filling out the required information on the various stratification criteria before the samples were selected for the KIIs.6 The final sample selection for the KIIs incorporated the contacts suggested by USAID for the two provinces for both the provincial and municipality level representatives. The list consisted of contact details for six province level officials and 17 municipality level officials (including 12 selected and five alternate samples to account for possible non-response or other issues). The same municipalities were selected for conducting the FGDs as well. Refer to Annex B for the names of municipalities in each province.

QUALITATIVE DATA COLLECTION – FOCUS GROUP DISCUSSIONS

A total of 11 focus group discussions (FGDs) were done with citizens, CSOs, and the private sector as detailed in Table 2.

Table 2: FGD Participants in Province 2 and Sudurpaschim

Stakeholder Province 2 Sudurpaschim

Citizens 1

[4 females, 3 males]

1

[2 females, 2 males]

CSOs 2

[1 female, 3 males;

2

[4 females, 4 males;

5 Stratification is the arrangement or classification of something into different groups. For this study this included grouping the municipalities by size/population, age, female mayor and if they bordered India before selecting among them for the sample. 6 A list of sampled municipalities for the KIIs, FGDs and CATI, as well as maps of sampled municipalities in Province 2 and Sudurpaschim are listed in Annex B, Assessment Methodology.



Stakeholder Province 2 Sudurpaschim

1 female, 5 males] 2 females, 2 males]

Private Sector

2

[1 female, 5 males;

0 female, 5 males]

3*

[1 female, 5 males;

0 females, 7 males;

0 females, 3 males]

Total 5 6

Note: * Despite using a screener, at the first FGD conducted with the private sector the moderator learned that one person now lived in Province 5 and the rest were agrovets seeking services from the government rather than collaborating with them on the COVID-19 response. Thus an additional FGD was conducted in Sudurpaschim with private sector representatives.

The locations for the FGDs were the same as that for the KIIs to get the perspective of both the supply and demand side on the local government’s response to COVID-19.

USAID provided a few contacts for the CSOs and the Private Sector representatives in Province 2 and Sudurpaschim, Since the assessment aimed at triangulating information from the demand and supply side in a municipality the plan was to conduct KIIs with municipal officials and FGDs with citizens, CSOs and private sector in the same municipality. Solutions therefore mobilized its network of local field agents in the municipalities already selected for the KIIs. These field staff coordinated with the NGO association, local chamber of commerce, and industry representatives in these municipalities to get the list of participants for the respective FGDs in the two provinces.

For the citizen FGD the research team targeted returnee migrants and vulnerable (low income) populations who received relief packages from government agencies during the COVID-19 crisis. However, this was only possible in Sudurpaschim Province since most of the returnee migrants had gone back to India by December 2020—January 2021 after the Indian economy had opened. Because of this, returnee migrants couldn’t be recruited in Province 2 for the FGD.

The field staff recruited at least ten participants for the FGDs to ensure that a minimum of 4-5 participants would be available throughout the sessions. The list of the recruited participants was shared with Solutions central office after which they were contacted to confirm their presence during the set date and time for the FGDs.

QUANTITATIVE DATA COLLECTION

Quantitative data was obtained from 66 LG officials at the municipal level (33 respondents in each of Province 2 and Sudurpaschim) and from 400 citizens (199 in Province 2 and 201 Sudurpaschim) as detailed in Table 3.



Table 3: Quantitative data and gender breakdown Province 2 and Sudurpaschim

Type of Survey Province 2 Sudurpaschim

Total Females Males Females Males

Municipal Officials 5 28 7 26 66

Citizens 39 160 54 147 400

QUANTITATIVE DATA COLLECTION – MUNICIPAL OFFICIALS SURVEY

Based on the initial findings from KIIs with municipal officials, NORC drafted a short computer assisted telephone interview (CATI) survey for additional municipal officials in Province 2 and Sudurpaschim. These municipalities were not a part of the qualitative sample (KIIs and FGDs). The total sample size was 66 respondents, with a break up of 33 municipal officials per province (see Table 3 above). Solutions compiled the required information including the name of the mayor, deputy mayor and chief administration officer of those selected municipalities, along with their address and phone numbers.

The mayors were designated as the main or the “selected” samples and the deputy mayors and admin heads as “alternate” samples. Alternate samples (first the deputy mayors and then the admin heads) were contacted only if the mayors could not be interviewed due to various reasons (e.g. refusals, out of office, on leave, or busy schedules).

NORC also developed a short CATI survey for citizens. The total sample size consisted of 400 respondents, with a breakdown of 199 citizens from Province 2 and 201 from Sudurpaschim. There were 39 females and 160 males surveyed from Province 2, and 54 females and 147 males surveyed from Sudurpaschim. The following criteria was prioritized in selecting potential citizen respondents and replacements:

− Returning migrant population from India.

− Informal sector laborers

− Low income households (economically disadvantaged or vulnerable communities)

The citizen's survey was carried out in ten municipalities in each province (i.e. 20 municipalities in total)—with 20 interviews conducted in each municipality. Though initially it was planned that the citizens survey would be conducted in the same 66 municipalities of Province 2 and Sudurpaschim where the municipal officials survey was being conducted, the number of municipalities were decreased to 20 municipality in each of the two provinces, in the absence of an existing usable sample frame and limited time/resources required to compile a sample frame from these municipalities. The 20 municipalities were selected in consultation with the NORC team by prioritizing the ones that bordered India.

In the absence of a list of citizens (including returnee migrants from India), a sample frame was compiled by the Solutions team using two sources—i) list of individuals who had been tested for



COVID-19 at the ward level (most of the people in the lists were returnee migrants from India and other countries) and ii) listing exercise carried out by Solutions’ local field team at the municipalities.

Solutions first reached out to the respective local level officials at the selected municipalities and requested them for a list of citizens who had been tested for COVID-19 at the ward level. An introductory letter from MOFAGA requesting the municipalities to cooperate and provide the study team with necessary information was also forwarded to the municipalities via email. After forwarding the letter, the team members from the central office made an attempt to reach out to all the 20 municipalities that were selected and requested the contacts there to share the citizens list if they had any. Despite sharing the introductory letter from MOFAGA, some municipalities were hesitant to provide the list of citizens who had been tested for COVID-19. Solutions therefore undertook a listing exercise of migrant and vulnerable citizens to obtain a sample. The listing exercise for citizens was carried out from the 18th of January in the municipalities where the central team could not establish contacts with the officials or the municipalities where the officials were hesitant to provide the information. A full listing exercise was carried out in 7 municipalities and partial listing was carried out in 4 municipalities (as the lists received from the ward offices were not enough/or most of the phone numbers were invalid/not usable)

Before sharing the lists with NORC, a team at Solutions randomly called a subset of phone numbers from both the sources to validate the numbers (working vs. non-working) and to ascertain that the contacts were residents of the selected municipalities. Around 40 percent of the numbers collected from the listing exercise were validated and around 60 percent of the phone numbers received from the municipality and ward offices were validated after filtering phone numbers that were incomplete or invalid (e.g. mobile numbers with less or more than 10 digits). The numbers which appeared to be invalid and the ones which were determined as wrong numbers/not of people from the municipality were removed. The list shared with NORC included the validated numbers along with the remaining numbers which had not been contacted for validation. The NORC team then randomly made the selection and uploaded the database by designating “selected” and “alternative” samples from which the telephone interviews were conducted from the central office.

Quantitative surveys were programmed, stored, and analyzed using online survey platform Qualtrics. Due to widespread lack of email among both segments of the sample, surveys were conducted via phone with trained enumerators from local data collection firm Solutions. NORC trained both the qualitative and quantitative data collection teams at Solutions. The data collection period lasted approximately four weeks from January 30th through February 16th, 2021. While many respondents needed to be replaced due to lack of valid contact information or inability to reach the respondent, targets were achieved for both the LG Officials and the Citizens survey.

LIMITATIONS

The following limitations should be considered when interpreting results from this report:

• Data availability and data quality: The research team collected all the primary data from KIIs, FGDs, and the surveys of 66 municipality officials and 400 citizens. None of the primary data was collected face-to-face and was all collected remotely, which resulted in potential selection bias as described below.

• Selection bias: As some key informants that the research team sought to interview declined to be interviewed, there is a possibility of selection bias, i.e. those respondents who choose to be interviewed might differ from those who do not in terms of their attitudes and perceptions,



affiliation with government/non-government structures, and socio-demographic characteristics and experience. Given the remote nature of the data collection, there is also the concern that the officials and citizens we are able to reach electronically may be better-off economically, which could also result in selection bias.

• Recall bias: As several questions raised during the interviews addressed issues that took place in the past (e.g., citizen reaction to and government response to the pandemic), recall bias may have affected the responses provided.

• Halo bias: There is a known tendency among respondents to under-report socially undesirable answers and alter their responses to approximate what they perceive as the social norm, called halo bias. In the case of this research this may manifest itself via the extent to which respondents will be prepared to reveal their true opinions and experiences when they are asked to provide feedback on governments’ response, collaboration and challenges associated with dealing with the COVID-19 pandemic. In other words, they may not be willing to reveal information that might reflect poorly on their government. However, in the context of the research design outlined here, this limitation should not have a significant impact as we are obtaining information from a variety of stakeholders and ensuring anonymity to their response.

• Remote data collection: Collecting data remotely was complicated by connectivity and reception issues, as well as by challenges with reaching the intended key respondents by phone or email. Multiple follow up calls were often required to ensure the participation of key informants in government positions, and in some cases KIIs and surveys had to be completed in multiple sessions.

• Sampling: The data collection firm had challenges in reaching a number of the participants listed on the contact lists for both the qualitative and quantitative samples. Solutions mobilized a local field team and their contacts and also created lists of citizens for the sample when needed.

FINDINGS AND CONCLUSIONS

FINDINGS

RESEARCH QUESTION 1: WHAT ARE THE LGS’ FUNCTIONS WITH RESPECT TO COVID-19 RESPONSE IN NEPAL? IN PARTICULAR, WHAT ARE THE ROLES AND RESPONSIBILITIES FOR MUNICIPALITIES (PALIKA) AND WARDS (BOTH URBAN AND RURAL), AND WHAT IS THEIR COOPERATION AND/OR COORDINATION WITH OTHER LEVELS OF GOVERNMENT IN PROVIDING THIS RESPONSE?

LGS FUNCTIONS WITH RESPECT TO COVID-19 RESPONSE IN NEPAL

Policy and guidance around COVID-19 response in Nepal occurred at the federal level. According to the Constitution of Nepal 2072 B.S., the federal government is the sole policy making body mandated to address an epidemic like COVID-19.7 The government formed a high-level committee – under the leadership of Deputy Prime Minister and Minister of Defense, Ishwor Pokharel, to address the COVID-19 crisis. This committee, represented by all relevant ministries and agencies including police and military—but not including representatives from the provincial and LG level— 7 The Constitution of Nepal, Schedule-5, List of Federal Power specifically mentions that the Federal Government has the power relating to “health policies, health services, health standards, quality and monitoring, national or specialized service providing hospitals, traditional treatment services and communicable disease control”.



reviewed the situation and proposed necessary policies to the Cabinet for final decision. The government also installed a National COVID-19 Crisis Management Centre (CCMC) and located it at the army headquarters which coordinated the implementation of the decisions of the committee. The respective agencies of the government including provincial and local level governments were then tasked to implement these decisions, but could not enact their own policies around the pandemic without the permission and support of the federal government.8

In addition to the lockdown, the GoN provided public health guidance about how to mitigate risk of exposure to COVID-19 including issuing guidance on use of masks, social distancing, hand-washing, and more through the Ministry of Health and Population (MoHP). Further guidelines and tools for measuring temperature, testing, isolating and maintaining quarantine, and contact tracing were developed and enforced. To keep the public informed, the MoHP published daily bulletins including important status updates. The Federal Government also sent instructions and guidelines to the Local Governments (LGs) regarding the distribution of food to the very poor and to informal sector laborers who lost earnings due to the lockdown.

The guidelines regarding health services during COVID-19, which were approved by the cabinet and uploaded onto the website of concerned ministries, including the Office of Prime Minister, state that:

• The Department of Health Services (DoHS), State Government (seven Provinces), and private hospitals shall be responsible for the supply of medical equipment, gloves, sanitizers, personal protection equipment (PPE) for dealing with COVID-19, and to extend the capacity of hospitals. MoHP shall play the role of coordination and the Ministry of Finance (MoF) shall provide the resources.

• All three levels of government—federal, provincial and municipal—shall be responsible for operating quarantine facilities including providing food for people living in quarantine as per the guidelines relating to operation and management of the quarantine.

• MoHP shall be responsible for providing insurance of NPR 2.5 million to the doctors, nurses, ambulance drivers, security forces and other persons working directly on COVID-19 response.

Thus according to these guidelines, the role of provincial and local level government involves operating quarantine, collecting statistics on people needing relief during this pandemic, and providing relief to them as decided by the cabinet. The municipalities (palikas) and the lowest units, the wards, are in the front line of management and implementation of both the health and non-health related decisions at the community and individual level.

UNDERSTANDING OF GOVERNMENT ROLES AND RESPONSIBILITIES

Mayor’s interviewed noted that at the start of the pandemic the municipalities felt quite burdened with the numerous GoN circulars, guidelines and instructions that were shared without any backup training and support. These guidelines were often unclear, sometimes contradictory, and needed clarification. However, the six municipal officials interviewed in each of Province 2 and Sudurpaschim articulated a variety of actions that they understood to be their responsibility: public awareness campaigns, transporting returning migrants and putting them in quarantine, distributing a variety of health products such as sanitizers, masks and requesting citizens to follow social distancing,

8 Provincial governments are much less involved when it comes to directly addressing public health issues like a pandemic compared to LGs.



conducting PCR tests, enlisting the help of volunteers, providing relief materials like food and resources for their vulnerable populations.

However in a KII, a Ministry official in Kathmandu said that MOFAGA did help LGs overcome confusion and that regular orientation was provided by the Ministry and by some INGOs. Another Ministry key informant acknowledged that coordination among government agencies is “very weak.” He noted “there was and still exists confusion regarding our roles and responsibilities. What the federal government should do, what the provinces and what the LGs should do is not clear and that is still hampering effective management. There are gaps and duplications.” This official also felt that MOFAGA did not coordinate well with the COVID-19 Crisis Management Committee (CCMC) and that different line ministries, for example the Home Ministry or MOHP established relationships only with the CCMC rather than directly with each other.9 Another problem noted was that federal line ministries, such as MOHP, could not reach out directly to the District Health Office and had to go through the provincial government.

At the provincial level, all key informants interviewed had a clear understanding of their roles and responsibilities. In Sudurpaschim, informants said that the provincial government should assist the federal government in carrying out its responsibilities. A Provincial Crisis Management Committee (PCMC) was established for the prevention and control of COVID-19, responsible to the Ministry of Social Development (MSD). Provincial officials provided technical assistance, managed the PCR testing, swab collection, isolation, transportation, and treatment of citizens. They also assisted with relief, quarantine, management of health materials, delivered ventilators to the intensive care unit (ICU) in every district, hired social mobilizers for awareness campaigns and mobilized female community health volunteers (FCHV) to monitor the health of individuals in isolation at home. In Province 2, provincial officials noted that they established a protection cluster, under the leadership of the social development division to support the preparation and response to the pandemic, targeting the most vulnerable populations including the elderly, persons with disabilities, women, children, migrant workers and other groups with underlying health conditions. The protection cluster included representatives from MSD, and different NGOs/INGOs working in the province. A service mapping was undertaken to determine which partner would work in which sector and the modality of the partnership, after first forming a gender-based violence (GBV) psychological social support (PSS) council in coordination with the United Nations Population Fund. The provincial official also indicated that in addition to assisting the government with relief distribution and management, some stakeholders also helped with the monitoring and inspection of the quarantine centers – to ensure that the centers were women/children friendly, disabled friendly or not. Inspecting and monitoring the quarantine facilities were carried out jointly with the Police force and with the Red Cross Society, since there were many cases of GBV and domestic violence reported across the province including rape, abuse and attempted murders. Keeping these issues in mind, the Province officials arranged for ambulances to ensure that the victims received immediate medical attention when needed.

MUNICIPAL COLLABORATION AND COORDINATION WITH OTHER LEVELS OF GOVERNMENT

Most municipalities collaborated and coordinated with both vertical (with federal, provincial, district and ward government) and horizontal (with neighboring and other municipalities) government organizations and agencies to respond to the pandemic.10 Municipalities reached out to the federal 9 The respondent did not mention the provincial, district, nor the local CCMC. 10 Information on municipal collaboration and coordination with CSOs and the private sector is detailed in Research Question 3.



government for guidance, and to the provincial government for financial and technical support. They also cooperated with different sector ministries (MoHP and MoFAGA). Key government agencies that the municipalities coordinated with included the security force under the CDO’s command (police), the Chief District Officer (CDO) who is responsible for law and order and a federal government representative, security under the CDOs command, the District Public Health Office directly under the MOHP, and the Army. Collaboration between and municipalities happened while sheltering and transporting people from each other’s territory. They even coordinated with foreign missions in other countries to bring stranded Nepali citizens home.

“To manage and for the treatment of COVID-19 we had coordinated with the Palika and sat for meetings – there was representation from all parties, different areas and Palika members with about 20-25 people and we had formed a committee. We had coordinated with the Palika for creating awareness of COVID-19 and to follow the rules set forth for the lockdown period.” [KII, Municipal Official, Sudurpaschim]

Key informants in provincial offices had a different opinion. In Province 2 a provincial official noted:

"Everything relied on proper coordination between the local level, the provincial level and the federal level—but we did not get to witness any effective coordination process during the pandemic period. I would stay there still isn’t any coordination even at this stage. The local level bodies do not have the habit of reporting to the provincial level regarding the details of their activities and efforts, as well as their progress regarding any form of service delivery. They tend to directly report to the federal level because of which we have no idea of what they are doing at times.” [KII, Provincial Official, Province 2]

In Sudurpaschim a provincial official stated that they coordinated with the wards and municipalities to create the quarantine centers and provided money for food. They also helped to transfer patients to the nearest hospitals. Based on the KIIs, there seems to be better collaboration and coordination between the municipalities and provincial officials in Sudurpaschim. One provincial officer in Sudurpaschim said: “Our department coordinates with palikas on a daily basis as well as try to motivate the health workers of the palika and also ask them to take care of their health properly. They also update us about swab collection, update about the positive cases, recovered cases and other relevant information.”

