Access to healthcare in Nepal and how this influences perceptions of the state is the subject of this briefing paper. The findings emerge from the report Health services and users’ perceptions of the state in Rolpa, Nepal. Central to the argument is that more needs to be done to understand health priorities in different areas and at different times of the year and for central evaluation and monitoring to be improved. To that end, four recommendations are proposed. The recent devastating earthquake makes these issues even more critical. This briefing paper is the second in a series on basic services in Nepal.