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Public Perception on Access to Health Services in Nepal 

Public Perception on Access to Health Services in Nepal .

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Public Perception on Access to Health Services in Nepal 

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  1. Public Perception on Access to Health Services in Nepal  Paper to be presented at the Panel: “The relationship between service delivery and state-building in fragile and conflict-affected situations: evidence from the first round of an original panel survey” in the THE DEVELOPMENT STUDIES ASSOCIATION ANNUAL CONFERENCE 2013 16th November 2013 THE MEDICAL SCHOOL, UNIVERSITY OF BIRMINGHAM, EDGBASTON CAMPUS Bishnu Raj Upreti, PhD, Director, Sony KC, Researcher Nepal Centre for Contemporary Research, (NCCR) G.P.O. 910, Kathmandu, Nepal Website: www.nccr.org.np Tel. 0097715000053 e-mail: bupreti@nccr.wlink.com.np sony@nccr.org.np

  2. Outline of presentation • The context • Methodological note • Findings on public perception on health service delivery • Conclusions

  3. 1. The context of ehealth services in Nepal • This paper is an outcome of ongoing research in Nepal under the SLRC • Decade of armed conflict and political transition • Severe disturbance in delivery of services • Emergence and growth of private helth service after 1990 and huge investment • Maoist objection to private health services and demanded for state responsibility of helath service . • Nationalization v/s privatization of health service debate at policy and political levels posed several operational complications • Service providing units of government were targeted • Recruitment, donation, • Killing, torture, abduction • Health posts as training camps and venue of meetings

  4. 2. Methodological note • Survey of 3175 households of Rolpa (717 HH), Bardiya (1213 HH) and Ilam (1246 HH) districts between September and November, 2012. • The areas were selected on the basis of the degree of impacts of the conflict • Purposive sample used to capture geographic variation in conflict, physical accessibility and access to services. • Data are not representative at the district level but representative at the village level (as Wards within the VDCs were randomly selected using the 2011 voters list) • 9th of the eleven components contained in the survey instrument was related to the perception on health service delivery. • The survey instrument on perception on health services was designed using three main indicators: a) Access to health services/time required, b) Frequency of taking the health services and c) Satisfaction of the respondents on the available health services.

  5. 3. Findings: public percetion on health service delivery Average time taken to reach the nearest health post Source: Field Survey, 2012

  6. 3. Findings on health service delivery-2 Access to health services by district

  7. 3. Findings -3 Use of health service by urban-rural context

  8. 3. Findings -4 Access to health service by age group of average age of household

  9. 3. Findings -5 Access to Health service by ethnicity

  10. 3. Findings -6

  11. 3. Findings -7

  12. 3. Findings -8 Satisfaction level of health service by age group of respondents

  13. 3. Findings -9 Satisfaction level of health service by gender

  14. 4. Conclusions • Though the decentralized health service delivery systems was affected by civil war and governance weaknesses and caused poor performance in general, this study found that people are not so negative as presented in the media and public discourse. • Access to health services is largely determined by gender, age group, livelihood activities, household size, number of children, roof type, wall type, religion, ethnic group and district • Health posts of terai areas are most accessible and accessed by more people compared to health posts of the hill areas. •  People in rural areas tend to take services from the health posts more often than the people in the urban areas since there are fewer options in the rural areas than that in the urban areas. • People's willingness and need to visit the health posts was determined by the occurrence of diseases. For example, as people are more suffered from the diseases they have higher priority to visit the health posts.

  15. 4. Conclusions-2 • While developing the future health service policies and strategies the actors in health sector have to consider the main reasons of dissatisfaction of the respondents by geography (ensuring health services to the people of geographically isolated and or remote, inaccessible areas), ethnicity (Muslim, Madeshi and Bramin-Chhetri), gender (female), rural urban context (providing more numbers of health services to the rural areas) and political .

  16. Thank you

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