public perception on access to health services in nepal
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Public Perception on Access to Health Services in Nepal . - PowerPoint PPT PresentationTRANSCRIPT
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, NepalWebsite: www.nccr.org.np
Tel. 0097715000053 e-mail: [email protected]
Outline of presentation
1. The context
2. Methodological note
3. Findings on public perception on health service delivery
4. Conclusions
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
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.
3. Findings: public percetion on health service delivery
Average time taken to reach the health postBy rural urban context
Time in minutes
By district Time in Minutes
Urban 31.28 Rolpa 61.53
Rural 44.6 Bardiya 20.93
Ilam 46.75
Total 40.22 Total 40.22
Average time taken to reach the nearest health post
Source: Field Survey, 2012
3. Findings on health service delivery-2
Districts
When did you or other household members last use this service?In past 7 days
In past 30 days
In past 6 months
In past year
More than one year ago
Total
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Rolpa 133 18.6
260 36.3
212 29.6
44 6.1 67 9.4 716
Bardiya
235 19.4
612 50.5
251 20.7
46 3.8 68 5.6 1212
Ilam 208 16.7
487 39.1
362 29.1
80 6.4 108 8.7 1245
Total 576 18.2
1359
42.8
825 26 170 5.4 243 7.7 3173
Access to health services by district
3. Findings -3
Context
When did you or other household members last use this service?In past 7 days
In past 30 days
In past 6 months
In past year
More than one year ago
Total
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Urban
188 18.0
447
42.9
267
25.6
59 5.7 82 7.9 1043
Rural
388 18.2
912
42.8
558
26.2
111 5.2 161
7.6 2130
Total
576 18.2
1359
42.8
825
26.0
170 5.4 243
7.7 3173
Use of health service by urban-rural context
3. Findings -4
Age group
When did you or other household members last use this service?In past 7 days
In past 30 days
In past 6 months
In past year
More than one year ago
Total
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
< 25 226
19.9 512
45.0 276
24.3 55 4.8 68 6.0
1137
25 to 50 316
17.6 750
41.8 481
26.8 99 5.5 150 8.4
1796
50 or > 34
14.2 97
40.4 68
28.3 16 6.7 25
10.4 240
Total 576
18.2
1359
42.8 825
26.0 170 5.4 243 7.7
3173
Access to health service by age group of average age of household
3. Findings -5
Ethnicity
When did you or other household members last use this serviceIn past 7 days
In past 30 days
In past 6 months
In past year
More than one year ago
Total
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Brahmin / Chhetri
200 19 441 41.9
286 27.2
47 4.5 78 7.4 1052
Janjati / indigenous group
264 17.6
628 41.8
390 25.9
99 6.6 122 8.1 1503
Dalit 50 20.2
114 46.2
62 25.1
9 3.6 12 4.9 247
Madhesi
33 16.3
92 45.5
49 24.3
5 2.5 23 11.4
202
Muslim 8 8.2 52 53.6
29 29.9
4 4.1 4 4.1 97
Other 21 29.2
32 44.4
9 12.5
6 8.3 4 5.6 72
Total 576 18.2
1359
42.8
825 26 170 5.4 243 7.7 3173
Access to Health service by ethnicity
3. Findings -6
3. Findings -7
3. Findings -8
Age group of respondents
Very satisfied
Fairly satisfied
Neither satisfied nor dissatisfied
Dissatisfied
Very dissatisfied
Total
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Row %
less than 25 48
11.7 264
64.4 73
17.8 21 5.1 4 1.0
410
25 to 50
202
11.0
1142
61.9 386
20.9 89 4.8 25 1.4
1844
50 or above 95
10.6 552
61.7 194
21.7 42 4.7 11 1.2
894
Total345
11.0
1958
62.2 653
20.7 152 4.8 40 1.3
3148
Satisfaction level of health service by age group of respondents
3. Findings -9
Gender of respondent
Overall satisfaction with the quality of the service on most recent use of the facility
Very satisfied
Fairly satisfied
Neither satisfied, nor dissatisfied
Dissatisfied
Very dissatisfied
Total
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Row %
Count
Male 15010.
982
159.
6 31522.
9 71 5.2 21 1.51378
Female 195 111137
64.2 338
19.1 81 4.6 19 1.1
1770
Total 345 111958
62.2 653
20.7
152 4.8 40 1.3
3148
Satisfaction level of health service by gender
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.
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 .
Thank you