Study on Status of Free Health Services at Primary Health Care Centers and District Hospitals in Selected Districts of Nepal

Abstract

Background: The free essential health service policy was envisioned to put in action in all districts in phase wise manner to increase the access and utilization of health care services. Ministry of Health & Population is in operation with frequent monitoring and supervision to free health service sites. However, there is lack of evaluation studies to guide policy makers in identifying the status of free essential health services and accessibility of poor people, and to assess the extent and intensity of the use of free essential health services in Nepal. So, this study aims to describe the status of targeted free essential health services for poor, helpless, disable, vulnerable and elderly people with special emphasis on preparing reference documents for policy makers. Methods: Six districts incorporating all eco-development regions were selected purposively. The study adapted both quantitative and qualitative methods of data collection. Qualitative analysis included transcription of the interviews, typing of the transcriptions, color coding and grouping in matrices with main domains whereas the quantitative data was coded for computer entry and processed in Excel software program. Results: The implementation of free health care policy is not consistent. Most of the process and procedures are implemented as per the policy guideline in Dang and Dolakha, partially implemented in Chitwan and Sunsari whereas in Bajhang and Taplejung, people are getting free services but the policy guideline was not followed. In Taplejung poor patients, elderly and disabled patients are getting free service as per support of Women Development Office and district hospital fund as per patient's verbal request and doctor's personal discretion. The service utilization and management of policy is better in Dang and Dolakha compared to other study districts.

Conclusions: The free health care service for target groups should be promoted at district and primary health care centre. Keywords: free health service; free health care policy; policy guideline; service utilization.