Healthcare accessibility is increasing worldwide as nations strive for Universal Health Coverage (UHC). However, access alone does not always translate to better health outcomes. Each year, five million people die from treatable conditions despite seeking medical care, highlighting critical gaps in the quality of care. This issue highlights the need for comprehensive assessments of health system performance that encompass both access and quality of care.

In low- and middle-income countries (LMICs), current methods for measuring health system quality often fall short, focusing primarily on specific facilities or one-time population surveys. Consequently, there is a lack of understanding regarding the broader perspectives of healthcare users. The People’s Voice Survey (PVS), developed by the Quality Evidence for Health System Transformation (QuEST) Network, aims to fill this gap. Through mobile phone surveys, PVS seeks to capture diverse user perspectives on health system performance, satisfaction, confidence, and trust in healthcare systems at a population level.

This study will implement the PVS in Nepal, targeting a wide demographic to assess their experiences and satisfaction with the health system. The insights gained will contribute to health system reforms and support Nepal’s efforts to achieve UHC, while also facilitating cross-country comparisons and learning within the QuEST Network.


To validate the PVS tool in the Nepalese context and assess health system performance in terms of service users’ satisfaction, confidence, and trust in the health system.


This study employs a mixed-methods approach, integrating qualitative and quantitative research designs. In-depth cognitive interviews will be conducted to validate and contextualize the survey tool. Participants from diverse backgrounds in rural and urban communities will assess the clarity, relevance, and cultural appropriateness of the survey items. Following this, a telephone-based cross-sectional survey will be conducted among a representative sample of Nepalese residents aged 18 and above. The study aims to complete 2000 interviews using a list of randomly generated phone numbers using Kobo Collect. The survey will capture various dimensions of health system performance, including service satisfaction, confidence, and user trust.

Expected Outcomes

The research is expected to yield robust measures of health system satisfaction, confidence, and user experience in Nepal. Key outcomes include:

  • Detailed insights into healthcare perspectives across different socio-demographic groups.
  • Identification of inequities in healthcare experiences.
  • Evidence-based recommendations to enhance healthcare delivery and inform policy-making.

Project Information

Thematic areas

Health system


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