Social inclusion in health services use: early changes following fee removal in rural Nepal

Abstract

Introduction: User fees for primary health services were removed by a new leadership of health ministry as part of attempt to enhance access by under served people. This study aimed to measure the changes in utilization of health services by marginalized groups of people following fee removal.

Methods: Records of 1850 health services users were selected randomly from peripheral health facilities -the district hospital, the primary healthcare centre, and four of eight health posts in Jumla district. Proportions of health services use by privileged and underprivileged ethnicities, men and women, and rich and poor people at two periods, before and after user fee removal, were calculated.

Results: After fee removal, use of health services by women, underprivileged ethnicities, and poor people increased by 2.4% (P=0.303, 95% CI 1.41 to 3.39), 6.8% (P<0.001, 95% CI 5.27 to 8.13) and 9.2% (P= 0.003, 95% CI 6.72 to 11.68) respectively in comparison to their privileged counterparts. When service utilization data were disaggregated by individual castes, 10.9% (95% CI 9.01 to 12.87) increment was observed in case of the Dalit caste.

Conclusion: Removal of user fees was followed by increased use of health services by marginalized people. Further works may be conducted to examine consistency of the results.