As seen in Figure 1 below, all municipal officials surveyed reported collaborating with the provincial government and other wards within their municipality. Most also reported collaborating with the federal government (95 percent) and neighboring municipalities (88 percent). Cooperation with other entities such as the District Coordination Committee (DCC) was only reported by 1-2 respondents. Types of assistance and collaborating varied across entities. Figure 2 shows that the most commonly cited types of support from the provincial and federal government was direct funding, virus tests, and PPE or masks, with a smaller number also citing receiving medicine or collaboration on crisis response. With wards within the municipality, collaboration took place for mobilization or labor resources (84 percent) and collaboration on crisis response (48 percent). This type of collaboration also happened with neighboring municipalities, though the prevalence of the categories is reversed, with most reporting collaborating on crisis response (98 percent) and some reporting collaborating on mobilization of labor resources (21 percent). One mayor in Sudurpaschim noted that since they were managing the holding center in the border area, they collaborated with different municipalities by updating the status of migrants residing in different municipalities. This mayor also said: “There were many people from Dhangadi that had entered Nepal from the ‘Gadda chowki’ in Mahendranagar or through Birgunj or Nepalgunj so they were helping us out as well by keeping our residents safely in their area.”



Figure 1: Coordination with other levels of government

Source: Municipal Officials Survey

Figure 2: Type of assistance and collaboration with other levels of government


RESEARCH QUESTION 2: WHAT IS THE CAPACITY OF LGS TO DELIVER COVID-19 RELATED SERVICES? TO WHAT EXTENT DOES THE PROVISION OF COVID-19 SERVICES INHIBIT OR STRESS SYSTEMS RELATED TO DELIVERY OF OTHER GOVERNMENT SERVICES? WHAT IS THE PERCEPTION OF THE PUBLIC TOWARDS LGS AS THEY CONTINUE TO RESPOND TO COVID-19?

KNOWLEDGE AND CAPACITY TO HANDLE THE CRISIS

Many municipal officials felt they lacked sufficient knowledge, as well as adequate medical equipment or medical supplies to deal with the pandemic. In a KII, a Mayor in Province 2 mentioned relying on federal guidelines to better understand the virus, as well as seeking information through news, online

100% 100% 95%88%

3% 2% 0%

ProvincialGovernment

Wards inyour Palika

FederalGovernment

NeighboringPalikas

DistrictCoordinationCommittee

Other None ofthese

A

B

C

D

E

F

A B C D E A B C D E E F E F



media, and other informal sources. Another Mayor in Province 2 also acknowledged the limited knowledge and capacity LGs have and stressed the need for adequate guidelines for their operations from the federal and provincial government. A third Mayor from this province said that he looked at the World Health Organization guidelines. Many mayors stressed that they had to deal with things as they came up, pointing to a lack of preparedness for this kind of disaster; several said that they are now confident in their municipalities’ ability to handle similar challenges in the future. In Sudurpaschim a mayor said “we were not that prepared, but we had to face the challenges presented to us. There was not enough police force and health workers present during this time. Political representatives like us had to put in extra effort to manage the situation.” However, the same Mayor shared that they followed shared regulations to deal with the crisis that included distributing relief, medicines, and collecting funds by bringing many organizations together. Another Mayor in Sudurpaschim also indicated that the municipality was not prepared at first, but they quickly managed and deployed their entire health personnel.

The capacity gap at the municipal level is highlighted by other stakeholders as well. One donor official in Kathmandu observed the shortage of human resources in its program municipality especially for clinical services which severely affected most basic activities, such as swab collection. In a KII, a USAID IP official stated that lack of knowledge by the municipalities had affected efficient allocation of resources, with municipalities spending more than what they should have on required items. For example, a CSO shared this observation during a KII in Kathmandu: “they have bought thermal guns for Rs 15000 in some cases whereas these guns could have been bought for Rs. 4000.” A federal ministry official in Kathmandu also gave an example of a municipality buying a testing machine, but not using it because they lacked a facility to install and use it in.

Mayors and other respondents in the Municipal Officials Survey were asked about the greatest challenges their municipality has faced in meeting the unexpected health and humanitarian needs of the people during the COVID-19 crisis (see Figure 3 below). The two most common challenges cited by nearly all respondents in the sample were lack of resources or funds (91 percent) and management of isolation centers or quarantine facilities (89 percent). Other common challenges include lack of awareness amongst the people (52 percent) as well as fear of own health and wellbeing (24 percent) and screening and management of returning migrants (18 percent).

Figure 3: Greatest challenges in meeting the health and humanitarian needs of the people


18%

18%

24%

52%

89%

91%

Screening and managing migrants

Other

Fear of own health

Awareness among people

Manage quarantine centers

Resources/funds



We summarize municipalities’ capacity to deliver COVID-19 related services under the following categories: resources, managing migrants and vulnerable populations, hiring new staff and procurement procedures.

Limited resources: Overall, considerable difficulty was felt by mayors in distributing resources, with challenges being felt in the method of relief distribution, targeting and prioritizing and timing of relief distribution. Many felt that the main challenge was a lack of financial resources. One provincial official in Sudurpaschim stated that municipalities had to spend on quarantine management, food, transport cost, often for hundreds of people; in some cases they even needed to import necessary items from abroad. Transportation coverage was noted as being problematic in both Province 2 and Sudurpaschim. One LG official from Province 2 experienced struggles related to emergency support, and noted that “[the LG] had to pay triple the price for the ambulance to keep them [on hand] for any kind of emergency. In my opinion, if we had our own resources we could re-utilize the amount that we paid for the ambulance for other important things.” A provincial official from Province 2 noted that their division only has one government vehicle allocated for the Ministry that is available for official use.

Many municipal officials mentioned lacking financial resources and disaster preparedness funds for effective management of the crisis.11 Municipalities received funding primarily from the provincial and federal government, and in several cases had to reallocate funds from development funds in order to carry out their COVID-19 response which affected other service delivery [More on the effect on other service delivery is provided below in this section].

Management of migrants and vulnerable populations: Several mayors mentioned challenges stemming from managing the large influx of migrants, particularly due to the strain on quarantining these individuals, testing them, and providing them transportation and temporary lodging in the facilities. One Mayor from Sudurpaschim said that the municipality struggled to manage the influx of migrant workers from Malaysia, Qatar, and India. A LG official from Sudurpaschim spoke of how the municipality tried to coordinate with the Indian authorities several times to open the borders and allow Nepalese citizens to enter the country, but noted that this was a struggle. When movement was especially restricted, people tried to enter the country via the Mahakali River, which proved challenging for municipalities to manage. Regardless of where the migrants came from, however, it was noted by one Mayor in a border municipality of Sudurpaschim that services were provided to all migrants even if they were not from their municipality.

Some mayors and provincial officials mentioned that they had to take extra steps to protect vulnerable populations from the impact of COVID-19. They also had to provide special services to weak and vulnerable populations in the quarantine which further added to their cost as well as their management responsibility. These services included providing transportation support for women requiring prenatal and postnatal care at medical facilities and the provision of domestic violence support services such as mediation and police intervention.

Respondents in the Citizens Survey were asked how long they have lived in the municipality in which they currently reside, and respondents who had recently moved within the last year were asked follow-up questions about why they had moved and where they moved from (see Figure 4 below). Around a third of respondents had recently moved (35 percent), with the majority of these individuals moving because of the COVID-19 crisis (79 percent). Just over half of these individuals

11 More details regarding funding for COVID-19 response can be found in RQ4.



migrated from India, while another fifth of respondents moved from another municipality outside of the district or from another country other than India or China.

Figure 4: Migration of citizens in the sample

Source: Citizens Survey

Note: The bar chart provides details only for the 140 respondents who said they moved in the last year due to the

COVID-19 crisis.

New hires: By law, LGs have the authority to hire temporary technical staff. However, limited budget and lack of human resources (HR) created difficulties. Many LG staff also left work to go home during this period. Most LGs had inadequate staff for clinical services such as swab collection for the PCR test and lab technicians. Overall, the lack of sufficient HR and preparation to deal with the pandemic resulted in high expenditures by the LGs. Several provinces have vacant doctors’ positions, and it is difficult to find health workers at the local level. As noted by an informant in Kathmandu:

“We cannot have good health service without good human resource management. It is a paradox that we are rushing to build hospital buildings without considering that there is a real shortage of medical manpower all over the country.” [KII, Ministry official, Kathmandu]

During KIIs, several municipal officials stated that they did not hire additional staff to deal with COVID-19. However, other municipal officials said that while they mobilized their own staff to manage critical tasks like accounting, new hires were needed to support the demands of medical provision or border security. In the survey of municipal officials (see Figure 5 below) 39 percent of respondents reported hiring additional manpower to address the crisis. The most common hire for these municipalities was health related staff (73 percent), followed by “other” staff (19 percent), administrative staff (12 percent), and social mobilizers (12 percent). The municipalities that did make



additional hires generally did not need to change an existing rule to make the hires--only a small number of them (8 percent) needed to do so.

Figure 5: Hiring during the COVID-19 Crisis by Municipalities

Source: Municipal Officials Survey Note: The lower left pie chart and bar chart on the right provides more information for 39 percent of the municipalities who said they hired additional manpower to address the COVID-19 crisis

Cumbersome public procurement system: According to a Ministry official in Kathmandu, recent changes to the existing public service procurement law makes it “very difficult” to act in crisis. The official also noted that health related procurement is “even more difficult” under the act. This was echoed by officials at all three levels of government engaged in the COVID-19 crisis. [More details on systems of control and transparency during the pandemic are provided in Research Question 4].

DELIVERY OF OTHER SERVICES DURING COVID-19

Addressing COVID-19 was the prime focus for many municipalities. A number of municipalities noted that development work had been slowed or halted as a result of budget reallocations for COVID-19 response. According to a Mayor from Province 2, one service that was discontinued was door to door routine checkups and treatments once a month for the elderly. However, a few Mayors mentioned that important development works were still continuing during the crisis or they were restarting activities that had been on hold for a while, such as road construction and maintenance. Support for agricultural work and farmers continued in some areas. Municipalities strived to carry out administrative and institutional responsibilities along with their COVID-19 responsibilities, but at times had to pause service provision.

“We prioritized COVID-19 first. Most of the offices were shut down whereas we also engaged ourselves in providing permission/permits for people to travel places with the purpose of health check-up or



emergency. We also provided seeds for farmers of our municipality through the municipality. So, all in all I would say that we prioritized the crisis first whereas we also didn’t stop working for the development work which we did side by side,” [KII, Municipal Official, Province 2]

The municipal officials survey (Figure 6) confirms that the COVID-19 pandemic did impact service delivery in their municipality (92 percent), with a wide range of impacts cited. The most widespread impacts to normal service delivery cited by over half of respondents included being unable to undertake capital improvement projects (97 percent), inability to carry out repair or maintenance activities at all (87 percent) or in a timely manner (74 percent), and being unable to carry out regular administrative duties (61 percent). Respondents also reported having to postpone plans to invest in infrastructure development (44 percent), postpone various training (31-36 percent), and impose social distancing norms (25 percent).

Figure 6: Regular municipal service delivery during the COVID-19 crisis

Source: Municipal Officials Survey Note: The bar chart to the right provides further details on how responding to COVID-19 affected regular service delivery for 92 percent of the municipalities who agreed with this statement.

Key informants in Kathmandu also felt that COVID-19 had disrupted other service provision in the municipalities. One donor official said “the FG and LGs were not able to balance their response to normal duties because everybody was focusing on COVID; health workers were not taking normal cases, maternal mortality, suicide cases went up at the beginning. No health service was provided at the local level.” A senior ministry officials’ observation however, was a little different. He said, “Because of fear, patients did not go to health facilities for non-COVID treatment; even health workers were hesitant to treat them—like pregnant women did not go for regular checkup. Health volunteers (Swayam Sevak) also did not attend their work properly”.

Citizens had varying experiences with accessing regular municipal services. Citizens noted that municipal offices in their areas were at times crowded, social distancing was not enforced well which made them feel uneasy about seeking other services. In a FGD, one citizen from Province 2 observed: “As the fear of COVID was very high in X district all the offices were closed. All the industries were closed. Nobody wanted to go outside so all the works were kept pending. When people went to the government offices even for the most urgent work, the officials made excuses citing COVID and kept the



work pending. After the lockdown was eased official works started but duties were not performed effectively.” In contrast, citizens in Sudurpaschim were more positive about the municipality continuing with their normal duties during the pandemic, and that their requests were handled in a timely manner. One municipality allocated specific days when citizens from different wards could go to the municipality for official work (for example, to get an approval letter). Some local government officials also noted that their offices became very crowded and that providing services was at times difficult to manage, but others noted that practices like shift work allowed the office to keep from being crowded and allowed them to handle regular service provision.

Respondents in the Citizen Survey were asked several questions about regular service delivery in their municipality during the COVID-19 crisis. When asked whether their municipality was able to fulfill regular service delivery mandates during the COVID-19 crisis, 68 percent of respondents said “yes”, 25 percent said “no”, and the remaining eight percent answered “don’t know.” Only 35 percent of the respondents reported requesting regular services during the COVID-19 pandemic; and these included requesting referral services, relief works, passes to move around during lockdown, and birth and death certificates. Among those who requested a regular service during COVID-19, 68 percent said their service attempt was successful and 32 percent said it was unsuccessful.

PERFORMANCE OF LOCAL GOVERNMENT ENTITIES ACCORDING TO CITIZENS, PROVINCIAL/FEDERAL GOVERNMENT, AND CSOS

Major stakeholders’ assessments of LGs’ performance are mixed.

Citizens: Respondents to the Citizens Survey were asked whether they had heard about any services or resources provided by the federal, provincial, or municipal government. Respondents who said “yes” were then asked to list all services they were aware of (without being provided with a set of response options). As seen in Figure 7 below, almost all respondents in the Citizens Survey were aware of services provided by the government in response to the COVID-19 crisis, with respondents most commonly citing quarantine centers (90 percent), food assistance (83 percent), provision of sanitation materials (69 percent), provision of PCR tests (62 percent), and provision of PPE or masks (57 percent). The most common source of this information was word of mouth, with over half of respondents saying they learned this information from friends or neighbors in their community. Other sources were less commonly cited.

Seventy six percent of the Citizens Survey respondents said that they received assistance from the government during the crises and 25 percent said they received nothing. Those receiving assistance cited receiving hygienic materials (70 percent), food assistance (64 percent), PPE or masks (60 percent), PCR tests (30 percent), and access to government quarantine facilities (25 percent). Most recipients reported being satisfied with the assistance they received, with 51 percent “somewhat satisfied” and another 23 percent “very satisfied”. Around a quarter of assistance recipients were not satisfied, with 17 percent “somewhat dissatisfied” and nine percent “very dissatisfied.”

Respondents in the Citizen Survey were also asked about their overall assessment of their municipality’s performance with respect to the COVID-19 crisis (see Figure 8 below). Respondents were split on their assessment of their municipality, with 46 percent “somewhat” and 17 percent “very satisfied.” The remainder were not satisfied, with 20 percent “somewhat dissatisfied” and 18 percent “very dissatisfied.” When asked “To your knowledge, did the government collect any information from citizens about their needs during the COVID-19 crisis?” 38 percent of respondents said “yes” and 62 percent said “no.” Respondents were similarly split on whether or not their municipality “took needs and priorities of the citizens into consideration during the crisis”: just over



half of respondents agreed (44 percent) or strongly agreed (11 percent) that their municipality did take the citizens needs into consideration, while the rest disagreed (27 percent) or strongly disagreed (18 percent).

Figure 7: Citizens’ Awareness of services or resources provided by the federal, provincial, or municipal government to this community in response to COVID-19 crisis

Source: Citizens Survey Note: The bar chart on the bottom left provides details on the source of information for 95 percent of respondents who stated they were aware of services provided by the government. The bar chart on the right depicts all services that 95 percent of respondents were off.



Figure 8: Citizens Perception of their municipality’s response to COVID-19


In the two FGDs, citizens across both provinces were more critical and seemed to be less aware of services provided by the municipality during the pandemic, compared to the respondents of the citizen survey. They felt that the municipality had not performed as expected, saying that “nothing was clear and transparent” and that the government did not provide any medicines or PCR tests. Citizens complained that the distribution of food was inadequate and that they did not receive the relief as claimed by the government. One citizen in Province 2 said that “other CSOs were more active in distributing relief than the government.” Some citizens had heard about “a test per house” (referring to PCR tests) but they did not get this, nor any sanitizers or masks. In Province 2 some participants were curious how the budget (NPR 2 billion the government had allocated for COVID-19 response) had been spent. Another said that “relief was distributed but it was not adequate, and that the distribution system did not enforce health measures therefore they did not go to collect relief”. Overall citizens were more dissatisfied with their municipality in Province 2 relative to Sudurpaschim.

“We have not received any services or facilities that we had expected from the government. Poor people are left hungry. It has been nine months since lockdown and the food relief has been distributed only once. We did not get any support from the ward as well. What municipality provided to the ward and what ward has distributed to its citizens, nothing was clear and transparent.” [FGD, Citizen, Province 2]

“There was no transparency. We had heard that the municipality received NPR one crore but we did not see any activity. We did not know where the money went. We came to know about it from word of mouth.” [FGD, Citizen, Province 2]

“I would score my municipality an A. [Not an A+ because] There were so many things that could have been done, but they have not done it because they could not reach everywhere.” [FGD, Citizen, Sudurpaschim]

“I am very impressed. Helping the most vulnerable/at risk people was very good and saved their lives.” [FGD, Citizen, Sudurpaschim]

Federal or provincial government: The Province level officials noted that the municipalities in Province 2 were “struggling” to manage the demands and that there were complaints by the public about municipalities not being able to effectively manage the quarantine center to control the spread of COVID-19. These facilities were not gender friendly with some centers admitting people in the morning and sending them home in the evening. In addition the Province 2 official said that there



were complaints that the food provided was not nutritious and unsuitable for elderly people. Officials in Sudurpaschim felt that initially the work of their municipalities was “effective” and “efficient” but after a few months their efforts slowed down.

In an interview in Kathmandu one federal ministry official acknowledged, “If LGs and provinces were not there, we couldn’t have achieved what we did to manage COVID crisis. We passed the test of federalism at the time of COVID.” Another ministry official in Kathmandu noted that big, and developed municipalities like Kathmandu performed poorly compared to smaller ones like Bhaktapur and Changunarayan. He stated that Nepalganj, Bhimdatta, Dhangadi, Bhairahawa, Krishna Nagar had better material supplies than many other municipalities. Birgunj also did quite well given the pressure it was facing from across the border.

