This project completion review (PRC) provides details on the outputs, lessons and recommendations from the DFID funded programme ‘Transition and Recovery of Nepal’s Health System’ which came to a close in May 2017.

The aim of the programme was to provide technical assistance to support the recovery of Nepal’s damaged health services, across 31 districts affected by a series of catastrophic earthquakes and aftershocks in April-May 2015.

Overall, outcome and output indicator results demonstrate that the programme has been successful, though not all targets were achieved by the close of the programme.

The follow-up actions required following project closure are as follows:

1. For DFID: in order to fast-track the mobilization of support in case of emergencies in disaster-prone countries, to consider the inclusion of an earmarked budget allocation to respond to disaster situations in all health sector operations. Such budget could be re-allocated before programme closure in case no emergencies arise.
2. For DFID: given the familiarity and success of the combined Financial Aid and Technical Assistance aid modality in Nepal, both in the regular support to the health sector and the earthquake response programme, a similar aid modality should be considered for future disaster recovery and relief operations.
3. For MoH and DFID: to limit the number and severity of permanent disabilities resulting from spinal cord injuries during future earthquakes, ensure that a public awareness campaign is launched on the safe transport and correct referral process of people possibly having injured their spinal cord. Such campaign should be targeted at the public, rescue workers, para-medical personnel and health workers. This action would also reduce the risks for people injured during other accidents, especially in road traffic accidents and accidents in the construction sector.
4. For the TA team: to continue monitoring the progress and quality of the unfinished infrastructure work initiated under the programme.
5. For MoH and DFID: to maximize the durability of the infrastructure financed under the programme, permanent as well as semi-permanent (the pre-fabricated structures), advocate with the National Planning Commission and the Ministry of Health for a reasonable budget in the Annual Work Plan and Budgets for maintenance.
6. For DFID and TA team: to elaborate a module for the prevention of gender-based violence and physical abuse (e.g. awareness and anger management counselling) to be used in the immediate aftermath of possible future earthquakes or other disasters.
7. For DFID and the TA team: in order to be able to again respond effectively in case of any future disaster, to engage with the government and other External Development Partners (EDPs) on changing disaster preparedness modalities as the devolution in Nepal evolves and changes in decision making, operational structures and procedures, and communications channels materialize. For instance, the role 
of the District Officer of Health may change under the upcoming provincial structure and support to her/his office may have to be re-directed to provincial and/or municipal structures.
8. For MoH, DFID and External Development Partners: to build on progress made in mental health in terms of the institutional arrangement, treatment protocols and people trained in both the diagnosis and treatment of mental health problems and provide resources for its sustainability and scale-up.

Download the full report for further details.