BackgroundIn 2005, the Indian Government introduced the Janani Suraksha Yojana (JSY) scheme - a conditional cash transfer program that incentivizes women to deliver in a health facility – in order to reduce maternal and neonatal mortality. Our study aimed to measure and explain socioeconomic inequality in the receipt of JSY benefits.MethodsWe used prospectively collected data on 3,682 births (in 2009–2010) from a demographic surveillance system in five districts in Jharkhand and Odisha state, India. Linear probability models were used to identify the determinants of receipt of JSY benefits. Poor-rich inequality in the receipt of JSY benefits was measured by a corrected concentration index (CI), and the most important drivers of this inequality were identified using decomposition techniques.ResultsWhile the majority of women had heard of the scheme (94% in Odisha, 85% in Jharkhand), receipt of JSY benefits was comparatively low (62% in Odisha, 20% in Jharkhand). Receipt of the benefits was highly variable by district, especially in Jharkhand, where 5% of women in Godda district received the benefits, compared with 40% of women in Ranchi district. There were substantial pro-rich inequalities in JSY receipt (CI 0.10, standard deviation (SD) 0.03 in Odisha; CI 0.18, SD 0.02 in Jharkhand) and in the institutional delivery rate (CI 0.16, SD 0.03 in Odisha; CI 0.30, SD 0.02 in Jharkhand). Delivery in a public facility was an important determinant of receipt of JSY benefits and explained a substantial part of the observed poor-rich inequalities in receipt of the benefits. Yet, even among public facility births in Jharkhand, pro-rich inequality in JSY receipt was substantial (CI 0.14, SD 0.05). This was largely explained by district-level differences in wealth and JSY receipt. Conversely, in Odisha, poorer women delivering in a government institution were at least as likely to receive JSY benefits as richer women (CI −0.05, SD 0.03).ConclusionJSY benefits were not equally distributed, favouring wealthier groups. These inequalities in turn reflected pro-rich inequalities in the institutional delivery. The JSY scheme is currently not sufficient to close the poor-rich gap in institutional delivery rate. Important barriers to institutional delivery remain to be addressed and more support is needed for low performing districts and states.

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associated with long-term mOCS use, and to quantify the cost and QALY burden of these events. Methods: A systematic review was undertaken to identify any studies reporting adverse event risk due to mOCS treatment. Seventy-two (72) studies were identified. The review focussed on eight disease outcomes representing the bulk of the mOCS cost and QALY burden: type II diabetes, myocardial infarction, glaucoma, cataract, ulcer, osteoporosis, infection, and stroke. A risk estimate for each adverse event was selected, based on the daily dose and mOCS exposure that best represented asthma-related mOCS use in Australian clinical practice. The excess risk of each complication in patients receiving mOCS, relative to those patients not receiving mOCS, was applied to the annual cost and QALY burden of each event in the Australian population. The cost and QALY burden attributable to mOCS was estimated on a per patient per year basis. Results: The expected annual cost of mOCS-related disease outcomes was estimated to be $598.32 per patient per year. Each patient treated with mOCS also suffers a QALY loss of 0.0367 per year of treatment. These effects are considered reversible once patients stop taking mOCS. ConClusions: mOCS are associated with a clear cost and QALY burden for patients with severe asthma which is likely underestimated by the approach adopted in this study. These results are likely to be useful for economic evaluations of new asthma interventions which replace or delay mOCS.