000			03365 a2200229 4500
999			_c667 _d667
003			OSt
005			20220906184550.0
008			191122b ||||| |||| 00| 0 eng d
060			_aTHS-00183
100			_aBhurtyal, Ashok. _91836
245			_aSocial inclusion in healthcare: before and after removal of user fees.
260			_cc2008.
300			_aix, 51p. :
500			_aThesis Report.
520			_aSUMMARY: Nepal's health policies have shifted in tune with the trendy international waves. The latest inclination was the removal of user fees for services available at peripheral health facilities. Social inclusion in healthcare was assessed in connection to this initiative, in Jumla district. This study used cross sectional descriptive design whereby records were reviewed to measure the proportions of service use by privileged and underprivileged ethnicities, men and women, and low and high economic classes at two cross sections, before and after removal of user fees. Interviews were conducted among users and providers of health services, management staff of the district health office and representative of non-government organizations. In the district total, the use of health services by the underprivileged ethnicities and women has changed after the removal of fees (P=0.000, 0.004 respectively). Change in the use of services by poor people, however, was not statistically significant (p=0.369). Such change is not uniform across all health facilities in the district : in some facilities the poor, women and underprivileged ethnicities have now greater access to services whereas elsewhere there has been little or no improvement. The two major stakeholders of healthcare, users and providers, had conflicting ideas on the delivery and use of free health services. This appeared to arise of the management problems that have been exacerbated with the removal of fees. Attempt to qualitative exploration of the factors that may have confounding effect to the fee removal yielded no strong evidence. It was suspected that natural increase in the people's awareness and assertiveness brought in by the democracy wave in the last few decades (and more so during the last three years) may be one such factor that may have combined effect with the government's initiative of free health services. Further studies are needed to assess the effect of fee removal on assess to healthcare by marginalized groups. Much focus may be laid on the anthropological investigation on the exploration of perspectives of the different stakeholders of healthcare delivery system, to verify and supplement information obtainable from quantitative assessment. Irrespective of the contributing factor, it is encouraging to see positive change in the use of health services by marginalized groups of people. This may contribute to sustainable progress toward greater access to health services by the people when it will be accompanied by favourable changes in the management of health service delivery. The national health system has the responsibility to utilize this change to align the delivery mechanism so as to foster greater access to health by all people.
546			_aEng.
650			_aSocial. _92979
650			_aInclusion. _92980
650			_aHealthcare. _92981
856			_uhttp://nhrc.gov.np/contact/ _yVisit NHRC Library
942			_2NLM _cTR