This paper explores people’s perceptions of government health services in Rolpa, Nepal, focusing especially on accessibility, effectiveness and accountability. It is based on a qualitative study conducted to explore in more detail the findings of a quantitative survey carried out in 2012. In-depth interviews with 52 respondents in Rolpa District documented people’s experiences and expectations of health services and how these influence public perceptions of government. Among them 21 were Brahmin/Chhetris, 12 Dalit, and 19 Janajatis. Altogether half were men and half were female. The central question was: did good experiences with government health services lead to more positive perceptions of government and its legitimacy? And, conversely, did negative experiences undermine trust in government? Previous research has suggested that people’s perceptions of government health services in Nepal are influenced by ethnicity, caste and gender (Askvik, Jamil and Dhakal, 2011; Devkota, 2008; UNDP, 2009). There are a limited number of studies that go beyond these lenses to examine supply-side factors such as the accessibility, quality (effectiveness) and accountability of services in Nepal.