CSOs: In an FGD in Province 2, CSOs noted that the municipalities could have mobilized them better than what they did, with some CSOs indicating that they could have been solicited for support earlier than they were contacted by the municipality. Several CSO respondents also express that LGs should have been more effective in mobilizing other actors (private sector and CSOs) while delivering services, that municipalities did not seem to have good guidance on this at the onset of the pandemic, and that they lacked formal coordination. CSOs in Sudurpaschim said that due to the increased corruption during relief distribution they carried out Public Expenditure Tracking Survey (PETS). They requested the municipality to provide expenditure details in a format that citizens would understand, but officials did not cooperate or accommodate this request. CSOs also undertook COVID-19 awareness campaigns, provided information to returning migrants and helping people reach the quarantine center.

Municipal mayors: Mayors and other respondents in the Municipal Officials Survey were asked about feedback they may have received from various sources regarding their municipality’s performance with regard to the COVID-19 crisis (see Figure 9 below). Perhaps unsurprisingly, respondents reported receiving generally positive feedback regarding their COVID-19 response. Over 90 percent of the sample reported receiving “all” or “mostly” positive feedback from citizens, while 75 percent reported the same about feedback from higher levels of government. Reports of “mixed” feedback were more common from the federal or provincial government (26 percent).

Figure 9: Feedback on Municipality’s handling of the COVID-19 crisis by various sources




In an interview one Mayor in Sudurpaschim said “…we have at least prevented the loss of lives and property. We are still helping those in dire need and weak economic condition of Dalit and differently abled people”

Donors: A few donor staff interviewed in Kathmandu had positive remarks about LGs performance during the crisis. One donor said that the LGs despite their limited capacity and varied degree of challenges (depending on their location—border, inland and accessible and remote municipalities), in most of the cases have done a commendable job. The staff added, “The local government have performed extremely well,” referring to the bordering municipalities. A USAID implementing partner said that the performance of the municipalities was satisfactory: “Initially everybody was struggling to get face masks, sanitizer, and other basic kits for prevention. And some municipalities were faster than others to mobilize their local resources and most municipalities kind of create their own solution.”

Private Sector: In FGDs, most private sector respondents were critical of municipalities and said they did not receive any support from the LGs. One private sector respondent detailed their frustration with the perceived lack of LG support:

“They have not done anything. What I feel sometimes, the factories should have been supported. We totally depend on India for supply, but we were at a point where we could introduce our local materials to the market. But the government even didn’t work on encouraging the local products to be uplifted/established in the market. In fact, most of the individuals whom I met or interacted with always shared that no support or help was provided by the government side and that most of the help they were seeking or were being provided was from the private sector.” [FGD, Private Sector, Sudurpaschim]

However, one private sector respondent in Province 2 spoke at length about the work that the municipality undertook to distribute relief, establish a COVID-19 focused hospital and quarantine facilities, and provide the respondent with a vehicle to run sensitization campaigns and distribute pamphlets and communication materials in various parts of the city in their efforts to make citizens more aware of the crisis and risk minimization measures. The respondent notes, “I must say that the Mayor did whatever he could do- he also tried coordinating with various levels of government in his effort to combat the crisis… I feel that everything was new at that time, and that was what could have been done.” Private sector discussants in Sudurpaschim also confirmed that municipalities in their province gave vehicle permits to the private sector. In an FGD, one private sector respondent in Sudurpaschim said, “The government in coordination with various organizations is now collecting data from the migrant workers and is working on providing them skills and self-employment opportunities”

Participants in an FGD with the private sector in Province 2 noted the following about the performance of their municipalities: (i) municipalities extended the deadline for corporate taxes and land revenue taxes by a couple months, (ii) coordinated with the chamber of commerce and industries to provide food and relief to people staying in isolation and quarantine centers, and (iii) they also distributed masks and sanitizers and arranged for vehicles for moving people from the borders to their localities.

RESEARCH QUESTION 3: IN WHAT WAYS DO LGS DEVELOP PARTNERSHIPS WITH OTHER ENTITIES, SPECIFICALLY CSOS AND THE PRIVATE SECTOR, IN THE PROVISION OF COVID-19 RELATED SERVICES? HOW HAVE LGS ENGAGED THE PRIVATE SECTOR TO ADDRESS HOW THE PANDEMIC AFFECTS SUPPLY-CHAINS AND THE VARIOUS FIRST- AND SECOND-ORDER IMPACTS OF COVID-19 (IMPACTS ACROSS THE ECONOMY, TOURISM, AGRICULTURE, AND FOOD SECURITY)?



WHAT ARE THE SHORT-TERM AND LONG-TERM REPERCUSSIONS NOT ONLY ON THE ECONOMY AND HOUSEHOLD LIVELIHOODS BUT ALSO ON OVERALL STABILITY IN NEPAL?

ENGAGING THE PRIVATE SECTOR

A LG official from Sudurpaschim reported receiving assistance from development banks after personally soliciting their support. The official noted that the municipality received funds from the banks and from other big cooperatives, as well as from owners of medical supply stores who provided PPE kits at the local levels. In another case the private sector provided food, drinking water, clothing, and hygiene products in their municipality. In an interview, a CSO representative in Kathmandu claims that the crisis actually improved trust between the private business sector and all three levels of Government. Another CSO KII respondent in Kathmandu echoed this sentiment, noting that some private sector projects such as hydropower projects supported rural municipalities, further building a relationship between their organization and the municipalities they operated in. However, the CSO key informant in Kathmandu also noted that in general people’s impression about the private sector is not positive, especially in rural areas. It is seen solely as a profiteer at their cost. Therefore, it is a real challenge for municipalities to engage or support the private sector in times of crisis.

Local government officials acknowledged receiving support from the private sector, including from organizations such as Hulas Steel, Jagadamba Steel, NEST Nepal, and the Federation of Nepalese Chambers of Commerce and Industry (FNCCI). In Sudurpaschim, one noted that the private sector provided ration and contributed to the renewable fund. Local traders provided rice and clothing and local private water suppliers arranged for access to drinking water throughout the district. Others provided soap and tooth brushes to the Chamber of Commerce. Development Banks like Sunrise also provided rations to the municipality from their separate budget for corporate social responsibility. In Province 2 the Lions Club provided and kits for households. Other mayors in Province 2 mentioned support from many industries, private schools, banks, cooperatives and individuals, but did not provide any names. Private sector actors were also said to provide transportation support coordinating with private hospitals to ensure ambulance coverage during lockdown.

Private sector actors in Province 2 and Sudurpaschim criticized the municipalities for their lack of effective coordination and mobilization of their support. Though many private businesses have contributed to addressing this crisis, there were varying perspectives of how formally they were engaged and at what point in the crisis they were asked by the government to mobilize. Some private sectors claimed that they engaged in the COVID-19 response on their own volition and that municipalities neither asked for them nor facilitated the work they did at the local level. In an FGD with the private sector in Sudurpaschim, transport providers noted receiving limited support from municipalities like vehicle permits and some help in distributing relief at the local level, but said that their actions were taken on their own initiative not as a result of any requests from municipalities. Some indicated that they helped with transportation returning migrant workers from India to reach home from the border, either charging a minimum fee or providing free service based on each migrant’s situation. Support was also provided to people who were stranded in the bus park with discounted bus fares. They provided support at the border, in distributing food and drinking water but said that the municipality did not even acknowledge or provide minimum support like security of the areas they were working.

“Initially they [the municipality] did provide relief which was good in quality as well as quantity. But after a few months they stopped it knowing that they couldn’t provide it for a very long time. The municipality



saw the importance of awareness, and therefore started providing awareness through radios, pamphlets, building hand wash corners, and providing sanitization facilities to transportation sector. Maybe that’s the reason they didn’t ask for support [from the private sector] as they themselves stopped providing support.” [FGD, Private Sector, Sudurpaschim]

The private business sector does see opportunity for future partnership and collaboration with municipalities in managing the crisis. They see their comparative advantage in enforcing government guidelines, dissemination of information, and scaling up to effectively manage service deliveries. In Sudurpaschim, private sector discussants suggested the following types of partnerships with the municipality: allocating a particular area for the private sector to support households, coordination with the transport sector to help transport the migrant workers, and coordination with the health sector to provide door-to-door medical and food items. One participant said: “if they [the municipality] had mobilized the private sector they could reach a lot of beneficiaries by making use of the large manpower that would come with the partnership.”

Figure 10: Cooperation with the private sector, NGOs and other entities

Source: Municipal Officials Survey Note: The bar chart satisfaction with cooperation with non-governmental entities was asked as a general question, irrespective of who the municipality cooperated with.

In addition to being asked about collaboration with other levels of government on crisis response, mayors and other respondents in the Municipal Officials Survey were also asked about collaboration with NGOs and other non-governmental entities (see Figure 10 above). Collaboration with NGOs and other non-governmental entities was rather widespread, with at least one survey respondent indicating their municipality cooperated with each type of NGO. The most commonly cited entities include NGOs (64 percent), private individuals (58 percent), private sector (47 percent), and donors (29 percent). The types of assistance and collaboration were quite diverse, with each non-governmental entity providing a range of different types of assistance, including a notable proportion of “other” types of assistance not captured by existing survey options. Notably, satisfaction among these recipients of assistance was very high, with 2/3rd of all respondents reporting being “very satisfied” (67 percent) or somewhat satisfied (30 percent).



ENGAGING CSOS

CSOs were engaged differently from private sector actors in helping the municipality respond to COVID-19. Some municipalities had made open calls for CSO support. While not all CSOs reported receiving a formal invitation for collaboration from the municipalities, many were glad to support the municipalities in handling the crisis. Most of them were engaged from the very beginning and their role became even more crucial when many of their officials tested positive and stayed home. In some cases they jointly developed and planned to manage the crisis with the Mayor. They helped municipalities distribute relief materials, counselled victims of domestic violence, provided kits to lactating and pregnant women, helped municipalities to collect data and information on returnee migrants, and raised awareness on health measures like sanitizer uses, hand washing, social distancing among others. In an FGD, CSOs in Sudurpaschim said that they also engaged with other agencies such as police to help in other areas such as domestic violence victims. In many instances they claimed that they actually initiated the meetings with the municipalities first and then coordinated work followed.

Respondents from CSO groups in Province 2 and Sudurpaschim felt that the terms of collaboration with the municipality were strict and that travel restrictions that were in place to limit the spread of disease also affected the extent of support that CSOs could provide. Most CSOs agree that the municipalities seem unsure of how to best mobilize them, likely due to a lack of internal planning and available guidelines for cooperation. One CSO in the Sudurpaschim FGD said “… they [usually] approve what we propose, but they do not provide any feedback or monitor the work of CSOs.” In the same FGD, respondents widely noted that local governments were not able to properly coordinate due to their unpreparedness for the crisis, which likely had an impact on the timeliness and efficacy of the engagement of CSOs to support them in their response.

Most CSOs were critical of the ways local governments engaged (or did not engage) their support. Some CSOs reported being disappointed with the local government as they were not giving priority to the psychological needs of vulnerable populations or migrants. Other CSOs reported being confused about how to coordinate with the municipality or local authorities and felt that there was more that could be done by the local authorities to get the support of CSOs, who were apparently very open to helping at the time. CSOs feel that LGs should have been better prepared in terms of developing a relief distribution mechanism and better mobilize.

As stated earlier 76 percent of Citizens Survey respondents said that they received assistance from the government, while only 31 percent said that they received assistance from NGOs or other entities during the COVID-19 crises. Citizens expressed greater satisfaction with assistance received from NGO compared to assistance received from the government. As stated earlier (under Performance of Local Government under RQ2), 74 percent of Citizens Survey respondents were either “very satisfied” or “somewhat satisfied” with assistance received from the government. As shown in Figure 11 below, of those who received any type of assistance from either private individuals (47 percent), NGOs (45 percent), private firms (30 percent), youth clubs or other local clubs (15 percent), and political parties (six percent), 92 percent were either “very satisfied” or “somewhat satisfied.”

Table 4 below shows citizen’s satisfaction with assistance received from private individuals, NGOs and private firms. Note however, that these results are somewhat compounded since the survey instrument did not ask about satisfaction by source. For example, for the 59 individuals who received assistance from private individuals across both provinces, 12 also received assistance from NGOs and 11 also received assistance from private firms, so their responses about satisfaction are not solely about assistance received from private individuals. We do see, however, greater



satisfaction with assistance received from non-governmental organizations in Province 2 compared to Sudurpaschim.

Figure 11: Percent of citizens who received assistance from NGOs and other entities during the COVID-19 crisis and were satisfied with the assistance

Source: Citizen’s Survey Note: The two bar charts at the bottom shows the types of NGO or other entities that 31 percent of respondents received assistance from, and the type of assistance they received. The satisfaction with the assistance (top right) is again for the same 31 percent of respondents who said they received assistance.

Table 4: Citizen’s Satisfaction with Assistance Received from Non-Governmental Organizations, Counts

Satisfaction with Assistance

Province 2 Sudurpaschim

Private Individuals NGOs

Private Firms

Private Individuals NGOs

Private Firms

Very satisfied 10 9 9 7 10 5

Somewhat satisfied 26 20 13 12 16 7

Somewhat dissatisfied 2 - - 1 - -

Very dissatisfied 1 1 1 - - 3

N = 39 30 23 20 26 15


ENGAGING DONORS

In Kathmandu one key informant donor representative compared the support mobilization during COVID-19 to the 2015 earthquake crisis and indicated that this time around it was less intensive



than for the earthquake crisis. MOFAGA did ask for a quick COVID-19 response but their own plan and activities were still evolving. One ministry official said that there was support from USAID that hired many people especially in the provinces of Karnali and Sudurpaschim to help with the pandemic. WHO was also noted to have helped throughout the country, as they have been redeploying their staff from other works to COVID-19 related services. He stated “we had more support from WHO than from the Ministry.” MOHP received 380 pieces of equipment from donors like WHO, USAID and others.

Another ministry official noted that MOF was responsible for mobilizing international agencies; this was confirmed by donor staff in KIIs who acknowledged that they were approached by MOF for redirecting funds for COVID-19, and for technical support to prepare epidemiological guidelines. MOFAGA used the community based disaster risk management (CBDRM) platform to coordinate the work of different agencies, avoid duplication, and undertake LG budget preparation and mobilization. The same ministry informant also suggested that “using the national disaster risk reduction and management authority (NDRRMA) could have been highly effective and useful, but since this authority was new it couldn’t function properly.” USAID IPs in Kathmandu also shared in an interview that depending on the nature of their program and the needs of their target municipalities, they also received and responded to municipalities’ requests for support. This included economic recovery, trainings, employment related information management, socio-economic surveys to know the impact of COVID-19, identification of dependent and vulnerable population, feeding and supporting homeless and unemployed people, and coordination with other stakeholders. They also watched the municipality’s resource distribution from an equity, justice and transparency point of view.

SUPPLY-CHAIN IMPACTS

The nature and severity of effect of lockdown varied with the type of industry and business. The agrovet industry, for example, was particularly affected because its imported goods and materials were stuck in customs, their skilled workforce that came from India could not enter, along with other logistical challenges. The hotel and tourism industries were greatly affected due to the closed borders. The broken supply chain proved problematic for a number of businesses that were not able to restock their products nor get their products from other countries in a timely way. A private sector respondent described the situation in a border municipality with major trade transit route as follows

“… Birgunj is the economic center of Nepal. Everyone relies on it. It is one of the biggest industrial areas. The main businesses here are trading industries and it is also one the popular transits for both people and raw materials. Birgunj is characterized by a border economy and most of the export/import takes place here. It is the major supplier of raw materials for most of the businesses across Nepal. Due to the closure of border, customs were completely halted, we couldn’t supply the materials that were in our warehouses.” [FGD, Private Sector, Province 2]

Private sector representative in an FGD in Sudurpaschim said that farmers had difficulties getting inputs like seeds and getting their products to the market. In the early days of the pandemic, farmers feared travelling into town to buy seeds, but their attitude towards going to the market changed after becoming more knowledgeable about the virus and how it was spread. Unfortunately, some farmers noted that portions of their production went to waste. However, one private sector respondent reported meeting with the municipality and providing supply chain assistance to distribute seeds to agrovet companies. With regards to agriculture, a Mayor from Province 2 reported that the municipality provided support to the agriculture sector, providing farmers with tractors at subsidized rates.



In the case of some border municipalities, a supply chain was established through personal contacts across the border in India. In others, it was done through an arrangement with the private sector and through mutual support among municipalities. USAID IPs in Kathmandu stated that some sub-metropolitan municipalities like Dhangadi supported other municipalities while Dipalyal Silgudi municipality cooperated with neighboring municipalities for supplies. Dullu municipality did not have any private sector firms so they took help from NGOs and INGOs working in their municipality. Godawari and Lamkeshor mobilized local businesses to provide mosquito nets and blankets, and Tulsipur mobilized partners in the local chamber and developed their own hand sanitizer. In some municipalities, the supply chain was completely broken and required reliance on the CDO for resources.

Interviewed private sector actors felt that their municipality did not work effectively to reestablish the broken production supply chain and they had to depend on others to access supplies.

OTHER SOCIETAL IMPACTS

Social systems, economy and governance systems were disrupted with severe social and economic impacts affecting peoples’ business and lives in multiple ways. Businesses were shut down for as long as ten months, according to one private sector respondent. Police were said to come to inspect the businesses that were still operating to ensure that operations were done according to current government regulations, and their presence always carried a threat of businesses being shut down. Private sector actors were unhappy at the lockdown’s effects on store hours, and said that a black market flourished as a result of these restricted hours.

With regards to finances, private sector discussants noted that many businesses experienced a loss and struggled to pay their laborers, at times leading to layoffs. Discussants reported having difficulty paying off bank loans for their businesses as well as rent payments for their storefronts. Private sector actors were also frustrated with government demands to continue paying taxes during lockdown. Even when the workers couldn’t come to work, they had to make payments even by borrowing money. Though they were not were not forced to make payments to their workers, they felt that they had to do so out of our sense of responsibility towards their workers. One discussant detailed at length the business and personal impacts that they experienced as a result of the government’s management of the pandemic:

“We still had to pay running costs and taxes. It was a very difficult time. There were health related expenses for family members, we all were frightened, unsure about the future and went through mental stress. Everything was closed. We could not test ourselves for COVID in the early days due to the lack of doctors and PCR kits. There were travel restrictions. We could not think about our business at that time. Other things seemed more important.” [FGD, Private Sector, Province 2]

In addition, discussants reported that there were some business owners who needed to take out bank loans but could not do so because they could not get required documents from the municipality. Consequently, micro, small, and medium entrepreneurs had to close their businesses [FGD, USAID Staff].

