ProblemSeven months after the April 2015 Nepal earthquake, and as relief efforts were scaling down, health authorities faced ongoing challenges in health-service provision and disease surveillance reporting.ApproachIn January 2016, the World Health Organization recruited and trained 12 Nepalese medical doctors to provide technical assistance to the health authorities in the most affected districts by the earthquake. These emergency support officers monitored the recovery of health services and reconstruction of health facilities, monitored stocks of essential medicines, facilitated disease surveillance reporting to the health ministry and assisted in outbreak investigations.Local settingIn December 2015 the people most affected by the earthquake were still living in temporary shelters, provision of health services was limited and only five out of 14 earthquake-affected districts were reporting surveillance data to the health ministry.Relevant changesFrom mid-2016, health facilities were gradually able to provide the same level of services as in unaffected areas, including paediatric and adolescent services, follow-up of tuberculosis patients, management of respiratory infections and first aid. The number of districts reporting surveillance data to the health ministry increased to 13 out of 14. The proportion of health facilities reporting medicine stock-outs decreased over 2016. Verifying rumours of disease outbreaks with field-level evidence, and early detection and containment of outbreaks, allowed district health authorities to focus on recovery and reconstruction.Lessons learntLocal medical doctors with suitable experience and training can augment the disaster recovery efforts of health authorities and alleviate their burden of work in managing public health challenges during the recovery phase.

The paper discusses the challenges faced in conducting such a policy analysis, the broad ranging and unremitting nature of the decentralisation process, and the contextual setting of the process of change.

Monetary incentives effectively promote antenatal care (ANC) attendance. However, in Nepal, late release of incentives is common, which leads to delays in payment to mothers, thereby negating the intended motivation. We evaluate a novel innovation where community organizers partnered with a Women's Saving and Credit Cooperative to provide interest-free loans for timely distribution to mothers. Through focus group discussions and interviews we found that monetary incentives motivate women to seek ANC services and timely incentives provide critical commodities postpartum. This qualitative evaluation shows the importance of timeliness in delivery of incentives and demonstrates the success of a community partnership innovation.

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