Socioeconomic Disparities in Access and Utilization of Health Care Services in Nepal

Abstract

Nepal has made impressive progress in some health indices in the last few decades. Despite this progress and policy intent of equitable access to quality health care services, disparities remain wide. Drawing from a field study conducted in a village in south-west Nepal, this paper looks into the disparity in access and utilization of health care services among three major caste/ethnic communities—Brahmin/ Chhetri, Adivasi/Janajati and Dalits. While the field data suggest that Dalits are increasingly utilizing health post services, the local outlet of government health care services, they are the ones whom the official health care system serves the worst. They fall ill more frequently, rely more on local health traditions and resort (unwillingly) to government health facilities. In many conditions, they experience treatment failures, and incur a high expense per episode of illness, when they seek medical help from private health facilities. The paper discusses the issues of access and utilization of health care services among the marginalized caste/ethnic groups in the context of medical pluralism and the importance of enhancing local health knowledge and practices with reference to COVID-19. The paper concludes with a note that the inequality in health cannot be addressed merely by the policy rhetoric of equal access to quality health services unless the equity concern is seriously articulated into the health care delivery system, the quality of traditional medicine is improved, the health knowledge of marginalized communities is enhanced, and related social determinants addressed.