Along with the above challenges faced by business owners, one private sector discussant said that they even faced some community backlash over fears that they were carrying the disease. Another private sector respondent noted that their hotel had been turned into a quarantine and isolation facility for doctors and COVID-19 patients in coordination with the LG.



Lockdown seriously hampered the tourism sector affecting works associated with tourism development. It also affected the employment opportunities for youth and impacted the rollout of various skill development and training programs, according to one Mayor in Sudurpaschim. Schools were also closed as a result of the disease spread and lockdown, and at times facilities were used to quarantine patients. In a citizen FGD one discussant mentioned that youth clubs were mobilized by the municipality to create employment opportunities for migrant workers, Dalit populations, and at risk families.

CSOs mostly intend to continue working in the sector of human rights, conducting awareness creation programs, involving locals in agro-based economic activities and employment generation. They want to work in identifying gaps in policies and organizing skill enhancement activities for youth rather than relief distribution and support. As one participant in an FGD said:

“The pandemic has taught us a lot of things including the effective model of partnership between CSOs, palikas and the citizens. This has also put us in a challenging situation of having to bring about economic development despite all the difficulties that the pandemic has put forth. Our long-term goal is to work towards identifying resources for economic development; emphasizing on the fact that the citizens along with the CBOs/CSOs should also have access to and a say on the plans and policies that are made. Further, [raising awareness] is also our long-term goal.” [FGD, Citizens, Sudurpaschim]

According to some respondents, there is a greater awareness about the partnership opportunities between the municipalities and the private sector/CSOs following the pandemic. One private sector respondent indicated that the government is already working with local organizations to collect data from migrant workers with the intention of providing them with skills and self-employment opportunities. One CSO respondent noted that local governments are very keen on working with CSOs now that they have become more aware of how their work could complement one another. CSOs offer their support for raising awareness.

Citizens are largely concerned with jobs and employment. They also requested a long-term action plan from the government to create jobs for youth and individuals coming back from abroad, raising awareness of the virus, and prioritizing migrant workers coming back to the country. Many young people were returning from abroad to their Municipalities, which has increased hope that the labor shortage in rural areas affecting the agriculture sector will be resolved. This is something positive that most municipalities were sensing, and they were planning to use it as an opportunity for increasing local production and commercialization of agriculture. A key informant ministry official in Kathmandu noted that in order to increase local production and commercialization of agriculture many municipalities took the policy decision to restrict keeping fallow land in their jurisdiction. This was possible because of the COVID-19 crisis, and could not be done under normal circumstances.

RESEARCH QUESTION 4: IN TERMS OF FINANCE AND FINANCIAL MANAGEMENT, WHAT FEDERAL AND LOCAL GOVERNMENT FUNDS HAVE BEEN MOBILIZED AND PROVIDED FOR COVID-19 RESPONSE? WHAT SYSTEMS OF CONTROL AND TRANSPARENCY HAVE BEEN ESTABLISHED? HOW ARE FUNDS BEING USED? HOW HAS THE CURRENT LOCAL PLANNING PROCESS (APRIL-JUNE 2020) OF MUNICIPALITIES ADVANCED COVID-19 SENSITIVE PLANS AND BUDGETS FOR FY 2020/2021? HOW DO THESE PLANS TARGET THE MOST VULNERABLE GROUPS OF THE COMMUNITIES?

Since this question has multiple parts it is grouped into several sub-sections: (1) funding, (2) control and transparency, (3) action/response by the government to the pandemic, and (4) looking forward.



FUNDING

Funds were provided by the Federal government to the Provinces, for further distribution to the municipalities. Funding was from several sources—the MOHP and MOFAGA, as well as in-kind assistance from donors and INGOs such as USAID12, GIZ, the German Embassy, World Health Organization, UNICEF, the Red Cross, and the Swiss Development Cooperation in the form of ventilators, PCR testing machines, face masks, thermal guns, etc. The Municipal Association of Nepal (MUAN) also distributed PPE sets, masks, and sanitizer in most affected (Red Zone) municipalities.

The Local Disaster Management Fund13 was used to fund some municipalities, but resources from this source were insufficient for several municipalities. Most LGs had to rely on funding from several sources – the Disaster Risk Management Fund (DRMF)14, funding from the Provincial and Federal government and donations. In addition, several LGs diverted funds in their own budget from one line item/heading—usually for developmental work, agriculture related activities, training and equipment—into COVID-19 response.15

Inadequate revenue collection (less than the targets) and transfers to the municipality further exacerbated problems with resources available for COVID-19 response.16 In a KII in Sudurpaschim a Mayor noted several reasons for lower own source revenues during COVID-19: “Our tax collection streams have become limited because till now the hotel industry is closed. The entertainment business is slowly picking up and other businesses are still not doing so well. New businesses have not been initiated or registered. We are not able to run our ‘Haat bazars’ (Community Markets). The transportation businesses have not fully started. The people who own buses complain about facing loss as they are only carrying few passengers and cannot even cover the cost of fuel. When the revenues are limited it immediately affects our upcoming plans as well”.

Initially, support was provided from the COVID-19 Fund17 to municipalities who built quarantine facilities especially during the initial lockdown. Later there were insufficient resources to compensate the municipalities. Federal rules stipulated that LGs were to spend only NPR 150 per day on quarantined individuals. This was not adequate for daily food and other expenses. Thus, the norms established were not practical, causing many LGs to be in arrears. Managing quarantine facilities was an expensive affair for the LGs. Wherever they had enough money it went well. But in places where the number of people was large, they ran out of resources and asked for help from MOFAGA.

12 USAID IPs provided conditional cash transfers to households to deal with COVID-19. Help desks were set up in municipalities to provide information regarding loans and assist with filling and submitting applications. Livelihood training was provided for returning migrants from India and other countries. 13 Disaster Management Funds exist at all three levels of government and are established under the National Policy for Disaster Risk Reduction 2018. Clause 7.47 of the DRR says, “Disaster management funds will be established at federal, provincial and local levels as per the law to mobilize the resources.” Further Section 22 of the Disaster Risk Reduction & Management Act, 2017 has a detailed provision for the DMF. 14 The Disaster Risk Management Funds are created at the local government level and include a combination of donor and GoN funds. 15 According to the Local Government Operations Act (2074), Clause 79 municipalities can shift 25 percent of their capital budget from one heading to another in the budget approved by the Assembly. Own source revenues can also be shifted to another expenditure on approval by the Assembly. 16 A GoN respondent also cited the National Disaster Risk Reduction and Management Authority (NDRRMA) that was established in 2017 through the Disaster Risk Reduction and Management (DRRM) to coordinate and implement DRRM-related functions in the country. Its mandates include leading, facilitating and supporting federal, provincial and local governments on disaster risk reduction, response and reconstruction. However, NDRRMA is relatively new and does not function effectively. 17 The COVID-19 fund was created by the Prime Minister’s Office and established at all 3 levels of government. Officials who were insured for the disease and later tested positive for the virus were eligible to received NPR 100,000 (USD 850) from this fund.



“Palikas spent most of their resources in quarantine and relief work than on disease control and treatment. They have not yet looked at the occupancy and livelihood related issues,” said the FG official.

Border provinces did not receive sufficient extra support to provide to the municipalities to deal with the large influx of returning migrants and faced many problems with setting up holding and quarantine centers. MOFAGA did provide some additional resources, but it was inadequate. A Mayor in Sudurpaschim said that it was a struggle to deal with migrants over a long period of time since the municipality had to quarantine them at the border (Dhangadi) before they went to their homes. Workers from India stayed in the holding facility for two months. A Provincial official in Sudurpaschim also noted that “Quarantine center could have been managed more properly. Each day we use to quarantine about 76,000 individuals….It is difficult to provide these individuals with proper service at a certain point.”

One KII respondent in Kathmandu stated that by the end of 2020 “COVID related expenses of [each] rural municipalities were 1.25- 2 crores Nepalese rupee (USD 107,901) and of these municipalities covered ¼ of the costs.” According to a key informant from GoN, the national government sent 1 billion NPR (USD 8.6 million) from the COVID-19 Fund to the local government and provided guidelines on the use of this fund. However, another key informant donor official in Kathmandu noted that the “Provincial government was complaining about the capacity of the federal government to deal with the pandemic and imposing guidelines and standards without considering ground realities.”

In Province 2 and Sudurpaschim, municipalities cited getting donations directly from individuals/citizens (NPR 8,000 to 12,000; USD 70-100), and relief funds from the provincial government in the amount of NPR 15-27 lakhs (USD 13,000-23,000).18 Several used funds originally earmarked for development, social works and skill development for COVID-19. Some mayors were also able to get funding from civil societies, private sector organizations, NGOs, or Nepalese diaspora outside the country. A Mayor from Sudurpaschim noted that the private sector, retired teachers, and other professionals were mobilized for COVID-19 awareness programs. Another Mayor from Sudurpaschim stated that the municipality has a crisis management committee and always has some budget allocated for managing crises—pandemics or epidemics or health crises—as well as a work plan and guideline for managing the pandemic.

“I had announced on Facebook that I needed support to tackle the COVID crisis and I was able to collect 1 crore 75 lakhs from the civil society such as industrialists, social workers and bankers. A VDC19 also provided 25 lakhs. The workers in our Palika also contributed their salary. The province also provided 25 lakhs as relief funds. They were involved from May [2020] with the increase in severity of the pandemic.” [KII, Mayor, Province 2]

“Civil Society has helped us completely. The press has also supported us. They have provided us with essential material.” [KII, Mayor, Sudurpaschim]

“Private sectors like Federation of Nepalese Chamber of Commerce and Industries (FNCCI) as well as people provided help personally as well. Local organizations had also provided help and support.” [KII, Mayor, Province 2]

18 Municipalities in Province 2 noted getting NPR 10-15 lakhs from the Province, but one municipality from Province 2 said that they did not receive any money from the Provincial Government. Municipalities in Sudurpaschim noted receiving NPR 27 lakhs from the Province. However, provincial officials in Sudurpaschim said that NPR 5 lakhs (USD 4260) was given to each municipality. 19 Village Development Committee.



CONTROL AND TRANSPARENCY

There is general recognition among key informants in Kathmandu that since the LGs were working under pressure to respond to the pandemic, it was difficult for them to track expenses. Most municipalities also lack the capacity and human resources to keep good records and accounts. In an interview a donor staff in Kathmandu noted that “compared to the federal [government] there are many examples that they [LGs] are more transparent.”

Municipalities were allowed to divert funds in their own budget to respond to COVID-19. However, according to a USAID IP, “there were inconsistencies in the rationalization provided for diverting funds as well as how they were used.” One municipal official in Sudurpaschim stated that they did not establish different financial records or bookkeeping to manage these funds, but created a different account for COVID-19. At the municipal level several mayors indicated that they had made their COVID-19 accounts public.

“We have made the accounts public and have cleared the accounts related to COVID-19 in the council meeting during Asadh. We kept a record of the contribution made by health workers and volunteers and provided a letter of appreciation for their time.” [KII, Mayor, Province 2]

“All our records are made public. These records are discussed in meetings that focus on COVID Management and includes all ward members, chairperson, mayor, and deputy mayor. The Mayor of the municipality is the coordinator of the meeting. The records are publicly released in our website. The media also helped in reporting the details of the records.” [KII, Mayor, Sudurpaschim]

Another Mayor in Province 2 said that at the end of the fiscal year (June/July 2020), all accounts were made public on the municipal website by major budget head. Mayors also stated that they followed the guidelines indicated by the provincial Cabinet and Chief Minister; that anyone using resources from the federal fund would keep good records and also undergo an audit. Several also said that they shared and discussed their COVID-19 accounts during public hearings and council meetings.

However, as noted earlier, in an FGD, CSOs in Sudurpaschim said that due to the increased corruption during relief distribution they carried out a Public Expenditure Tracking Survey (PETS). They requested the municipality to provide expenditure details in a format that citizens would understand, but officials did not cooperate or accommodate this request. Citizens either noted the lack of information on how municipalities spent the money received for COVID-19, or were unaware of funds being received by the municipality to deal with COVID-19. In Province 2 practically all the citizens in the FGD were aware that the municipality had received funding but said “we don’t know where the money went.” In Sudurpaschim, citizens said they were not aware or did not know about the funding.

“We had heard that the budget [for COVID-19] was allocated through the newspapers, but don’t know how much and where it was used.” [FGD, Citizens, Province 2]

“We know that funds were received from the government but we have no knowledge about the whereabouts of the money. Government has not released the data publicly.” [FGD, Citizens, Province 2]

“For sure they must have received it [funds], otherwise how could they distribute food items and other COVID-19 related services like the PCR test and support the quarantine center. But what amount, and from where is something I am not aware of.” [FGD, Citizens, Sudurpaschim]



Procurement procedures at the municipal level followed the process detailed in the Public Procurement Act. Thus, all services and material provided in the quarantine centers followed rates and procedures set by law. Provincial officers acknowledged that the crisis caused a large price hike, thermal guns that usually cost NPR 2,000 sold at NPR 7,500. Similarly, PPEs sold at NPR 17,000 when their normal price is NPR 1,000-2,000, however all rules were followed regarding auditing and making accounts public. A federal Ministry official noted that “health related procurement in crisis management procurement is very difficult as per the act. The old procurement act was good but the present one is very difficult. [It] tries for strict control, but at times of crisis it is difficult to apply them.” According to a provincial official in Sudurpaschim, the expenses incurred for COVID-19 were compiled and prepared by the monitoring committee in coordination with the different political parties. “There were two representatives from political parties and one representative from the Palika. In our case there was a representative from Nepali Congress and Nepal Communist Party. The two of them and ward chairman were in the Expense Committee. They would manage the expenses and make public the expenses made.” Both provincial and municipal officials noted that during a time of crisis procurement timelines can be relaxed marginally. A provincial official from Province 2 said: “For instance, once a crisis has been announced, if it takes 30 days to approve a request, we can shorten the time by a week or 3 days depending on the severity of the need.”

“We follow the rules assigned by the government of Nepal regarding how to spend the fund. Everything is audited and made public as it is government funding. There was no special arrangement made for the COVID crisis.’ [KII, Provincial Officer]

“Our records are made public every four months.” [KII, Mayor, Province 2]

One Mayor from Province 2 noted that the crisis was handled by the LGs that deal directly with citizens, “had the government structure been like before, it wouldn’t have worked. That is, if everything was centralized and had to be controlled by the central level, things could have gone haywire. But now the local government also has the capacity and the authority to carry out various tasks on its own. Hence the wards were somehow able to effectively manage the crisis as they knew the situations on the ground.”

In a KII, a federal ministry official also noted “if local governments and provinces were not there we couldn’t have achieved what we did to manage the COVID-19 crisis. We passed the test of federalism at the time of COVID.”

ACTION/RESPONSE BY THE GOVERNMENT TO THE PANDEMIC

There is mixed perception on the overall response of GoN (federal, provincial, and municipal) to the pandemic. Overall, respondents in Kathmandu felt that the LG performance was good and that in the absence of sufficient guidelines from the federal government, most LGs set their own standards. One key informant in Kathmandu, a donor staff, noted “if I compare the three tiers of government, I can say that local governments have done a tremendous job compared to the provincial and federal government.” Others felt that there was a haphazard response to the COVID-19 crisis, due to limited capacity. For example, a CSO staff in Kathmandu said that even though the LGs were “enthusiastic about contact tracing, they did not know how to do it.”

Table 5 below shows the response and challenges faced by the municipalities in several areas when dealing with COVID-19.



Table 5: Municipal Response and Challenges dealing with COVID-19

Type of Response Action Taken Challenges

Health related (quarantine, PCR test, building hospitals)

– Rural municipalities quarantined up to 4000 people at one time during May 2020; in some cases, separate rooms were maintained only for women.

– Over 100 hospitals were added across the country to deal with COVID-19; with intensive care units becoming available for the first time in some municipalities/provinces.

– PPEs, sanitizers, and PCR tests were bought by municipalities if they had sufficient resources.

– Building quarantine sites accounted for most of the expenses.

– Newly built hospital lack adequate staff and equipment.

– Most municipalities struggled with setting up quarantine centers and doing contract tracking.

– Quarantine areas lacked safety and security; and faced hygiene issues with respect to water and sanitation.

– Essential medical equipment was delayed from the provincial and federal government.

Relief (food, clothing, money)

– Vouchers were provided to farmers affected by COVID-19 to buy seeds and fertilizers.

– Food was provided to homeless and unemployed people.

– Municipalities spent more on relief than on disease control and treatment.

– A black market emerged for food. Municipalities found it difficult to monitor the market for vegetables and oil. With a lack of food resources, what was available sold at twice or three times the original price.

Migrants

– Migrants were taken from the border and transported home.

– Municipalities coordinated with their wards or each other to transport migrants to quarantine areas.

– LGs were required to keep records and a data base of migrants by occupation, skills and other details for economic and employment planning. However, this database is incomplete in most LGs.

– Lack of coordination between the three levels of governments to deal with migrants; in some border municipalities (Bhimdutta and Dhangadi) the army, police and government agencies did not update the local and provincial government.

– Some municipalities did not know how to manage water, food and shelter. A lot of money was spent with limited coordination.

Vulnerable population

– Food service was provided by most LGs to this population. In some cases, food items were provided for one month.

– Received cash transfers from USAID.

– Isolation centers were established for disabled and vulnerable populations. The Social Support Unit provided help to those who needed special care.

– Since the lockdown continued for 5-6 months, support for just one month was inadequate.

– Some municipalities required help in identifying their dependent and vulnerable populations.

Respondents in the Citizens Survey who received any COVID-19 assistance from the government were asked about the types of assistance they received as well as their satisfaction with the assistance (see Figure 12 below). Three-quarters of respondents received assistance from the government during the crisis, with these respondents commonly citing receiving hygienic materials (70 percent), food assistance (64 percent), PPE or masks (60 percent), PCR tests (30 percent), and access to government quarantine facilities (25 percent). Most recipients reported being satisfied with the assistance they received, with 51 percent “somewhat satisfied” and another 23 percent “very satisfied.” Around a quarter of assistance recipients were not satisfied, with 17 percent “somewhat dissatisfied” and nine percent “very dissatisfied.”



