There is no printed copy available to order.
Abstract:
Basic health services (BHS) constitute a minimum set of health services that the Government of Nepal, through its constitution, pledges to offer free of charge to all Nepali citizens, regardless of demographic, geographic, or socioeconomic status. This package encompasses various services targeting disease burdens and the country's health system capacity, serving as the primary level of care for individuals, families, and communities. By bringing free BHS closer to the community, the national health system endeavors to realize universal health coverage and health-related Sustainable Development Goals by 2030. The Public Health Service Regulation 2020 provides further details on the 10 categories of BHS defined by the Public Health Service Act 2018. The Basic Health Service Standard Treatment Protocol was developed in 2021, and the Basic Health Service Operation Guidelines in 2022.
To address gaps in the baseline status of BHS in Nepal, we assessed the availability of 41 selected services in public health facilities (HFs), as well as quality of care in terms of HF readiness, the care process, and client experience. The population’s access to and use of 21 selected services, including out-of-pocket payments, were also examined. The data analyzed were from the 2022 Nepal Demographic and Health Survey and the 2021 Nepal Health Facility Survey.
The availability of BHS varied across different levels of designated HFs, with federal and provincial HFs offering more services than those at the local level. Inadequate HF readiness in terms of basic amenities, equipment, infection control items, medicines, and human resources, combined with inconsistent adherence to service delivery standards, resulted in compromised quality of care. Results also highlighted inadequate accessibility of public HFs and some respondents making out-of-pocket payments for BHS at public HFs.
Achieving universal coverage of quality BHS requires comprehensive health system efforts. Strategies include strengthening legal compliance across all levels of government, promoting accountability, and ensuring the provision of all listed services at all designated HFs. Health systems should invest in developing an integrated infrastructure that includes all basic amenities, equipment, and human resources. Additionally, a transparent monitoring system needs to be established to track performance, financing, and expenditures at various levels to ensure evidence-informed and tailored financing mechanisms. Moreover, expanding the scope of national surveys to include a wider range of services listed in the BHS package, including Ayurveda and other alternative medicines, is crucial.
Baseline Status of Basic Health Service Delivery, 2022 Nepal DHS and 2021 Nepal HFS (PDF, 3417K)