Why Nepal lags in COVID-19 testing

Not only did Nepal’s health authorities buy the wrong test kits for hugely inflated prices at the beginning of the lockdown, an investigation has shown that even the more accurate testing machines it ordered were faulty.

The government had come under criticism for ordering unreliable Rapid Diagnostic Tests (RDT) instead of real time Polymerase Chain Reaction (PCR) assays, but it has emerged that many of the PCR machines imported in March are not being used anymore because they gave faulty results.

The Department of Health Services purchased five portable Real-time PCR machines through the private contractor Omni Business Corporative International (OBCI), the company was dragged into  controversy in April for a large order of medical equipment and test kits from China that were found to be overpriced.

Documents show that the government spent Rs12 million in buying the portable PCR machines at Rs2.1 million each, as well as 50,000 reagent kits for an additional Rs218 million. The PCR machines were from the Chinese company Iponetic, and were installed at provincial hospitals through the National Public Health Laboratory (NPHL).

The government testing lab in Janakpur in Province 2 received one of the machines on 4 April, but the machine would only give eight results in eight hours, and even those proved to be so unreliable that the lab stopped using it. Three of the samples that it showed to be negative for COVID-19 were found to be positive when re-tested at NPHL in Kathmandu.

According to Ram Vinay Shah at the Province 2 laboratory in Janakpur, the machines were not checked for quality by NHPL before distributing them to the provinces. “The machines were never checked for quality and were sent directly to us from the airport,” Shah said. “Which is why we got the wrong results and stopped using them after 12 days.”

The shortage of PCR test capacity and unusable machines means that an estimated 25,000 swab samples are in queue to be tested in 20 government labs across Nepal, and many of the 102,000 people in quarantine and the 7,000 positive cases in isolation have been waiting for their tests results so they can go home.

By 20 June, Nepal’s caseload had jumped to 8,605 and 22 have died of COVID-19. However, public health experts say that the number of confirmed cases would be much higher if adequate testing was done.  

The NPHL replaced the faulty PCR machine in Janakpur with another one made by a Chinese company named USR. But this one also ended up giving false negative results, and was put in storage. Janakpur needs to conduct an average of 100 tests a day but the machine could only give 10 results daily.

Shah is outraged. He told us: “They kept giving us the broken ones. It gave us unnecessary trouble, put the health of patients in jeopardy, and we lost valuable time in controlling the spread of the disease.” 

After both the portable machines given by NHPL gave incorrect results, the state laboratory decided not to use portable PCR test machines anymore. Janakpur has now purchased a Real-time PCR machine with 96 wells through the Provincial Supply Management Center in Janakpur.

This machine has been in operation for 12 days, and doing 90 COVID-19 swabs tests every four hours. So far, the new machine has not given any trouble, and Shah says the lab is now processing the backlog of swab tests.  

All seven OBCI-supplied portable machines distributed by NHPL to the seven provincial labs also stopped being used after a few tests because of their unreliability. Most labs have now replaced them with 36- or 96-well real time PCR machines.

Given the culture of kickbacks and corruption, public health experts suspect collusion between the private importer on buying the portable PCR machines, just as there was with the contract for RDT kits. Despite most countries stopping to use RDT, the government still has 60,000 RDT kits on order.

Says former Auditor General Sukdev Khatri: “There financial rules for procurement specifying the brand and model of machines, and they should be purchased according to the procedures. But the trend of buying low quality equipment at high prices by cabinet decision means there is too much temptation for corruption.”