Background: Ensuring delivery of quality health services in a sustainable and equitable manner is a challenge in Nepal. A host of factors may have impeded the access, quality and utilization of the health services particularly by the marginalized and disadvantaged sections of the population. Review essential health care services (EHCS) provided by the public health facilities, level of progress, effectiveness, sustainability, equity and efficiency, quality of care and inclusion of marginalized and disadvantaged populations in health care services

Methods: A total of 40 VDCs from 10 districts representing five regions and three eco-zones were covered. Altogether 800 mothers with under two year children, 40 health service providers, 145 key informants and 40 exit clients were interviewed. Forty focused group discussions were also conducted. From each district, health records of one hospital, PHCC, HP, SHP and Ayurvedic health facility each were collected.

Results: More than two-third (68.2%) of the mothers received antenatal checks, highest in hills (85%) followed by terai (64.5%) and mountain districts (52.8%).Tetanus vaccine coverage (80.7%) seems higher compared to Nepal Demographic Health Survey 2001 (45%). FP use rate in mountain, hill and terai are 57.6%, 54.1% and 49.7%, higher than in DoHS 2003/2004 statistics, which were 26.8%, 36.4% and 45.3% respectively. Nine out of ten patients visiting the health facilities were outpatients. The coverage of DPT 3, Polio 3, BCG and measles are 92.8%, 93.4%, 95.2% and 90.7% respectively. From the service utilization perspective, disparities in terms of gender, ecological regions, season of the year and health facility were revealed.

Conclusion: Health sector services are yet to be made responsive to the ecological and district specific health problems, and be made more inclusive linking with doable safety nets.