Study on Utilization of Free Health Services by Target Population in two Tertiary Level Hospitals in Western Region
Authors: Mahato, P., Paudel, G.S. and Sigdel, R.R.
Publisher: Western Regional Health Directorate, Nepal Health Sector Support Programme
Place of Publication: Pokhara
The interim constitution of Nepal has endorsed health care as a human right in interim constitution of 2063 (2007). According to the mandate of Interim Constitution of Nepal which emphasized that every citizen shall have the rights to basic health services free of costs as provided by law, Government of Nepal (GoN) drafted a policy to provide Essential Health Care Services free of charge to poor, ultra-poor, destitute, disabled, senior citizens and Female Community Health Volunteers (FCHV)s up to 25 bedded district hospitals and Primary Health Care Centre (PHCC)s in 15th December 2006. In October 2007, GoN declared all health services at health posts (HPs) and sub-health posts (SHPs) free of charge to all. This was followed by another decision by MoPH to provide free health care services to all targeted people at district hospitals having less than 25 bed, free outpatient care to the targeted groups expanded to all districts, making deliveries free of charge for all women and making 40 essential drugs free to all citizens starting from January 2009. Since its implementation there were few studies done to evaluate the status of free health care in district hospitals, Primary Health Care Centres (PHCC), Health Posts (HP) and Sub-Health Posts (SHP), but there were very limited studies done in tertiary care hospitals and no studies done in tertiary care hospitals of western region. This study was done with the objecting of evaluating the status of free health care and its utilization by the target groups. Two tertiary care hospitals of western region: Western Regional Hospital (WRH), Pokhara and Lumbini Zonal Hospital (LZH), Butwal was selected purposively and qualitative as well as quantitative methodology was used for conducting this research. Secondary data collection of the free health services maintained in registers of both hospitals was used as method of data collection for quantitative analysis whereas key informant interview and client exit interview was also conducted from both the hospitals as a method of data collection for qualitative analysis. The findings of this study indicate that the utilization of free services is not very satisfactory at the tertiary care hospitals in western region. The results from WRH showed that the utilization of free services was 8.4%. It was found that the highest free health service utilizing group was poor group at WRH (78.8%). Similarly, the ethnic group which was found to be utilizing the free service more than any other was interestingly the upper caste group. The spatial distribution of the clients of free services was seen to be distributed in an equitable way. This was indicated by share of clients from Kaski district being 51.8% and clients from 57 districts coming for FHS utilization. The results from LZH shows that the utilization of free health services was only 2.7% in LZH. The reason behind data of LZH being so low was due to incomplete data available for analysis. The highest free health service utilizing group was the senior citizens at LZH (84.4%). The difference in target group utilizing free services at LZH could again be due to improper secondary data available for analysis. Like our finding in WRH, the upper caste group was the target group that utilized highest percentage of free health services. Although the exact reason for this result in both hospitals could not be understood by quantitative analysis, but it was evident from the qualitative analysis that it could be due to misuse of these services by groups other than target groups. Finally the share of clients in LZH from Rupandehi district was highest: 56.4% with clients from 21 districts coming for FHS utilization. Several recommendation were made for hospitals as well as government in order to improve the status of FHS and its utilization by target groups. The recommendation for both hospitals were as: increasing awareness regarding the free health services among the general population as well as the target groups; simplifying the process of identifying the target groups could be helpful in making free services easily accessible to target groups; easy availability and accessibility of medicines and other services available for the target groups in appropriate quantity and of appropriate quality; monitoring and controlling mechanism for free health service utilisation. The recommendation for WRH were: strengthening of Social Service Unit (SSU) as evident from key informant interview that there is still presence of difficulties in identifying the target groups; Improving and increasing access to free services available to the target groups as indicated by client exit survey who expressed their dissatisfaction with the availability of services. The recommendation for LZH were: a need to maintain daily registers in a systematic and complete way especially in the out-patient department of LZH; establishment of SSU in order to make the identification process well documented; and availability of record more easier. The recommendation for government include: increasing the funding in FHS; timely medicine supply and manpower available for effective and ongoing provision of FHS to the target groups; as was evident from key informant interview and expanding the FHS to hospitals and medical institutions besides the government institutions.