Figure 12: Citizen feedback on assistance received from the government during COVID-19


LOOKING FORWARD

Local governments have realized the need to plan for the next year and deal with the new context with respect to high unemployment and school closures. A budget template has been prepared by MOFAGA for the next years’ budget which is now being used by LGs. The template specifies less mechanized work and greater focus on labor intensive work to increase employment opportunities. MOFAGA is also drafting a recovery plan for LGs which includes preparing for and dealing with disasters going forward; the Samapurak (Equalization) budget is also being used to assist LGs. A federal Ministry official also noted that along with budget planning there is a need for a LG assessment framework and method to assess the socio-economic impact of COVID-19.

Another federal Ministry official noted that municipalities should consider COVID-19 while making their next years’ budget; that there should be a separate budget for COVID-19. However, by December 2020—January 2021 the Ministry had not yet provided written guidelines for this. Municipal mayors confirmed that they have a separate line item in their budget going forward for COVID-19. Several noted that resources had been diverted from the five-year plan to COVID-19. This will have repercussions on development work for the next two years. However, a Mayor from Sudurpaschim stated that “even if we have made budget cuts on other development works, we have not compromised the support we need to provide for the vulnerable sections of the community.” Another mayor from Sudurpaschim stated that since the development budget was not fully utilized last year, it will be utilized next year, and therefore not impact future budget plans or priorities.

In Province 2, one Mayor said that the municipality had decided to construct a building with 15 to 20 beds to support ICU patients and be better prepared to deal with future public health crises. Another Mayor in Province 2 said that they would follow the policies circulated by the provincial and federal government. But “learning from the past we are now planning to have a separate budget for disasters.” A third Mayor in Province 2 said that they planned to improve the existing two hospitals in the municipality and converting the public health center into an emergency ward. In Sudurpaschim, a Mayor shared that their future plans included improving the health sector and health facilities in every ward. The focus was reproductive health by increasing the number of birthing centers and providing ultrasound services at the ward level. Providing vaccines for children, and stressing the

6%

6%

25%

30%

60%

64%

70%

Received transportation facilities (to reachhome from the border etc.)

Received medicine

Stayed in government quarantine facility

Received PCR test

Received personal protective equipment(PPE) or mask(s)

Received food assistance

Received hygiene and sanitation materials/kits



importance of proper diet to improve the menstrual health and stop the malnutrition of adolescent girls was also mentioned. Lastly this Mayor said; “We desire to make health services easily available especially to the poor and marginalized who are unable to seek private health services.”

In a KII a provincial official in Province 2 said that in order to minimize impact on the social economic sector the federal government has been working on introducing various programs focusing on poor and vulnerable populations in the next budget. It is establishing model villages in each of the seven provinces where the needs of vulnerable populations will be prioritized. Other guidelines are being made to establish centers for elderly people and preparing a GBV victim support fund and a model village for differently-abled people in each of the seven provinces. On a more somber note, another provincial official from Province 2 noted that due to lack of basic resources they did not see the point in planning something that cannot be properly implemented. This same official said the following:

“We have not even been able to plan our resources for disaster relief (for the victims of cold waves, flooding, landslides etc.) as we have not been able to monitor the current level of services being provided by the municipalities and have not been able to take stock of what they possess at present. Formulating policies and preparing it in paper is not enough and doesn’t make sense when we cannot implement them and provide resources to execute these policies.” [KII, Provincial Official, Province 2]

CONCLUSIONS

Research Question 1: Function, roles and responsibilities, cooperation and collaboration with other levels of government

• All policy and guidance on COVID-19 response took place at the federal level with the establishment of committees, national crisis management center, and guidance on health, quarantine, and distribution of food to the vulnerable population. Municipalities and wards became the front line in both managing and implementing the health and non-health related decisions regarding COVID-19 response.

• While the federal and provincial government seemed to be knowledgeable about their roles and responsibilities regarding COVID-19 at the start of the pandemic municipal official were overwhelmed by the numerous guidelines and instructions that were sometimes unclear and contradictory. Weak coordination across the three levels of government was often cited as the cause of the confusion.

• Most municipalities stated that they collaborated and coordinated with both vertical and horizontal government organizations and agencies to respond to the pandemic. Provincial officials in Province 2 felt that the collaboration and coordination was not effective, while those in Sudurpaschim felt there was daily communication with the municipalities.

Research Question 2: Capacity of LGs to deliver COVID-19 services, effect on regular government services, and perception of public to the LGs response.

• Many municipal officials felt they lacked sufficient knowledge, medical equipment and supplies to deal with the pandemic and had to deal with issues on an ad hoc basis. Lack of funds and management of quarantine facilities were considered the most challenging.

• Most mayors stopped development work in their municipalities and diverted these funds to deal with the pandemic. Repair and ongoing maintenance and regular administrative duties were also



affected in the majority of the municipalities that responded to the survey. However, 68 percent of citizens surveyed responded that their municipality was able to fulfill their regular service delivery mandates during the pandemic.

• Stakeholders’ assessment of LG performance regarding dealing with the pandemic varied by data source. In the citizens’ survey, almost all citizens were aware of services provided by the government, 76 percent said they received some form of assistance, and of those 74 percent were “somewhat satisfied” or “satisfied” with the assistance received. However, citizens in FGDs were more critical and less aware of services provided by their municipality. Overall, citizens were more dissatisfied with their municipality in Province 2 compared to Sudurpaschim. Federal or provincial officials felt that municipalities were struggling with their COVID-19 response, and CSOs felt that they could have been mobilized earlier and more than they were. Donors and their implementing partners’ staff were more positive about the municipalities’ performance during the crises, especially the border municipalities.

• Citizens expressed a higher level of satisfaction from assistance received from the private sector, NGOs or private individuals compared to assistance from the municipality.

Research Question 3: LG partnerships with private sector/CSOs, effect on supply chain and other societal impacts.

• Majority of the municipal officials surveyed (64 percent) said that their municipality cooperated with NGOs, and 58 percent said they cooperated with private individuals; the majority were satisfied with this cooperation. Private sector actors in Province 2 and Sudurpaschim criticized the municipalities for their lack of effective coordination and mobilization of their support.

• Some municipalities made open calls for CSO support with the pandemic. While not all CSOs reported receiving a formal invitation for collaboration from the municipalities, many were glad to support the municipalities in handling the crisis, but critical of the way they were engaged.

• Most donors and implementing partners assisted the GoN to deal with the pandemic.

• The supply chain impact of COVID-19 was most on the agrovet industry. In some municipalities, the supply chain was completely broken and required reliance on the CDO for resources.

• The pandemic also affected businesses, tourism, and employment opportunities for youth.

Research Question 4: Fund mobilization, systems of control and transparency, use of funds and planning for the future.

• Municipalities obtained funding from a variety of sources to deal with the pandemic – the DMF, the DRMF, the COVID-19 fund, donors and INGOs as well as the private sector and individual citizens. However, the amount was insufficient to deal with the scale of the pandemic. Border municipalities dealing with the influx of returning migrants were especially constrained.

• Most municipalities lack the capacity and staff to keep good records and accounts, but several mayors interviewed indicated that they had made their COVID-19 accounts public and discussed them during public hearings and council meetings.



• Municipalities faced several challenges in dealing with the pandemic, but all to the best of their capacity undertook health and relief activities, and dealt with the large number of migrants and vulnerable populations.

• Looking forward, LGs have realized the need to plan for the next year and deal with the new context with respect to high unemployment and school closures. A budget template has been prepared by MOFAGA for the next years’ budget which is now being used by LGs. While MOFAGA has indicated there should be a separate budget for COVID-19, it has not yet provided written guidelines for this.

LESSONS LEARNED AND RECOMMENDATIONS

KII respondents cited several lessons that were spotlighted while dealing with the pandemic. Most indicate the need for better systems and procedures as follows:

Better data collection system and management of citizens working abroad. There is inaccurate data of Nepalese living/working abroad, thus LGs were surprised and could not plan for the number that returned home due to the pandemic. A large number of migrants and citizens returned to Nepal and managing this influx was a challenge.

Improve municipal capacity and resources to deal with crises in the future. Lack of experience in handling a crisis of this magnitude resulted in LGs being unprepared to deal with the pandemic. A number of LG officials from Province 2 and Sudurpaschim felt that they were unprepared to tackle the pandemic, noting that they lacked human resources to manage healthcare provision and that the influx of migrants was particularly difficult to manage. Several stakeholders also commented on the need for better management and planning by municipalities to deal with the crisis, as well as coordination and cooperation among different levels of government.

LG officials in Province 2 and Sudurpaschim noted that at times extra staff were hired in order to meet the needs of the public, among them skilled medical workers like nurses, doctors, and lab technicians in addition to volunteers from the public or from local organizations to help distribute relief, operate medical equipment, manage holding centers or quarantine facilities, and more. This data is supported by findings from the Municipal Officials survey, which found that the most common staff hired were health related staff. The mobilization efforts undertaken by the LG point to a need for additional staff to be hired in order to have the necessary human resources on hand for future public health crises.

Streamline procurement procedures and accounting systems. Due to urgent need products were sometimes procured at a much higher price than normal—for example, thermal guns were procured for NPR 15,000 instead of NPR 4,000. Delays in procurement of machines by the provincial government also affected the ability of municipalities to help citizens. Municipal officials noted that settling expenditures incurred during quarantine especially from migrant citizens who were rescued, treated and serviced during the pandemic proved to be very difficult.

Create disaster risk financing options and insuring housing and businesses during emergency. There was a suggestion by a municipal official in Province 2 to create a separate renewable fund at all three levels of government for crisis management. “Every municipality should have a separate fund that can be used to sustain such a crisis for 2-3 months so we can work more smoothly.” Data from the Municipal Officials survey further supports this, as 91 percent of respondents indicated that one of the most common challenges to meeting the unexpected health



and humanitarian needs of the people were lack of resources or funds. While a DMF already exists at each level of government, it is not adequately funded.

Prioritize the health sector in an integrated way. Several key informants stressed the need to invest in basic infrastructure like roads, drinking water and other services that help tackle health problems.

Improve cooperation with the federal and provincial government, and coordination with multiple stakeholders across several sectors including health, development, food security, medical doctors, etc. In an FGD in Province 2 a citizen noted that it would have been more efficient if all sectors had been working together (private, CSO and government) and coordinated to provide services during COVID-19 since relief materials were distributed to some areas four times, while other areas did not receive anything. Another citizen in the Province 2 FGD suggested: “The ward can assign some volunteers. By assigning volunteers, the government could have reached door-to-door. Youths could have become the representatives from the government. The local government could work together with other organizations, it would have made their work fast, easy, and transparent; also, it would encourage other organizations as well.”

Overall, the ad hoc coordination between federal, provincial and local governments failed to create synergies. One USAID IP in Kathmandu noted “in the future we must put the local government in the front seat and give them greater authority.”

There prevails a common understanding among most stakeholders that this pandemic crisis should be used as an opportunity to learn and realize what the government lacks and how to overcome it. Regarding their roles, the most important thing to do is to spread knowledge and awareness and make people capable of managing the crisis on their own. They suggested that including the issues related to disasters and disaster management in the school curriculum through the support of CSOs and their experiences may be a way to go forward.

Increase private sector/local government engagement. Private sector representatives said that they could use their access to up-to-date technology to provide health and livelihood services door-to-door to the people. They could use their large commercial network and manpower to expand services which will not be possible for the municipalities alone. In return, municipalities could provide small incentives to the private sector like permits, support the cost of meeting health related guidelines like sanitizer, masks among others.

Increase engagement with CSOs. The CSOs observed that the municipalities did not fully mobilize the CSO potential in their jurisdiction to provide services effectively and in a timely manner. Regarding future cooperation with the municipality, CSOs suggested that the cooperation should be more systematic, and that the Municipality should involve CSOs and get their feedback while making plans and policies, and engage them early on in times of crisis. This includes creating a platform for CSOs and NGOs to work in a planned way, clearly defining their roles, responsibility and area of work to avoid duplication, and keeping up-to-date record of CSOs and their expertise to effectively mobilize them in eventual future crisis. They complained that the municipality remembers them only when things get out of hand. In an FGD, CSOs in Sudurpaschim asked that they be considered “…as a government body, as a supporting partner.”



ANNEX A: ASSESSMENT STATEMENT OF WORK USAID DRG-LER I

Tasking Request #83

Nepal Effectiveness of Local Governments to Address COVID-19 Crisis Research

Date of Request: May 26, 2020

Type of Task:

• Auxiliary Study (Other Research)

Statement of Work (SOW):

Nepal continues to face significant challenges to implement its constitutionally mandated transition to a new federal structure, which is exacerbated as it tackles the coronavirus (COVID-19). The country has been in lockdown since March 24, 2020 and recently the government extended the lockdown to June 14, 2020 and international flights are suspended till July 1.

Fighting the COVID-19 is a national priority set by the Federal government and measures taken by federal, provincial and local governments have been crucial in reaching the public and implementing preventive and relief activities in response to the pandemic. While immediate attention is focused on health and humanitarian assistance, a holistic response is required to protect democratic principles and rights, build citizen trust and a more effective and accountable response.

The Government of Nepal is putting in place a series of measures to address the situation, but more needs to be done, especially in the areas of coordination and collaboration between federal, provincial and local government to properly prepare to face the pandemic and address its impact in all sectors. The coordination and collaboration between three tiers of government in responding COVID-19 still needs reinforcement.

The Democracy and Governance Office would like to explore how local government could increase its effectiveness to address the COVID-19 crisis at the local level. Understanding the effectiveness of decentralized governance structures in a time of crisis can help the Mission understand the overall governance challenges that have the potential to compound negative impacts of COVID-19 on communities and individuals, and how the lack of a coordinated response across federal, provincial and local governments can heighten lack of trust and legitimacy making it more difficult to enforce public health guidance, policies and paves the way for corruption-related incidents and human right violations.

Facts and information from this study will help inform existing activities and future democracy and governance program designs and the Mission’s future CDCS.

Possible questions:

• Did the federal government’s response to COVID-19 include a set of flexible development policies/procedures for Palikas to adapt to the rapidly changing environment or were the policies a “one size fit all approach” where Palikas were expected to adopt these new procedures without the benefit of a risk assessment?



• Was the federal government effective in providing local governments enforcement and control measures/guidelines, ensuring that medical services were available and providing sufficient funding so that the response at the local level for these services including quarantine management and other relief efforts could be effective?

• How has the provincial government been effective in responding to the COVID-19 pandemic in general and specifically in supporting local governments in their response to relief activities? What was the criteria used by the provincial government in selecting municipalities to provide provincial support?

• How has the local government been responsive in implementing preventive measures against the spread of the COVID-19?

• How did the local government remain effective in delivering general services to the public before COVID-19? After COVID-19 has the local government been effective in providing emergency services and distributing relief packages to people and reaching marginalized communities in an equitable manner?

• How was local government effective in promoting oversight with mobilizing political parties, civil society, private sector and other stakeholders at the local level in collaborating responses to COVID-19?

• Has the local government been successful in leveraging local resources including the private sector and others, to support the COVID-19 response?

• Has the local government been successful in helping citizens to maintain their economic livelihood activities, work with administration to regulate influx of returnee migrants from borders and address the issues of returned migrant workers?

• What is the general perception of Nepalis on the role of local governments in providing real time, accurate information in this crisis situation?

• How effective was the local government in collaborating and coordinating with the federal and provincial government in response to COVID-19? How did the COVID-19 response activities explain the principle of coexistence among three levels of governments?

• Were local governments successful in adapting GON emergency response plans addressing financial management and the effective control/ tracking/ accounting - for financial resources disbursed to its citizens during this crisis?

• How did local governments adopt COVID-19 related policies to have a future framework established to address future emergency crises? Learning from COVID-19 pandemic, how will local and provincial governments prepare for the future with scenario or risk mitigation plans considering health, natural, economic or other crisis in general?

• What was the value added among decentralized local governments in collaborating their responses to the COVID-19 pandemic?

• What are some recommendations for how local governments can be more effective in responding to future crises like COVID-19 or other disasters?



• What lessons can we learn now that will inform existing and future programming of the USAID/Nepal Democracy and Governance portfolio and the Missions new CDCS?

Possible sample/cases respondents:

• Information from various stakeholders in 8 to 10 local governments from various provinces with high COVID impact and USAID zone of influence (mix of southern bordering local governments and northern hill local governments, urban and rural setting e.g. from Sudurpaschim, province 5 and province 2)

• Information from selected respondents from provincial government, federal government and USAID officials

• Information from the mixed group of people from different wards (small unit of municipality).

Deliverable(s):

Research Paper/ Case study report

Dates of performance and timeline:

May – December 2020

Submission Instructions:

You will have fourteen (14) calendar days to submit a brief concept note and budget.



ANNEX B: ASSESSMENT METHODS AND LIMITATIONS

SAMPLING METHODOLOGY

Sampling for the quantitative surveys was done on a quasi-random basis to ensure adequate representation across the various types of municipalities in the Provinces of interest.

For the Citizen’s Survey, the first stage of sampling involved municipality- or palika-level selection. First, palikas selected for the Qualitative surveys were excluded from eligibility to ensure data is collected from as wide a range of respondents as possible. Remaining palikas were then categorized across several dimensions of interest including population size, urban/rural, women-led, and amount of time since incorporation. Once these categorizations were made, NORC tabulated counts for instances of each category by Province to determine the availability and prevalence of the various features of interest. The table below presents the breakdown of types of municipalities in each of the target Provinces that comprised the palika-level sample frame:

CATI Survey - Sample frame to draw from (exclude KII municipalities)


# Districts 8 9

# Municipalities 130 82

# Women-led 0 1

Urban 73 29

Rural 57 53

Municipality 128 82

Sub-Metropolitan 0 0

Metropolitan 0 0

Small (under 25k) 29 87

Medium (25-42k) 57 13

Large (over 42k) 44 12

Declared 3-4 years ago 107 67


Old 5 3

Using this information as a guide, NORC selected 10 palikas from the sample frame in each Province with as much representation and diversity across the available categories as possible. Given the limited number of palikas of interest in each Province, many of these selections were forced by the unique features of various palikas, but selections were randomized where possible when multiple palikas shared the same features. For example, the fact that there was only one women-led palika across both Provinces necessitated that palika was selected for the citizen survey based on our selection criterion. The table below summarizes the palika-level selections in each Province:



CATI Survey - Selected Municipalities


# Districts 8 6

# Municipalities 10 10

# Women-led 0 1

Urban 5 6

Rural 5 4

Municipality 10 10

Sub-Metropolitan 0 0

Metropolitan 0 0

Small (under 25k) 4 3

Medium (25-42k) 4 3

Large (over 42k) 2 4



Old 3 3

The second stage of sampling involved random selection of citizens in each of 20 selected palikas. Once the palika-level selections were made, respondent lists were sourced and compiled by Solutions for each palika. NORC then generated random numbers for each respondent and sorted on this random number by palika to randomly select 10 respondents per palika, with the remaining respondents designated as replacements to be contacted in order in the event that the selected respondent could not be reached or did not consent to be interviewed.



