Health Post Usage in a Mountainous District in Nepal. Essential Drugs Monitor No. 014 (1993)
(1993; 2 pages)


John C. Chalker and Madhu Dapali from the British Nepal Medical Trust (BMNT) and independent researcher Bhagwati Khadka conducted interviews in 1990 to assess community attitudes toward government health care posts in eastern Nepal. BMNT worked with the District Public Health Officer to begin cost sharing drug schemes (CSDSs) to fund a regular supply of drugs to health centres and hospitals. Previous data showed that health centre usage dropped significantly following the enactment of these schemes and has slowly increased. Eleven focus groups in Taplejung, a mountainous district in the northeast corner of Nepal with nine government health centres and one district hospital, were interviewed to find a potential explanation for this trend. Questions were centred primarily on health centre usage. The researchers found that the Nepalese believe there are two main causes of disease: illnesses “emerged from the body” and occurred “because a god or spirit was angry.” Most individuals did not seek medical treatment for their diseases. If treatment was desired, dhamis (traditional healers) and medicines were used significantly more than health centres for various reasons. Nine groups felt that if illness was caused by god or spirit, going to a health centre would make it worse. There were also general distrust of the drugs and personnel at health centres and physical and economic barriers to using them. Women rarely went to health centres because most staff members were male; women can only receive limited treatment from male doctors for cultural and religious reasons. The study concluded that concentrating exclusively on drug supply fails to maximize health post usage in Nepal; the problem must instead be tackled from a broader view that includes cultural and religious factors. Researchers also suggest finding a way to incorporate dhamis into government health care. (Abstract by Flannery Bowman)

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