Adhikari Shiva Raj, Sapkota Diksha, Thapa Arjun, Pandey Achyut Raj
Deparment of Economics, Patan Multiple Campus, Tribhuvan University, Nepal.
Kathmandu University, School of Medical Sciences, Dhulikhel, Kavre, Nepal.
J Nepal Health Res Counc. 2019 Jan 28;16(41):372-377.
Access to high quality medicines is often considered as one of the main obstacle in achieving health for all. With the objective of increasing access to health services of poor segment of population, government of Nepal has implemented free health care program. However, there is strong need for evaluating the performance and coverage of free health Care scheme. In this context, this study aims to provide better understanding on the implementation status of free health care scheme in context of Nepal.
It is a qualitative study conducted in 7 districts of Nepal. Total of 14 focused group discussion were conducted among service providers and service users. All the discussions were carried in neutral and natural setting making sure that each of participants feels free to express their opinion. Focused group discussions were transcribed, translated into English, coded and analyzed manually.
Participants shared that free health care has contributed positively in making essential health services reachable, affordable and accessible to all specially benefiting poor segment of population. However, multitude of factors like geographical access, perception of community people towards health services, availability of medicines, laboratory services and human resources come into play determining the utilization of health services. Service providers recommended that there need to be improvements in procurement and supply system for uninterrupted supply of services.
Despite having some problems in availability of medicines, human resource and diagnostic services, free health care has improved access to health services specially for poor population. Decentralizing the procurement process can be one promising option to overcome the inappropriate supply of medicines.
获得高质量药品通常被视为实现全民健康的主要障碍之一。为了增加贫困人口获得医疗服务的机会，尼泊尔政府实施了免费医疗保健计划。然而，迫切需要评估免费医疗保健计划的绩效和覆盖范围。在此背景下，本研究旨在更好地了解尼泊尔免费医疗保健计划的实施状况。
这是一项在尼泊尔7个地区开展的定性研究。在服务提供者和服务使用者之间总共进行了14次焦点小组讨论。所有讨论均在中立和自然的环境中进行，确保每位参与者都能自由表达意见。焦点小组讨论内容被转录、翻译成英文、编码并进行人工分析。
参与者表示，免费医疗保健在使基本医疗服务能够被所有人获得、负担得起且易于获取方面发挥了积极作用，尤其使贫困人群受益。然而，诸多因素，如地理可达性、社区居民对医疗服务的认知、药品供应、实验室服务和人力资源等，都会影响医疗服务的利用情况。服务提供者建议，需要改进采购和供应系统，以确保服务的不间断供应。
尽管在药品供应、人力资源和诊断服务方面存在一些问题，但免费医疗保健改善了特别是贫困人口获得医疗服务的机会。分散采购过程可能是克服药品供应不当问题的一个有前景的选择。
