Utilization, Availability, Accessibility and Quality of Basic Health Care Services in Nepal: A Cross-Sectional Demographic and Health Facility Survey

Background The Government of Nepal is committed to the progressive realization of universal health coverage through the provision of basic health care services (BHCS). This study aims to evaluate the availability, accessibility, quality and utilization of BHCS in the public health facilities of Nepal, using data from two nationally representative surveys. Methods We analyzed data from the Nepal Demographic and Health Survey (NDHS) 2022 and the Nepal Health Facility Survey (NHFS) 2021, focusing on the services included in Nepal’s BHCS package. A descriptive analysis of BHCS availability, accessibility, service quality, and utilization using data from 1,448 public health facilities, 457 observations, and 320 client interviews from the NHFS 2021, along with data from 14,845 women (15–49 years) from the NDHS 2022. It assessed 41 NHFS 2021 services across eight of ten BHCS categories for availability, two NDHS 2022 indicators for accessibility, five NHFS 2021 indicators for facility readiness, 13 for adherence to care standards, seven for experience of care, and nine NDHS 2022 indicators for service utilization. The quality of care index was calculated with equal weight assigned to three domains: experience of care, Adherence to standards, and service readiness. Results Out of the 41 services in the BHCS package, 16 were available at more than 90% of the public health facilities included in the study, although less than 1% of facilities offered all 41 services. Over half (54%) of women reported that the nearest health facility to their residence was a public facility. Utilization of child health services was relatively low, with only 6% of children under five receiving growth monitoring and care-seeking for common illnesses also being low—19.6% for fever, 25.4% for diarrhea, and 25.5% for acute respiratory infections. In contrast, maternal services such as antenatal care (80.5%) and deworming (84.1%) were more widely utilized by pregnant women. The overall quality of care for normal, low-risk deliveries at the national level was rated 69.3 out of 100. Conclusions Despite a constitutional mandate to provide BHCS, this study found low availability of BHCS in public health facilities in Nepal. Although accessibility was not a significant problem, we found low utilization of services (especially regarding child health) and moderate quality of care. Early BHCS implementation demonstrates the need for realism and service review.