SAMPLE MUNICIPALITIES FOR THE QUANTIATIVE AND QUALITATIVE DATA

Local Government Officials Survey

Province District Municipality

Province 2 Bara Nijgadh Municipality

Kalaiya Sub-Metro City

Aadarsha Kotwal Rural Municipality

Bishrampur Rural Municipality

Dhanusha Sahidnagar Municipality

Hanspur Municipality

Dhanuji Rural Municipality

Janakpur Sub-Metro City

Mahottari Ekdara Rural Municipality

Loharpatti Municipality

Bardibas Municipality

Bhangaha Municipality

Parsa Chhipaharmai Rural Municipality

Pokhariya Municipality

Jirabhawani Rural Municipality

Paterwa Sugauli Rural Municipality

Rautahat Gaur Municipality

Chandrapur Municipality

Yamunamai Rural Municipality

Gujara Municipality

Saptari Balanbihul Rural Municipality

Rajgadh Rural Municipality

Saptakoshi Municipality

Bodebarsain Municipality

Sarlahi Malangwa Municipality

Ishworpur Municipality

Kaudena Rural Municipality

Parsa Rural Municipality

Bishnu Rural Municipality

Siraha Naraha Rural Municipality

Bariyarpatti Rural Municipality

Lahan Muncipality

Aurahi Rural Municipality



Province District Municipality

Sudurpaschim Achham Sanfebagar Municipality

Dhakari Rural Municipality

Kamalbazar Municipality

Panchadewal Binayak Municipality

Ramaroshan Rural Municipality

Chaurpati Rural Municipality

Baitadi Sigas Rural Municipality

Purchaundi Municipality

Dasharathchand Municipality

Patan Municipality

Bajhang Bungal Municipality

Jayaprithivi Municipality

Bajura Swamikartik Khapar Rural Municipality

Dadeldhura Bhageshwor Rural Municipality

Amargadhi Municipality

Parshuram Municipality

Darchula Mahakali Municipality

Doti Aadarsha Rural Municipality

Kailali Kailari Rural Municipality

Mohnyal Rural Municipality

Tikapur Municipality

Bhajani Municipality

Lamkichuha Municipality

Janaki Rural Municipality

Bardgoriya Rural Municipality

Ghodaghodi Municipality

Godawri Municipality

Kanchanpur Belauri Municipality

Mahakali Municipality

Shuklaphanta Municipality

Laljhadi Rural Municipality

Krishnapur Municipality

Bedkot Municipality



General Citizens Survey

Province District Municipality (Palikas)

Province 2 Bara Bishrampur Rural Municipality

Dhanusha Dhanuji Rural Municipality

Mahottari Loharpatti Municipality

Parsa Chhipaharmai Rural Municipality

Rautahat Gaur Municipality

Saptari Saptakoshi Municipality

Balanbihul Rural Municipality

Sarlahi Malangwa Municipality

Siraha Bariyarpatti Rural Municipality

Lahan Municipality

Sudurpaschim Achham Sanfebagar Municipality

Chaurpati Rural Municipality

Baitadi Dasharathchand Municipality

Dadeldhura Amarghadi Municipality

Bhageshwor Rural Municipality

Kailali Bhajani Municipality

Tikapur Municipality

Kailari Rural Municipality

Kanchanpur Laljhadi Rural Municipality

Belauri Municipality



FGD Municipalities

Province Sample Type Municipality, District

Province 2 General Citizen Birgunj, Parsa

CSO Birgunj, Parsa

CSO Jaleshwor, Mahottari

Private sector partners Birgunj, Parsa

Private sector partners Jaleshwor, Mahottari

Sudurpaschim General Citizen Bhimdatta, Kanchanpur

CSO Dhangadhi, Kailali

CSO Bhimdatta, Kanchanpur

Private sector partners Belauri Municipality-4 Belauri

Dhangadhi, Kailali

Tikapur Municipality-1 Bangaun

Joshipur RM-2, Kailali

Private sector partners Bhimdatta, Kanchanpur

Private sector partners Dhangadhi, Kailali

KIIs – Municipality level

Province Municipality/Palika

Province 2 Tilathi Koiladi Rural Municipality

Bhagwanpur Rural Municipality

Jaleshwor Municipality

Jitpur Simara Sub-Metro City

Birgung Metropolitan City

Maulapur Municipality

Sudurpaschim Dhangadhi Sub-metro

Dipayal Silgadhi Municipality

Shikhar Municipality

Bitthadchiur Rural Municipality

Punarbas Municipality

Bheemdatta Municipality



Map of Sampled Municipalities in Province 2



Map of Sampled Municipalities in Sudurpaschim



ANNEX C: DATA COLLECTION INSTRUMENTS Supply Side Stakeholders

Group I: Supply Side - Mayors/ Deputy Mayors (KII)

RQ1: What are the LGs’ functions with respect to COVID-19 response in Nepal? In particular, what are the roles and responsibilities for municipalities (Palika) and wards (both urban and rural), and what is their cooperation and/or coordination with other levels of government in providing this response?

RQ1.1. In your opinion what are the roles and responsibilities of your Palika in responding to the COVID-19 pandemic?

a. What exactly did you do to address health-related demands like quarantine, testing, tracing, isolation, referrals?

b. How did you prioritize your COVID-19 related responsibilities in relation to your other responsibilities?

RQ1.2. Are you cooperating and/or coordinating with other levels of government for this response? [Interviewer: probe about cooperation and coordination with (i) wards, (ii) provincial and (iii) federal level government health, and security) if not stated by the respondent.]

a. Are you cooperating and/or coordinating with any neighboring Palikas? If yes, please elaborate how you are cooperating/coordinating. If no, why not?

RQ1.3. Do you feel that your Palika was adequately prepared or unprepared to deal with the pandemic?

a. In your opinion, are there any policies that state what steps to take if faced with any pandemic? If not, what kind of policy would be helpful to prepare Palikas to deal with a crisis such as this?

RQ2: What is the capacity of LGs to deliver COVID-19 related services? To what extent does the provision of COVID-19 services inhibit or stress systems related to delivery of other government services? What is the perception of the public towards LGs as they continue to respond to COVID-19?

RQ 2.1. COVID-19 has been a major challenge for some municipalities across the country. It has been almost 9 months (from Chaitra, 2077) that the nation has been coping with this pandemic. Being the government closest to the people, has your Palika faced any challenges in meeting the unexpected health and humanitarian needs of the people? What was your main challenge and how have you been managing this demand all these months?

a. The COVID-19 crisis has changed over time. It will be interesting to know how you handled the problem from the beginning. Please give us examples.



b. We understand that you have three types of responsibilities – the regular institutional work, development work, and COVID-19 related work. How did you prioritize and manage your work?

c. Being a border municipality, you must have had migrant workers entering through your jurisdiction. How did you manage the people who came from abroad—especially those coming from India? [Interviewer: probe to see how the municipality dealt with migrant workers staying in the Palika and those moving through to reach their final destination.]

d. In your opinion, did your Palika have sufficient or insufficient knowledge necessary to deal with your COVID-19 related responsibilities? Please elaborate.

e. How did handling your COVID-19 responsibilities affect your ability to handle your regular responsibilities? Please elaborate.

f. Did you hire additional staff to handle your additional responsibilities? What kind of staff were they? Were they hired to deal with COVID-19 or help with your institutional and/or development responsibilities?

i. Health related staff (like nurse, AHW, etc.)

ii. Accounting

iii. Record keeping

iv. Administration support staff

v. Information communication

vi. Social mobilizer

vii. Other

g. How did you hire them? Did you have to change the existing rules to hire them?

RQ.2.2. How do you feel about your own performance and effectiveness in dealing with the COVID-19 crisis?

a. Are you satisfied with the way you have managed this crisis compared to other emergencies you have dealt with in the past? [Interviewer: only ask this question if there is limited response on the leading question.]

b. Is there anything that you could have done better had you had done it differently?

c. What would you do differently than you did this time, if you had to cope with the similar crisis in the future?

d. What do your citizens say about your performance?

e. What do others (provincial government, federal government, civil society, press, private sector, etc.) say about your performance?



RQ3: In what ways do LGs develop partnerships with other entities, specifically CSOs and the private sector, in the provision of COVID-19 related services? How have LGs engaged the private sector to address how the pandemic affects supply-chains and the various first- and second-order impacts of COVID-19 (impacts across the economy, tourism, agriculture, and food security)?

RQ.3.1. Managing the COVID-19 crisis obviously required additional resources which you had not budgeted for. Let us talk about the pressures regarding financing your COVID-19 related work.

a. As of today, how much has your municipality spent on COVID-19 health related works? This would include public health related problems such as quarantine, masks, health equipment, health staff salaries, and others.

b. How much did you have to spend on relief works like food distribution, cash support, and others so far?

c. Since these expenses must have been much higher than what you had put aside as an emergency budget, how did you meet the gap?

d. Did you have to mobilize contribution from:

i. Private sector

ii. NGOs/ INGOs

iii. Clubs

iv. Community groups

v. Cooperatives

vi. Individuals

e. How did you mobilize them? What was the volume and nature of their contribution? At what point in the crisis were they engaged? [Interviewer: probe for what month and whether it took place during the first lockdown, during prohibitory orders in Kathmandu Valley, or at any other point where government restrictions on citizen movement were in effect.]

f. Which major private sector institutions came forward to make financial and/or material contributions?

g. Did you partner with any CSOs? In what way?

h. Did any international donors (Bilateral donors, INGOs, or individuals) contribute significantly? If so, please tell us who they are and what their role was.

i. Did you receive contributions from any other sources?



RQ4: In terms of finance and financial management, what federal and local government funds have been mobilized and provided for COVID-19 response? What systems of control and transparency have been established? How are funds being used? How has the current local planning process (April-June 2020) of municipalities advanced COVID-19 sensitive plans and budgets for FY 2020/2021? How do these plans target the most vulnerable groups of the communities?

RQ4.1. We would now like to ask you questions about any funding you may have received to deal with the COVID-19 pandemic and how you maintained and tracked your financial accounts and records for these funds.

a. Did you received any funding from the Federal Government? If yes, how much did you receive?

b. Did you receive any funding from the Provincial Government? If yes, how much did you receive?

c. Did you set up different financial records and bookkeeping to manage these funds?

d. Who maintained the accounts? Could your in-house staff do it or did you have to hire more staff?

e. Did you make your accounts public? If you did, how did you make your accounts public and how often?

RQ4.2. Has dealing with the COVID-19 crisis affected your budget, program and priorities for the next year (2078/79)? Please elaborate and explain how or why it has or has not.

a. How do your future budget plans affect the programs targeted for vulnerable sections of the population in your jurisdiction such as dalit, women, children, old and people with disability?

b. Prior to COVID-19, what promises did you make, and how were they affected by COVID-19?

c. Will you still be able to deliver all of the promises that you made before the crisis? If not, what will you drop and what will you reprioritize?

d. How is this crisis going to affect your longer-term goals stated in your Periodic Plan or Integrated Urban Development Plans?

RQ4.3. After dealing with the pandemic this year, are you thinking of establishing any new policies or procedures in your municipality that would prepare you to deal with future public health crisis in the country? Please elaborate.

Wrapping up interview:

a. Would you like to add any points to what we discussed so far?

b. What suggestions do you have for the Federal and Provincial governments regarding responding to COVID-19?



Supply Side Stakeholders

Group II: Supply Side - Federal Government Agencies and Officials (KII)


RQ1.1. Yours is one of the key ministries working with the Municipalities to manage COVID-19 crisis in the country. What role has your Ministry played in managing this crisis? What are your specific responsibilities in dealing with COVID-19?

RQ 1.2. Is your Ministry cooperating and collaborating with other Federal Ministries such as health, education, etc. in responding to the COVID-19 pandemic? Please elaborate.

RQ 1.3. How is your department/Ministry cooperating and coordinating with the Palikas and wards in responding to the COVID-19 crisis?

RQ 1.4. In your opinion, did the Federal Government clearly communicate the roles and responsibilities of the Palika in responding to the COVID-19 crisis? If yes, please elaborate what these roles and responsibilities are and how they were communicated.

a. Did the Federal Government provide additional and sufficient resources to the Palikas to carry out their new COVID-19 related responsibilities? Please elaborate on your opinion. [Interviewer: first probe if additional funds were provided and then if the Federal Government thinks this funding was sufficient or not.]

RQ1.5. Has the federal government provided any guidelines to the local government to incorporate COVID-19 related planning in the next budget?


RQ2.1 In your opinion, how have the municipalities been managing the COVID-19 crisis? Have they been effective?

a. Do you think that local governments were adequately equipped to manage this kind of crisis while delivering regular services to their citizens?

b. Do you see any gaps in their service provision? If so, what are they?

c. Do you think that this experience has made them more mature and confident to tackle this kind of crisis in the future?



d. Do you think this experience is a kind of test for the “federalism implementation” as many people are saying?

e. Do you think municipalities need additional support to enhance their performance? If yes, what kind? If no, please elaborate.

f. What can federal agencies like yours do to support the performance of municipalities?

RQ2.3. After dealing with the pandemic this year, are you thinking of establishing any new policies or procedures in your municipality that would prepare you to deal with future natural disasters or shocks in the country? Please elaborate.


RQ3.2. Are you aware of whether or not the federal government requested support from national or international NGOs in managing the COVID-19 crisis?

a. If so, which organizations were mobilized?

b. Could you describe the nature of the requested support?


RQ4.1. The federal government and Provincial governments have provided funds to the local government bodies to meet the demands of COVID-19. A special COVID-19 fund had been created at the Prime Minister’s office where the government put some money and appealed to others to make contributions.

a. To your knowledge, approximately how much was collected in the national fund?

b. How was this fund then spent?

c. What ratio of this fund was sent to the Local Governments? What was the formulae used to distribute the fund? Did all local governments get an equal amount or did border provinces and Palikas get additional funding to deal with an influx of returning migrants/laborers?

d. What was the mechanism to control the fund? Was it the normal accounting and auditing or any special arrangement was made for this purpose?



RQ4.2. What was the legal procurement mechanism that Local Governments had to follow in using national funds for COVID-19 response? Did they have to follow standard operating practices, or were there different procurement mechanisms? If different, how was this information communicated to the local governments? Could they comply with those requirements? If no, why not? If yes, please explain.

a. There were many allegations of national fund misuse by the Local Government and local implementing agencies. How did you ensure transparency?

b. What mechanism was in place to control leakage and corruption?

c. Was the accounting and auditing mechanism effective to check such leakages? Do you have any examples?

RQ4.3. The newspapers reported cases where national resources were transferred from one budget to another without properly following rules. Is this something common or an exception for COVID-19 response?

a. Has the government prioritized COVID-19 related programs in its new budget for the fiscal year (2020-21)? If yes, please elaborate how. If no, why not?

b. Is the Federal Government supporting the local governments in aligning their programs and budgets towards COVID-19 sensitive planning?

c. What new guidelines is the Federal Government providing to the municipalities to address the needs of most vulnerable groups of society in the next budget?

RQ4.4. After dealing with the pandemic this year, is the Federal Government thinking of establishing any new policies or procedures that would help municipalities deal with future public health crisis in the country? Please elaborate.



b. What suggestions do you have for the Federal, Provincial or Local governments regarding responding to COVID-19?




Group III: Supply Side - Private Sector (FGD)


RQ3.1. When the government instituted the lockdown due to the COVID-19 pandemic in March of 2020, how did it affect your business?

RQ3.2.What measures has your municipality taken to support your business following the lift of the government lockdown? Have they been effective?

a. What measures has your municipality taken to support the community? Have they been effective?

b. How have these measures affected the economy?

RQ3.3. What did the municipality do to reestablish the broken supply chain of products? [Interviewer: Please probe for effects on agriculture and on other industries.]

RQ3.4. What is your impression of your municipality’s mobilization of the private sector during the COVID-19 crisis?

RQ3.5. Did your organization/firm receive any invitation from the municipality to work with them during this crisis?

a. If yes, did you accept the invitation?

b. If yes, what were your organization’s/firm’s responsibilities while working with the municipality? Please list them.

[Interviewer: If the above questions do not yield detailed answers, please ask the following: Was your organization involved with municipality efforts to procure and supply relief materials at any point during the COVID-19 crisis? Did the municipality demand or request your support in building any facilities and isolation centers? Were your organization’s facilities used for COVID-19 relief service provision purposes? If yes, under what terms and conditions were they used?]

RQ3.6. In your opinion, is there increased awareness of partnership opportunities between the municipality and the private sector following the COVID-19 crisis? What are some of these opportunities? Are these areas in which the municipality and private sector can continue to partner? Please tell us more.

RQ3.7. What would you suggest municipalities do to effectively mobilize private sector resources to meet this kind of crisis in the future?


a. Would you like to add any points to what we have discussed so far?

b. What suggestions do you have for the Federal, Provincial, or Local governments regarding responding to COVID-19?




Group IV: Supply Side - Civil Society Organizations (FGD)


RQ3.1. Did municipalities ever invite your organization to collaborate to address the COVID-19 crisis? Was the invitation about some partnership or for something else?

a. If yes, what did the municipality expect from you or your organization?

b. If yes, was your organization able to meet the request/demand that the municipality laid out for you?

RQ3.2. Did your organization contribute any financial, technical, material, human, or other resources to the municipality to support citizens throughout the COVID-19 crisis?

a. If yes, what was the nature of your collaboration?

b. If yes, at what point during the COVID-19 crisis did you engage with them? Do you feel that your engagement was timely or that you should have been engaged sooner?

c. If yes, are you satisfied with the way your organization has partnered with the government?

d. If yes, is this cooperation continuing?

RQ3.3.What would you suggest municipalities do in order to effectively mobilize CSOs during times of crisis?

RQ3.4. Civil society organizations in general have alleged that the State has ignored the role of CSOs and tried to address the crisis alone. Do you feel the same way when it comes to your role to address the crisis within your municipality?

RQ3.5.Experts say that COVID-19 and its effect in society and the economy is likely to remain for some time. What role do you see for your organization in the immediate term in addressing the needs of citizens during the current COVID-19 crisis?

a. What about the role it could play in the longer term?

