A community led innovation benefiting women and children: Health facilities and credit cooperative work together to promote maternal health care in Sahare VDC, Nepal.

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.

Post-earthquake health-service support, Nepal.

PROBLEM: Seven 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. APPROACH: In 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 SETTING: In 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 CHANGES: From 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 LEARNT: Local 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.

Health system decentralisation in Nepal: identifying the issues.

PURPOSE: The purpose of this paper is to describe and discuss policy analysis in Nepal and review the wide range of choices feasible in decentralisation decision making. DESIGN/METHODOLOGY/APPROACH: In this paper an iterative qualitative method was developed and used in the research, which consisted of focus group interviews, key informant interviews, document analysis, including descriptive statistics, and analysis of the policy context. Participants in the research reflected the urban/rural mix of districts and the geography of Nepal. Analysis combined transcribed interviews with findings from document searches and analysis of the policy context. Coding was pre-determined during the training workshop and further codes were generated during and after the fieldwork. FINDINGS: The paper finds that Nepal is in the process of decentralising public services from the central level to the local level, particularly to local bodies: District Development Committees (DDCs), Village Development Committees (VDCs) and Municipalities. Key contextual factors referred to are the overall structure of decentralisation, the social context of poverty and the political instability leading to a fluid political situation characterised by political tension, armed conflict, controversies and agreements while carrying out the research. The key issues identified and discussed in the paper are the policy process leading to decentralisation, the organisational structure and tension in the proposed system, the systems of resource generation, allocation, planning and management and lastly the forms of accountability, participation, public-private relations and collaborative strategies. ORIGINALITY/VALUE: 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.