Study on Free Care Implementation Program: Interaction between Service Providers and Recipients with regard to Free Health Services at Community Level

Abstract

Background: Periodical interaction and discussion between Community, Service Providers and Health Facility Management Committee can play a vital role to create common understanding and shared responsibility for implementing effective health services. The government should initiate such interaction program before and during the process of implementing new health policy and program with a view to increase community participation in health service delivery. However, such interaction was neither initiated by the government nor organized by the community and concerned stakeholders. Therefore, it is essential to conduct this interaction program, which enables us to reduce the gap and to promote understanding between service providers and service users. Methods: Two districts Morang from Terai belt and Kavre from Hill region were selected purposively for conducting interaction program. Three health facilities (one primary health care center and two sub-health posts) and four health facilities (one primary health care center and three Ssub-health posts) were selected purposively from Morang and Kavrepalanchowk districts respectively. A total of 295 participants took part in the interaction program. Voices of the interaction were tape‐recorded with consent of the participants. The recorded audiotapes were transcribed and combined with the scratch notes taken from the interaction and further expanded the notes to prepare a detail transcripts of the interactions. Results: There was no established mechanism for communication/interaction between health service providers and recipients about existing health care facility and services at the health facility. A considerable number of the population mainly from the marginalized and poor sections of the community were still deprived of free health care services although there have been substantial increase in number of patients/clients at health facilities after implementation of free health care services. Despite of no major socio-cultural barriers, some people particularly poor and marginalized sections of the community prefer to consult traditional healers. Conclusions: Most marginalized and poor living far from the health facilities is still seen deprived from free health care services one of the reasons being the lack of information regarding the services. In order to strengthen the free services, joint effort is needed from the side of service providers and receivers as well. Keywords: free health care services; health service providers; hill and terai; implementation; interaction program; poor and marginalized; recipients; utilization of health service.