RQ3.6. What would you suggest for future cooperation between CSOs and the municipality?

RQ3.7. Do you have any other observations that you would like to share regarding the partnership between CSOs and municipalities?


a. Would you like to add any points to what we have discussed so far?




Group V: Supply Side - Implementing Partners (KII)


RQ1.1. What support has your program been providing to municipalities in Province 2 and Province 7 in helping them respond to the COVID-19 pandemic?

RQ1.2. Are you working with the Federal and/or Provincial level government at all regarding COVID-19? If yes, please tell us the nature of your work.

RQ1.3. To your knowledge, are municipalities cooperating and/or coordinating with other levels of government in responding to COVID-19?


RQ2.1. What is your opinion of the municipality’s capacity to serve citizens during the COVID-19 crisis?

a. As far as you know, are municipalities where you are working conducting their normal duties during COVID-19? This would include services like registrations, referrals, relief works, quarantine management, outreach, etc.

b. In your opinion, was there any impact on the municipality’s execution of normal duties or service delivery due to the new services it needed to provide for citizens affected by COVID-19?

i. If there was, could you please describe how these normal services were impacted?

c. Were special services and resources provided to citizens affected by COVID-19?

i. If so, how were these supports provided? Did it involve home visits by the municipality?

d. In your opinion, did the municipality provide sufficient support to its citizens?

i. Do you feel that the support could have been improved at all?

ii. How do you feel that this support compares to neighboring municipalities and wards?




RQ3.1. Has your municipality mobilized NGOs, Community Organizations, and private businesses to provide COVID-19 services? [Interviewer: probe to ask about each type of organization separately.]

a. To your knowledge, has your municipality received any support from NGOs, Community Organizations, or private businesses?

i. If yes, what kind of support has it received? Cash support, relief package, health related like ambulance, hospital expenditure, outreach, COVID-19 messaging, or any other support?

ii. If yes, could you provide the name of these organizations?

iii. If yes, at what point did these organizations start providing support? Is their support still ongoing?

RQ4: In terms of finance and financial management, what federal and local government funds have been mobilized and provided for COVID-19 response? What systems of control and transparency have been established? How are funds being used? How?

RQ4.1. Local governments have received financial support to deal with COVID-19 related health and economic issues from the Federal Government as well as from provincial governments in various installments. They have also added their own resources to meet the demand. How did your municipality do?

a. Are you aware of any government funds that have been earmarked for returnee migrants?

b. Do you know how much the Municipality has received from the Federal and Provincial government so far to deal with COVID-19?

c. Are you aware how much each ward received and for what purpose?

d. Do you know how the amounts were spent?

e. Were any of the budget meant for vulnerable sections of the population diverted or reduced to meet other demands? Do you have any examples?







Group VI: Supply Side - Donor (KII)


RQ1.1. What is your general impression of the performance of municipalities in responding to COVID-19?

a. How has your program provided COVID-19 related assistance to the citizens of the municipalities you operate in?

b. Have the municipalities served by your program cooperated with other municipalities or with other levels of government?

i. If yes, could you describe the nature of this cooperation using your own observations?

c. Do you think your program’s assistance has had any impact on the performance and COVID-19 response of the municipalities you operate in?

d. Do you think your program’s assistance has had any impact on the coordination and cooperation that has taken place between the municipality and other levels of government in responding to COVID-19?


RQ2.1. As you may be aware, the municipality you operate in had to deal with the challenge of addressing the COVID-19 crisis alongside its normal duties. How has the municipality balanced these two challenges?

a. As far as you know, are the municipalities that you assist conducting their normal duties during COVID-19? This would include services like registrations, referrals, relief works, etc.

b. In your opinion, was there any impact on the municipality’s execution of normal service delivery duties due to the new services it needed to provide for citizens affected by COVID-19?

i. If there was, could you please describe how these normal services were impacted?

c. Were special services and resources provided to citizens affected by COVID-19?



i. If so, how were these supports provided? Did it involve home visits by the municipality?

d. In your opinion, did the municipality provide sufficient support to its citizens?

i. Do you feel that the support could have been improved at all?

ii. How do you feel that this support compares to neighboring municipalities and wards?


RQ3.1. What is your opinion of the municipality’s efforts to mobilize the private sector for COVID-19 aid support? What about the efforts of the ward, provincial, and federal government in their mobilization of the private sector?

a. What is the private sector’s role in supporting government efforts to manage the COVID-19 crisis?

b. In general, do you think that there is anything that municipalities could do to improve private sector mobilization of resources for future crises?

RQ3.2. Are you aware of whether or not the federal government requested support from national or international NGOs in managing the COVID-19 crisis?

a. If so, which organizations were mobilized? Was USAID included?

b. If USAID was asked to support government efforts, could you describe the nature of the requested support? For example, was USAID asked to build facilities, distribute medicine or personal protective equipment, etc.?

RQ3.3. How has your organization supported municipal efforts to manage the COVID-19 crisis?

a. In your opinion, do you think that the municipality is more or less likely to partner with international organizations, NGOs, and the private sector after the COVID-19 crisis?

RQ4: In terms of finance and financial management, what federal, provincial and/or local government funds have been mobilized and provided for COVID-19 response? What systems of control and transparency have been established? How are funds being used? How has the current local planning process (April-June 2020) of municipalities advanced COVID-19 sensitive plans and budgets for FY 2020/2021? How do these plans target the most vulnerable groups of the communities?



RQ4.1. Local governments have received funds to deal with COVID-19 related health and economic issues from the Federal Government as well as from provincial governments. They have also added their own resources to meet the demand. How did your municipalities do?

a. Have municipalities supported by your organization received any support from provincial and federal governments to manage the COVID-19 crisis?

i. If so, what kinds of support?

b. How did the municipality provide services and resources to COVID-19 affected citizens?

i. At what point during the crisis was support provided? Is it still ongoing?

c. Are you aware of any financial consequences that the municipality experienced as a result of COVID-19 support provision?

d. Do you feel that the municipality has been transparent about how it is spending and distributing resources for the COVID-19 crisis?






Demand Side Stakeholders

Group I: Demand Side – General Citizens (FGD)


RQ1.1. The federal and provincial government have entrusted local governments to meet the COVID-19 related health concerns and needs of the general population. How has your municipality served its citizens in this respect?

a. Are you aware of any services or resources that the government has provided in response to the COVID-19 crisis?

i. If yes, could you share some of the things the government has done? Please speak about any efforts it has undertaken to provide quarantine centers, make virus tests available to the public, provide personal protective equipment to the public, etc. If known, please identify what level of government provided the type of support.

ii. If yes: To your knowledge, what levels of government are providing these resources?

b. Are you satisfied with the performance of your municipality with regards to its response to the COVID-19 pandemic?

c. Do you have any suggestions for how your local government could change their public health crisis response in the future?


RQ 2.1. As you may be aware, your municipality had to deal with the challenge of addressing the COVID-19 crisis alongside its normal duties. How has your municipality balanced these two challenges?

a. As far as you know, did your municipality conduct its normal duties during COVID-19? This would include services like registrations, referrals, relief works, etc.

b. Did you ever attempt to request a normal service from the municipality during the COVID-19 crisis? Again, this would include services like registrations, referrals, relief works, etc.

i. If yes, what was your experience like?




RQ. 3.1. How did the government mobilize NGOs, CSOs, and the private sector to deal with COVID-19 in your municipality? [Interviewer: be sure to ask separately about the mobilization and support provided by each of the three types of organizations—NGOs, CSOs and the private sector.]

a. Did you receive any support from NGOs, private individuals, or private firms in this crisis?

i. If yes, what kind of support did these parties provide you? For example, medicine, personal protective equipment, food assistance, cash, or other kinds of support.

b. In your opinion, could your municipality have done more to cooperate with the private sector and NGOs/CSOs and provide COVID-19 related services to citizens? If, yes, what specifically could have been done?


RQ4.1. Local governments have received funds to deal with COVID-19 related health and economic issues from the Federal Government as well as from provincial governments in various installments. They have also added their own resources to meet the demand. How did your municipality spend the resources?

a. Are you aware of any funding received by your Palika to handle COVID-19 related health and economic issues? If yes, how did you learn about this?

b. Do you have any knowledge about how your municipality spent those resources? If yes, how did you learn about this?

c. Did you know where you could go and what was available to you as a citizen in terms of medical, financial, and other kinds of government-supplied services and resources?

i. What kinds of resources were being distributed?

d. Are citizen needs and priorities being taken into account by the municipality during the COVID-19 crisis? How? What are some of the things the municipality did that you are aware of to address your needs during this crisis?






Online and Telephone Survey for Nepal Covid-19 Study

Survey of Citizens (November 2020)

Hello, my name is XXXX. I am calling from Solutions Ltd., a market research, survey, data collection and consulting firm based in Kathmandu, Nepal. We are helping NORC, a research center associated with the University of Chicago in the US, conduct an independent survey on behalf of USAID to learn about the Nepali government’s response to the COVID-19 pandemic.

The primary goal of this study is to explore the effectiveness of local governments in addressing the COVID-19 crisis at the local level. Findings are intended to inform USAID’s existing activities, future program designs, as well as their development strategy in Nepal.

This survey should take no more than 15 minutes to complete. Your participation in this survey is voluntary and you will not get paid for participating. If you are unable to answer a question, you may skip it or even stop the survey at any time; this will have no negative consequences for you. However your feedback will be very useful and help design future USAID programs in Nepal. Your response will be kept confidential and anonymous. The information you provide will be used in summary form only, and will not identify you as a participant of this survey.

If you have questions or need assistance in any way, please e-mail Dipa Shrestha, Senior Associate and Survey Manager at Solutions Ltd., at [email protected] or call her at 9801159251 so that we may assist you. Thank you very much for your participation.

(consent) Do you agree to participate in this survey?

(1) Yes [SKIP TO Q1]

(2) No

(refused_oe) [Only ask if Consent=No] If you are comfortable, would you please explain why you would not like to participate in the survey? ___________________________________________________ END SURVEY




Thank you for agreeing to participate. I will n

ow ask you a few questions about yourself.

(Q1) What is your gender?

(1) Male

(2) Female

(3) Other

(Q2) Which of the following best describes your occupation? [Enumerator please listen closely to the answer and code based on the response].

(1) Fishing

(2) Farming

(3) Agricultural/Fishing wage labor

(4) Non-Agricultural/Non-fishing manual worker/laborer (e.g. construction, stone cutting, mining etc.)

(5) Private sector/NGO/INGO employee, not requiring higher education (e.g. clerk, restaurant server, factory worker)

(6) Private sector/NGO/INGO employee, requiring higher education (e.g. manager, consultant, director etc.)

(7) Skilled Professional, not requiring higher education (e.g. barber, beautician, mechanic, driver, plumber, carpenter etc.)

(8) Skilled Professional, requiring higher education (e.g. doctor, engineer, teacher, lawyer etc.)

(9) Entrepreneur/Personal business (e.g. hotel, restaurant owner, shopkeeper)

(10) Religious worker

(11) Government civil servant

(12) Artist (actor, sculpting, painting, wood carving etc.)

(13) Armed forces/military

(14) Police

(15) Housekeeper (for pay)

(16) Housework (for own home)

(17) Foreign Employment



(18) Other, please specify:

(Q3) How long have you lived in the palika/gaupalika in which you currently reside?

(1) 0-12 months (recently moved)

(2) 7-12 months

(3) 1-2 years [SKIP TO Q6]

(4) 3-5 years [SKIP TO Q6]

(5) More than 5 years [SKIP TO Q6]

(Q4) [Ask if Q3=1 or 2] Where did you move from?

(1) Another municipality within this district in Nepal

(2) Another municipality outside of this district in Nepal

(3) India

(4) China

(1) Other, please specify: ______________ [OPEN-ENDED]

(Q5) [Ask if Q3=1 or 2] Did you move to this palika/gaupalika because of the Covid-19 crisis?

(1) Yes, please specify reason: ______________ [OPEN-ENDED]

(2) No

Now I will ask some questions about the government’s response to the Covid-19 crisis.

(Q6) Are you aware of any services or resources that the federal, provincial or municipal government has provided to this community in response to the Covid-19 crisis?

(1) Yes

(2) No [SKIP TO Q11]

(Q7) [Ask if Q6=1] To your knowledge, what has the government done in response to the COVID-19 crisis? [Enumerator please listen closely to the answers and code based on the response].

(1M) Provided quarantine centers

(2M) Arranged for/provided isolation centers

(3M) Made PCR tests available to the public

(4M) Performed contact tracing



(5M) Provided personal protective equipment (PPE) or masks to the public

(6M) Issued guidance or mandates for people to wear masks

(7M) Issued guidance or mandates for lockdowns

(8M) Issued guidance or mandates for quarantine

(9M) Issued guidance or mandates for isolation

(10M) Provided special unemployment benefits

(11M) Provided special tax relief, loans, or other economic stimulus

(12M) Provided food assistance

(13M) Provided clothes/blankets etc.

(14M) Provided transportation facilities (to reach home from the border etc.)

(15M) Imposed limits on gatherings over a certain size

(16M) Imposed other social distancing norms

(17M) Imposed limits on local travel

(18M) Imposed limits on international travel

(19M) Sanitizing/Disinfecting certain areas/locations

(20M) Conducted Awareness/sensitization programs

(21M) Mike broadcast about the risks of the disease and measures to prevent transmission

(22M) Provided hygiene and sanitation materials/kits (water tanks, sanitizer booths, soaps, disinfectants, sanitizers etc.)

(23M) Constructed COVID hospitals

(96M) Other, please specify: ____________ [OPEN-ENDED]

(Q8) [Ask if Q6=1] How did you learn what was available to you as a citizen in terms of medical, financial, and other kinds of government-supplied services and resources?

(1) Newspapers

(2) Radio

(3) Internet/social media

(4) Public sign postings

(5) Through community friends/neighbours



(6) Mike broadcast

(96) Other, please specify: ________________ [OPEN-ENDED]

(Q9) Did you receive any assistance from the government during this crisis?

(1) Yes


(Q10) [Ask if Q9=1] What type of assistance did you receive? Please select all that apply.

(1M) Stayed in government quarantine facility

(2M) Stayed in government isolation center

(3M) Received PCR test

(4M) Received medicine

(5M) Received personal protective equipment (PPE) or mask(s)

(6M) Received special unemployment benefits

(7M) Received special tax relief, loans, or other economic stimulus

(8M) Received food assistance

(9M) Received clothes/blankets etc.

(10M) Received transportation facilities (to reach home from the border etc.)

(11M) Received hygiene and sanitation materials/kits (soaps, disinfectants, sanitizers etc.)

(12M) Received transportation facilities


(Q11) [Ask if Q9=1] Are you satisfied with the assistance you received from the government?

(1) Very satisfied

(2) Somewhat satisfied

(3) Somewhat dissatisfied

(4) Very dissatisfied



Now I will ask some questions specifically about your municipality’s’s response to the Covid-19 crisis and its ability to fulfill its mandates and duties during this time.

(Q12) Generally speaking, are you satisfied with the performance of your municipality with regards to the Covid-19 crisis?

(1) Very satisfied




(Q13) To your knowledge, did the government collect any information from citizens about their needs during the Covid-19 crisis?

(1) Yes, specify: ___________ [OPEN-ENDED]

(2) No

(Q14) Would you say your municipality appropriately took the needs and priorities of the citizens into consideration during the Covid-19 crisis?

(1) Strongly agree

(2) Agree

(3) Disagree

(4) Strongly disagree

(Q15) Do you have any suggestions for how your municipality could change their public health crisis response in the future? [ALLOW 2 RESPONSES]

____________________________________________________ [OPEN-ENDED]

____________________________________________________ [OPEN-ENDED]

(Q16) As far as you know, was your municipality able to fulfill its mandates and duties during COVID-19? This would include services like registrations, referrals, and relief or local development works.

(1) Yes

(2) No

(98) Not sure

(Q17) Did you ever attempt to request any services from the municipality during the COVID-19 crisis? If so, what services? Please select all that apply.



(1M) Registration

(2M) Referral

(3M) Relief or local development works

(4M) Request for a Pass (to move around during the lockdown period)

(5M) Birth or death certificate

(6M) Licenses

(7M) Payment of fees


(1) No, did not request any normal services during the crisis [SKIP TO Q18]

(Q18) [Ask if Q17!=0] Was your attempt successful? Please provide a few details about your experience.

(1) Yes, please specify: ____________ [OPEN-ENDED]

(2) No, please specify: _____________ [OPEN-ENDED]

Thank you for your responses. Now I would like to ask just a few more questions about assistance you may have received from entities other than the government.

(Q19) Did you receive assistance from non-governmental organizations (NGOs), private individuals, or private firms in this crisis? Please select all that apply.

(1M) NGO

(2M) Private individuals

(3M) Private firms

(96) None of these [SKIP TO Q21]

(98) Do not know [SKIP TO Q21]

(Q20) [Ask if Q19!=96 and Q19!=98] What type of assistance did you receive from these entities? Please select all that apply.

(1M) Stayed in a non-governmental/private quarantine facility

(2M) Stayed in a non-governmental/private isolation center

(3M) Received PCR test





(6M) Received cash assistance

(7M) Received loan(s)

(8M) Received food assistance

(9M) Received hygiene and sanitation materials/kits (soaps, disinfectants, sanitizers, sanitary pads for women etc.)

(10M) Received clothes/blankets etc.

(11M) Received transportation facilities


(Q21) Are you satisfied with the assistance you received?

(5) Very satisfied




(Q22) In your opinion, could your municipality have done more to cooperate with the private sector and NGOs/CSOs to provide COVID-related services to citizens? If so, what specifically could have been done?


(2) No

Thank you very much. This concludes our interview.



Online and Telephone Survey for Nepal Covid-19 Study

Survey of LG Officials (November 2020)

Hello, my name is XXXX. I am calling from Solutions Ltd., a market research, survey, data collection and consulting firm based in Kathmandu, Nepal. We are helping NORC, a research center associated with the University of Chicago in the US, conduct an independent survey on behalf of USAID to learn about the Nepali government’s response to the COVID-19 pandemic.

The primary goal of this study is to explore the effectiveness of local governments in addressing the COVID-19 crisis at the local level. Findings are intended to inform USAID’s existing activities, future program designs, as well as their development strategy in Nepal.

This survey should take no more than 15 minutes to complete. Your participation in this survey is voluntary and you will not get paid for participating. If you are unable to answer a question, you may skip it or even stop the survey at any time; this will have no negative consequences for you.. However your feedback will be very useful and help design future USAID programs in Nepal. Your response will be kept confidential and anonymous. The information you provide will be used in summary form only, and will not identify you as a participant of this survey.

If you have questions or need assistance in any way, please e-mail Dipa Shrestha, Senior Associate and Survey Manager at Solutions Ltd., at [email protected] so that we may assist you. Thank you very much for your participation.

(consent) Do you agree to participate in this survey?

(3) Yes [SKIP TO Q1]

(4) No

(refused_oe) [Only ask if Consent=No] If you are comfortable, would you please explain why you would not like to participate in the survey? ___________________________________________________ END SURVEY




Thank you for agreeing to participate. I will now ask you a few questions about yourself.

(Q23) Which of the following best describes your role within your Palika?

(1) Mayor

(2) Deputy Mayor

(3) Chief Administration Officer

(4) Other, please specify: _______ [OPEN-ENDED]

(Q24) How long have you served in your current role?

(5) Less than 6 months

(6) 6 months to a year

(7) 1-2 years

(8) 3-5 years

(9) More than 5 years

Now I will ask some questions about your Palika’s response to the Covid-19 crisis and challenges you may have encountered.

(Q25) According to your understanding, what are the roles and responsibilities of your Palika in responding to the Covid-19 crisis? [Enumerator please listen closely to the answers and code based on the response]..

(1M) Screening for every individual entering our palika for their health condition

(2M) Providing quarantine centers

(3M) Arranging for/provided isolation centers

(4M) Making tests available to the public

(5M) Performing contact tracing

(6M) Providing personal protective equipment (PPE) or masks to the public

(7M) Issuing guidance or mandates for people to wear masks

(8M) Issuing guidance or mandates for lockdowns

(9M) Issuing guidance or mandates for quarantine

(10M) Issuing guidance or mandates for isolation

(11M) Providing special unemployment benefits



(12M) Providing special tax relief, loans, or other economic stimulus

(13M) Providing food assistance

(14M) Providing clothes/blankets etc.

(15M) Providing transportation facilities (to go home from the border etc.)

(16M) Imposing limits on gatherings over a certain size

(17M) Imposing other social distancing norms

(18M) Imposing limits on local travel

(19M) Imposing limits on international travel


(21M) Conducting Awareness/sensitization programs

(22M) Miking about the risks of the disease and measures to prevent transmission

(23M) Providing hygiene and sanitation materials/kits (water tanks, sanitizer booths, soaps, disinfectants, sanitizers etc.)

(24M) Constructing COVID hospitals


(Q26) Which of the following has your Palika done in response to the Covid-19 crisis? [Enumerator please listen closely to the answers and code based on the response].

(1M) Screening for every individual entering our palika for their health condition

(2M) Providing quarantine centers

(3M) Arranging for/provided isolation centers

(4M) Making tests available to the public

(5M) Performing contact tracing

(6M) Providing personal protective equipment (PPE) or masks to the public

(7M) Issuing guidance or mandates for people to wear masks

(8M) Issuing guidance or mandates for lockdowns

(9M) Issuing guidance or mandates for quarantine

(10M) Issuing guidance or mandates for isolation

(11M) Providing special unemployment benefits



(12M) Providing special tax relief, loans, or other economic stimulus

(13M) Providing food assistance

(14M) Providing clothes/blankets etc.

(15M) Providing transportation facilities (to go home from the border etc.)

(16M) Imposing limits on gatherings over a certain size

(17M) Imposing other social distancing norms

(18M) Imposing limits on local travel

(19M) Imposing limits on international travel


(21M) Conducting Awareness/sensitization programs

(22M) Miking about the risks of the disease and measures to prevent transmission

(23M) Providing hygiene and sanitation materials/kits (water tanks, sanitizer booths, soaps, disinfectants, sanitizers etc.)

(24M) Constructing COVID hospitals


(Q27) Did your Palika hire additional manpower to handle the crisis response?

(1) Yes

(2) No [Skip to Q8]

(Q28) [If Q5=1] What kinds of staff were hired?

(1M) Health related staff

(2M) Accounting

(3M) Record keeping

(4M) Administration support staff

(5M) Information communication

(6M) Social mobilizer


(Q29) [If Q5=1] Did your Palika need to change an existing rule to make these additional hires?



(1) Yes

(2) No

(Q30) What would you say have been the greatest challenges in meeting the unexpected health and humanitarian needs of the people? Select up to three.

(1) Lack of resources

(2) Lack of guidance from the national government

(3) Return of migrants from India who lost employment due to Covid-19

(4) Screening and management of the returnee migrants

(5) Management of Isolation centers/quarantine centers

(6) Fear of own health and well-being

(7) Lack of awareness amongst people

(8) Lack of proper coordination between the various government levels

(96) Other, please specify: ____________ [OPEN-ENDED]

(Q31) Has responding to the Covid-19 pandemic affected other regular service delivery in your Palika?

(1) Yes


(Q32) How have other services been affected due to your response and spending on the Covid-19 pandemic? [Enumerator please listen closely to the answers and then code based on the response].

(1) Unable to undertake capital improvement

(2) Unable to pay salaries of staff

(3) Had to lay-off staff

(4) Had to postpone skill development activities planned for the locals

(5) Had to postpone trainings on income-generating activities planned for the locals

(6) Unable to carry out repair and maintenance activities on time

(7) Unable to invest in infrastructure development at community level

(8) Unable to bring about reforms in the health and education sector as planned

(9) Unable to carry out regular administrative duties (registration, referrals etc.)



Now I will ask some questions about your Palika’s coordination with other governmental and non-governmental entities.

(Q33) Has your Palika cooperated and/or coordinated with other levels of government for this response? Please select all that apply.

(1M) Federal Government

(2M) Provincial Government

(3M) District Coordination Committee

(4M) Neighboring Palikas

(5M) Wards in your Palika



(Q34) [Display as a table and enter responses for each entity selected in Q11] What type of assistance did you receive from each of these entities? [Enumerator please listen closely to the answers and then code based on the response. Please select all that apply.]

(12M) Received virus tests



(15M) Received direct funding

(16M) Collaborated on crisis response

(17M) Collaborated on mobilization of labor resources


(Q35) Managing the Covid-19 crisis obviously required additional resources which you had not budgeted for. Has your palika cooperated and/or coordinated with any non-governmental entities? Please select all that apply.

(1M) Private Sector, please specify: ________ [OPEN-ENDED]

(2M) NGOs: ________ [OPEN-ENDED]

(3M) INGOs: ________ [OPEN-ENDED]

(4M) Donors

(5M) Civil Society Organization

(6M) Private individuals





(Q36) [Display as a table and enter responses for each entity selected in Q13] What type of assistance did you receive from each of these entities? Please select all that apply.

(1M) Received virus tests



(4M) Received direct funding

(5M) Collaborated on crisis response

(6M) Collaborated on mobilization of labor resources

(7M) Collaborated on collecting information about affected citizens and demands


(Q37) Are you satisfied with the assistance you received?

(9) Very satisfied




Now I will ask your thoughts about your Palika’s performance in dealing with the Covid-19 crisis as well as any feedback you have received from external parties.

(Q38) Have you received feedback from citizens on your Palika’s performance in handling the Covid-19 crisis? If so, has this feedback generally been positive or negative?

(1) All positive

(2) Mostly positive

(3) Mixed

(4) Mostly negative

(5) All negative

(97) N/A – Have not received feedback from citizens



(Q39) Have you received feedback from the Federal or Provincial government on your Palika’s performance in handling the Covid-19 crisis? If so, has this feedback generally been positive or negative?

(1) All positive

(2) Mostly positive

(3) Mixed

(4) Mostly negative

(5) All negative

(97) N/A – Have not received feedback from Federal or Provincial government

(Q40) Have you received feedback from CSOs in your community on your Palika’s performance in handling the Covid-19 crisis? If so, has this feedback generally been positive or negative?

(6) All positive

(7) Mostly positive

(8) Mixed

(9) Mostly negative

(10) All negative

(98) N/A – Have not received feedback from CSOs

(Q41) Is there anything that you or your palika could have done better had you done it differently? If so, what would you do differently than you did this time, if you had to cope with a similar crisis in the future?


(2) No

Thank you very much for your time. This concludes our interview.



ANNEX D: SOURCES OF INFORMATION

KEY INFORMANTS

Kathmandu KIIs

Organization Respondent Name(s) Title

Government/ MOFAGA Bishnu Gautam Joint Secretary

Government/ MOFAGA Gopi Khanal Joint Secretary

Government/ MOHP Dr. Mahendra Shrestha Chief Specialist, Public Health

Association/ MUAN CSOs (Semi) Kala Nidhi Devkota Executive Director

Association/ NARMIN (Semi) Bimal Pokharel Executive Director

NGO Sudip Pokharel Officer

GIZ (Donor) Sewa Shrestha Deputy Country Project Manager

SDC (Donor) Prakash Regmi Officer

USAID (Donor) Nur Pant, Reshma Thapa, David Isaak, Sushil Poudel, Bishwas Rana, Ramesh Adhikari

Group of officers

DAI (IP) Tammie Harris Chief of Party

FHI 360 (IP) John Tyynela Chief of Party

Abt Associates (IP) Mark Pommerville Chief of Party

Province Level KIIs

Province Title Respondent Name

Province 2 Director Bijaya Kumar Jha

Province 2 Chief SDD Dev Kumari Khatri

Province 2 Secretary MOSD Krishna Prasad Kapri

Sudurpaschim Focal Person - COVID-19 Division Hemraj Joshi

Sudurpaschim Senior Health Officer Narendra Singh Karki

Sudurpaschim Secretary MOSD Raghu Ram Bist



Municipality Level KIIs

PROVINCE MUNICIPALITY TITLE RESPONDENT NAME

Province 2 Bhagwanpur Rural Municipality Mayor Bechan Prasad Yadav

Province 2 Birgung Metropolitan City Mayor Bjaya Sarabgi

Province 2 Jaleshwor Municipality Mayor Ram Shankar Mishra

Province 2 Jitpur Simara Sub-Metropolitan City Mayor Krishna Prasad Paudel

Province 2 Maulapur Municipality Deputy Mayor Gauri Shankar Prasad

Province 2 Tilathi Koiladi Rural Municipality Mayor Satish Kumar Singh

Sudurpaschim Bheemdatta Municipality Mayor Surendra Bista

Sudurpaschim Bitthadchiur Rural Municipality Chairman Prem Bdr. Bohora

Sudurpaschim Dhangadhi Sub-Metropolitan City Deputy Mayor Sushila Mishra Bhatta

Sudurpaschim Dipayal Silgadhi Municipality Mayor Manju Malasi

Sudurpaschim Punarbas Municipality Mayor Jiwan Raj Thapa

Sudurpaschim Shikhar Municipality Mayor Sitaram Joshi

DOCUMENTS REVIEWED

CONSTITUTIONAL RIGHTS AND LOCAL GOVERNMENT’S OPERATION ACT 2074

SCHEDULE-7

(Relating to clause (3) of Articles 57, Article 109, clause (4) of Article 162, and Article 197)

List of Concurrent Powers of Federation and State

S.N. Matters

1. Civil and criminal procedure, evidence and oaths (legal recognition, public acts and records, and judicial proceedings)

2. Supply, distribution, price control, quality and monitoring of essential goods and services

3. Preventive detention for reasons connected with the security of the country, prison and detention management, and maintenance of peace and order

4. Transfer of accused persons, detainees and prisoners from one State to another State



S.N. Matters

5. Laws relating to family affairs (marriage, transfer of property, divorce, persons on the verge of extinction, orphan, adoption, succession and joint family)

6. Acquisition, requisitioning of property and creation of right in property

7. Contracts cooperatives, partnership and agency related matters

8. Matters relating to bankruptcy and insolvency

9. Drugs and pesticides

10 Planning, family planning and population management

11. Social security and employment, trade unions, settlement of industrial disputes, labour rights and disputes related matters

12. Legal profession, auditing, engineering, medicines, Ayurvedic medicines, veterinary, Amchi and other professions

13. State boundary river, waterways, environment protection, biological diversity

14. Matters related to means of communication

15. Industries and mines and physical infrastructures

16. Casino, lottery

17. Early preparedness for, rescue, relief and rehabilitation from, natural and man-made calamities

18. Tourism, water supply and sanitation

19 Motion pictures, cinema halls and sports

20. Insurance business operation and management

21. Poverty alleviation and industrialization

22. Scientific research, science and technology and human resources development

23. Utilization of forests, mountains, forest conservation areas and waters stretching in inter-State form

24. Land policies and laws relating thereto

25. Employment and unemployment benefit



SCHEDULE-8

(Relating to clause (4) of Article 57, clause (2) of Article 214, clause (2) of Article 221 and clause (1) of Article 226)

List of Local Level Power

S.N. Matters

1 Town police

2. Cooperative institutions

3. Operation of F.M

4. Local taxes (wealth tax, house rent tax, land and building registration fee, motor vehicle tax), service charge, fee, tourism fee, advertisement tax, business tax, land tax(land revenue), penalty, entertainment tax, land revenue collection

5. Management of the local services

6. Collection of local statistics and records

7. Local level development plans and projects

8. Basic and secondary education

9. Basic health and sanitation

10 Local market management, environment protection and bio-diversity

11. Local roads, rural roads, agro-roads, irrigation

12. Management of Village Assembly, Municipal Assembly, District Assembly, local courts, mediation and arbitration

13. Local records management

14. Distribution of house and land ownership certificates

15. Agriculture and animal husbandry, agro-products management, animal health, cooperatives

16. Management of senior citizens, persons with disabilities and the incapacitated

17. Collection of statistics of the unemployed

18. Management, operation and control of agricultural extension

19 Water supply, small hydropower projects, alternative energy

20. Disaster management

21. Protection of watersheds, wildlife, mines and minerals

22. Protection and development of languages, cultures and fine arts



SCHEDULE-9

(Relating to clause (5) of Article 57, Article 109, clause (4) of Article 162, Article 197, clause (2) of Article 214, clause (2) of Article 221, and clause (1) of Article 226)

List of Concurrent Powers of Federation, State and Local Level

S.N. Matters

1. Cooperatives

2. Education, health and newspapers

3. Health

4. Agriculture

5. Services such as electricity, water supply, irrigation

6. Service fee, charge, penalty and royalty from natural resources, tourism fee

7. Forests, wildlife, birds, water uses, environment, ecology and bio-diversity

8. Mines and minerals

9. Disaster management

10. Social security and poverty alleviation

11. Personal events, births, deaths, marriages and statistics

12. Archaeology, ancient monuments and museums

13. Landless squatters management

14. Royalty from natural resources

15. Motor vehicle permits

SECTION 11 UNDER THE ROLES AND RESPONSIBILITIES AND AUTHORITY OF THE VILLAGE ASSEMBLY/MUNICIPALITY

(9) Basic Health and sanitation

a. Implementation and regulation of policies, laws, criteria and development of plans on basic health and sanitation

b. Conduction and promotion of basic health services c. Establishment and operation of hospitals and other health institutions d. Health service-related physical infrastructure development and management e. Control and regulation of healthy drinking water, quality food products and sound

pollution f. Increasing awareness on sanitation



g. Determination and regulation of service charge for healthy waste collection, recycling, processing and disposal

h. Blood circulation service and local/urban health service conduction i. Coordination, collaboration and partnership with private and non-government sectors

for sanitation and healthy waste management j. Regulating chemical and harmful wastes management k. Reproductive health, family planning and maternal child welfare l. Establishing services in order to minimise, control and prevent current particulate and

protein deficiency related malnutrition among women and children m. Establishment and regulation of pharmacies

SECTION 11 (22) (B) AS PER THE SCHEDULE 9 OF THE CONSTITUTION

Health

a. Health related target and quality control at the local level to be based upon federal and state Level targets and criteria

b. Local level clinic registration, giving permission for operation and regulation of general hospitals, nursing homes, diagnosis centers and other health institutions

c. Local level production, treatment and distribution of traditional herbs and other medicinal items

d. Management of health insurance along with other social security programmes e. Minimum price determination and its regulation on medicines and other medical items at

the local level f. Right use of medicines and medicines and Antimicrobial Resistance minimization at the

local level g. Purchase, warehousing and distribution of medicines and health equipment at the local

level h. Health information mechanism to be established at the local levels i. Public health surveillance at the local level j. Local level promotion of health services along with counteractive, medicinal,

reestablishment of health services and palliative health service operation k. Promoting healthy lifestyle, nutrition, physical exercise, yoga, to stay healthy by following

healthy habits and promotion of public health services l. Control and management of zoonotic and pathogenic diseases m. Control the use of and increasing awareness on tobacco, alcohol and other drugs n. Promotion and management of ayurvedic, homeopathy, natural healing methods along

with other traditional treatment services. o. Planning and implementation for public health, emergency health services along with

control of epidemics p. Prevention and control of disease q. Management of emergency health services flow and local services



ANNEX E: DISCLOSURE CONFLICTS OF INTEREST

Name

Title

Organization

Evaluation Position? Team Leader Team member

Evaluation Award Number (contract or other instrument)

USAID Project(s) Evaluated (Include project name(s), implementer name(s) and award number(s), if applicable)

I have real or potential conflicts of interest to disclose. Yes No

If yes answered above, I disclose the following facts: Real or potential conflicts of interest may include, but are not limited to: 1. Close family member who is an employee of the USAID operating

unit managing the project(s) being evaluated or the implementing organization(s) whose project(s) are being evaluated.

2. Financial interest that is direct, or is significant though indirect, in the implementing organization(s) whose projects are being evaluated or in the outcome of the evaluation.

3. Current or previous direct or significant though indirect experience with the project(s) being evaluated, including involvement in the project design or previous iterations of the project.

4. Current or previous work experience or seeking employment with the USAID operating unit managing the evaluation or the implementing organization(s) whose project(s) are being evaluated.

5. Current or previous work experience with an organization that may be seen as an industry competitor with the implementing organization(s) whose project(s) are being evaluated.

6. Preconceived ideas toward individuals, groups, organizations, or objectives of the particular projects and organizations being evaluated that could bias the evaluation.

I certify (1) that I have completed this disclosure form fully and to the best of my ability and (2) that I will update this disclosure form promptly if relevant circumstances change. If I gain access to proprietary information of other companies, then I agree to protect their information from unauthorized use or disclosure for as long as it remains proprietary and refrain from using the information for any purpose other than that for which it was furnished.

Signature

Date

U.S. Agency for International Development

1300 Pennsylvania Avenue, NW

Washington, DC 20523